WorldWideScience

Sample records for disc herniation localization

  1. Herniated Cervical Disc

    Science.gov (United States)

    ... and inflammation that occur as a result of disc herniation. These include aspirin, ibuprofen, naproxen and a variety ... many factors including the exact location of the disc herniation and the experience and preference of the surgeon. ...

  2. Herniated lumbar disc

    OpenAIRE

    Jordon, Jo; Konstantinou, Kika; O'Dowd, John

    2009-01-01

    Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1.

  3. Herniated lumbar disc

    OpenAIRE

    Jordan, Jo; Konstantinou, Kika; O'Dowd, John

    2011-01-01

    Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1.

  4. LUMBAR DISC HERNIATION

    Science.gov (United States)

    Vialle, Luis Roberto; Vialle, Emiliano Neves; Suárez Henao, Juan Esteban; Giraldo, Gustavo

    2015-01-01

    Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physiotherapy, sometimes associated with percutaneous nerve root block. Surgical treatment is indicated if pain control is unsuccessful, if there is a motor deficit greater than grade 3, if there is radicular pain associated with foraminal stenosis, or if cauda equina syndrome is present. The latter represents a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence over the long term. PMID:27019834

  5. Pseudoenhancement of intervertebral disc herniation

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    Araki, Y.; Ootani, M.; Furukawa, T.; Tsukaguchi, I. (Dept. of Radiology, Osaka Rosai Hospital (Japan)); Mitomo, M. (Dept. of Radiology, Osaka Univ. Medical School (Japan))

    1992-08-01

    Two patients with intervertebral disc herniation appeared to demonstrate abnormally diffuse and intense enhancement of the disc after intravenous administration of gadolinium-DTPA for MRI. Surgery disclosed a dilated epidural venous plexus in one and vascular granulation tissue in the other, associated with the herniated disc material. The mechanism of this 'pseudoenhancement' of the disc appears to be a partial volume effect of disc material and the adjacent veins or granulation tissue. Pseudoenhancement of a herniated disc should be included in the differential diagnosis of a diffusely enhancing epidural mass. (orig.).

  6. Clinical and Radiological Characteristics of Lumbosacral Lateral Disc Herniation in Comparison With Those of Medial Disc Herniation.

    Science.gov (United States)

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-02-01

    Lateral disc herniation (foraminal and extra foraminal) has clinical characteristics that are different from those of medial disc herniation (central and subarticular), including older age, more frequent radicular pain, and neurologic deficits. This is supposedly because lateral disc herniation mechanically irritates or compresses the exiting nerve root or dorsal root ganglion inside of a narrow canal more directly than medial disc herniation. The purpose of this study was to investigate clinical and radiological characteristics of lateral disc herniation in comparison with medial disc herniation. The 352 subjects diagnosed with localized lumbosacral disc herniation and followed up for at least 12 months after completion of treatment were included and divided into medial and lateral disc herniation groups, according to the anatomical location of the herniated disc in axial plain of magnetic resonance image. Clinical and radiological data were obtained and compared between the two groups. The lateral group included 74 (21%) patients and the medial group included 278 (79%). Mean age of the lateral group was significantly higher than that in the medial group. The lateral group showed a significantly larger proportion of patients with radiating leg pain and multiple levels of disc herniations than the medial group. No significant differences were found in terms of gender, duration of pain, pretreatment numeric rating scale, severity of disc herniation (protrusion and extrusion), and presence of weakness in leg muscles. The proportion of patients who underwent surgery was not significantly different between the 2 groups. However, the proportion of patients who accomplished successful pain reduction after treatment was significantly smaller in the lateral than in the medial group. In conclusion, patients with lateral disc herniation were older and had larger proportion of radiating leg pain than those with medial disc herniation. Lateral disc herniation was more

  7. Clinical and Radiological Characteristics of Lumbosacral Lateral Disc Herniation in Comparison With Those of Medial Disc Herniation

    Science.gov (United States)

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-01-01

    Abstract Lateral disc herniation (foraminal and extra foraminal) has clinical characteristics that are different from those of medial disc herniation (central and subarticular), including older age, more frequent radicular pain, and neurologic deficits. This is supposedly because lateral disc herniation mechanically irritates or compresses the exiting nerve root or dorsal root ganglion inside of a narrow canal more directly than medial disc herniation. The purpose of this study was to investigate clinical and radiological characteristics of lateral disc herniation in comparison with medial disc herniation. The 352 subjects diagnosed with localized lumbosacral disc herniation and followed up for at least 12 months after completion of treatment were included and divided into medial and lateral disc herniation groups, according to the anatomical location of the herniated disc in axial plain of magnetic resonance image. Clinical and radiological data were obtained and compared between the two groups. The lateral group included 74 (21%) patients and the medial group included 278 (79%). Mean age of the lateral group was significantly higher than that in the medial group. The lateral group showed a significantly larger proportion of patients with radiating leg pain and multiple levels of disc herniations than the medial group. No significant differences were found in terms of gender, duration of pain, pretreatment numeric rating scale, severity of disc herniation (protrusion and extrusion), and presence of weakness in leg muscles. The proportion of patients who underwent surgery was not significantly different between the 2 groups. However, the proportion of patients who accomplished successful pain reduction after treatment was significantly smaller in the lateral than in the medial group. In conclusion, patients with lateral disc herniation were older and had larger proportion of radiating leg pain than those with medial disc herniation. Lateral disc herniation was more

  8. Radicular interdural lumbar disc herniation

    Science.gov (United States)

    Boulahroud, Omar; Elasri, Abad; Elmostarchid, Brahim; Boucetta, Mohammed

    2009-01-01

    Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. The patient, a 34-year-old soldier, was admitted with a 12-month history of low back pain and episodic left sciatica. Neurologic examination showed a positive straight leg raising test on the left side without sensory, motor or sphincter disturbances. Spinal CT scan and MRI exploration revealed a left posterolateral osteophyte formation at the L5–S1 level with an irregular large disc herniation, which migrated superiorly. An intradural extension was suspected. A left L5 hemilaminectomy and S1 foraminotomy were performed. The exploration revealed a large fragment of disc material located between the inner and outer layers of the left S1 radicular dura. The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively. PMID:19888608

  9. Thoracic disc herniation: Surgical treatment.

    Science.gov (United States)

    Court, C; Mansour, E; Bouthors, C

    2018-02-01

    Thoracic disc herniation is rare and mainly occurs between T8 and L1. The herniation is calcified in 40% of cases and is labeled as giant when it occupies more than 40% of the spinal canal. A surgical procedure is indicated when the patient has severe back pain, stubborn intercostal neuralgia or neurological deficits. Selection of the surgical approach is essential. Mid-line calcified hernias are approached from a transthoracic incision, while lateralized soft hernias can be approached from a posterolateral incision. The complication rate for transthoracic approaches is higher than that of posterolateral approaches; however, the former are performed in more complex herniation cases. The thoracoscopic approach is less invasive but has a lengthy learning curve. Retropleural mini-thoracotomy is a potential compromise solution. Fusion is recommended in cases of multilevel herniation, herniation in the context of Scheuermann's disease, when more than 50% bone is resected from the vertebral body, in patients with preoperative back pain or herniation at the thoracolumbar junction. Along with complications specific to the surgical approach, the surgical risks are neurological worsening, dural breach and subarachnoid-pleural fistulas. Giant calcified herniated discs are the largest contributor to myelopathy, intradural extension and postoperative complications. Some of the technical means that can be used to prevent complications are explored, along with how to address these complications. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. [Physiotherapy in lumbar disc herniation ].

    Science.gov (United States)

    Stoll, T; Germann, D; Hagmann, H

    2001-08-01

    Physiotherapy is the treatment of choice in patients with symptoms caused by a lumbar disc herniation. In clinical practice a broad range of physiotherapeutic modalities has been revealed to be helpful. During the acute stage the efficacy of the McKenzie-concept, mobilisation therapies and traction has been demonstrated in randomized controlled trials with a blind assessor. In addition, pain reducing physical therapies such as cold or electrotherapy and non-steroidal anti-inflammatory drugs, analgesics and/or muscle relaxants are sensible initial accompanying treatments. The effectiveness of active physiotherapies such as training of local strength endurance of back and abdominal muscles has been proven in patients during the chronic stage. The indications for a in-patient rehabilitation programme, for surgery and the danger of developing chronic low back pain are discussed.

  11. Herniated lumbar disc: injection interventions for sciatica

    OpenAIRE

    Jordan, Joanne L; Konstantinou, Kika; O'Dowd, John

    2016-01-01

    Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosus) beyond the intervertebral disc space. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1.

  12. Factors that influence recurrent lumbar disc herniation.

    Science.gov (United States)

    Yaman, M E; Kazancı, A; Yaman, N D; Baş, F; Ayberk, G

    2017-06-01

    The most common cause of poor outcome following lumbar disc surgery is recurrent herniation. Recurrence has been noted in 5% to 15% of patients with surgically treated primary lumbar disc herniation. There have been many studies designed to determine the risk factors for recurrent lumbar disc herniation. In this study, we retrospectively analysed the influence of disc degeneration, endplate changes, surgical technique, and patient's clinical characteristics on recurrent lumbar disc herniation. Patients who underwent primary single-level L4-L5 lumbar discectomy and who were reoperated on for recurrent L4-L5 disc herniation were retrospectively reviewed. All these operations were performed between August 2004 and September 2009 at the Neurosurgery Department of Ataturk Education and Research Hospital in Ankara, Turkey. During the study period, 126 patients were reviewed, with 101 patients underwent primary single-level L4-L5 lumbar discectomy and 25 patients were reoperated on for recurrent L4-L5 disc herniation. Preoperative higher intervertebral disc height (Pdisc herniation had preoperative higher disc height and higher body mass index. Modic endplate changes had a higher tendency for recurrence of lumbar disc herniation. Well-planned and well-conducted large-scale prospective cohort studies are needed to confirm this and enable convenient treatment modalities to prevent recurrent disc pathology.

  13. Three-level cervical disc herniation

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    St. Iencean Andrei

    2015-09-01

    Full Text Available Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6 treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

  14. Migrated herniated disc mimicking a neoplasm.

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    Hoch, Benjamin; Hermann, George

    2010-12-01

    Disc sequestration is defined as migration of a herniated disc fragment into the epidural space such that it is completely separated from the parent disc. We report a case of a migrated herniated disc that was initially pathologically diagnosed as a cartilage neoplasm. In addition to confounding morphological features, this interpretation may have been influenced by an initial radiological interpretation that did not include herniated disc in the differential diagnosis of a spinal lesion with prominent peripheral contrast enhancement. MR imaging is most helpful in considering other lesions in the differential diagnosis including abscess, hematoma, and primary or metastatic neoplasms. Pathologically, degenerative changes in herniated discs, including clustering of chondrocytes and neovascularization, may be severe resulting in a pseudoneoplastic appearance. Increased awareness of the radiological and pathological features of migrated herniated disc should limit confusion with other tumors.

  15. Intradural disc herniation: how I do it.

    Science.gov (United States)

    Rodrigo, Víctor; Claramonte, Marta; Martín, Mónica; Calatayud, Juan B

    2018-03-12

    Intradural disc herniation is a rare phenomenon in spine surgery. Diagnosis is difficult despite current neuroradiologic imaging techniques. We present a case of a 59-year-old man with lumbar and radicular pain and a recurrent lumbar herniation. A laminectomy was performed after no clear disc herniation in the epidural space was found and an intradural mass was palpable. A durotomy showed an intradural disc fragment that was removed, followed by an arthrodesis. Only intraoperative findings lead to a definitive diagnosis for intradural herniation. A durotomy needs to be performed. In this case, an arthrodesis was necessary to avoid complications of segmental instability.

  16. Intradural cervical disc herniation: a case report

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    Chung, Seung Eun; Lee, Sang Ho; Jo, Byung June; Yoon, Deug Hee [Wooridul Spine Hospital, Seoul (Korea, Republic of); Kim, Tae Hong [Inje University College of Medicine, Inje (Korea, Republic of)

    2005-07-15

    Intradural cervical disc herniation is an extremely rare condition and its pathogenesis is not certain. We experienced a case of intradural cervical disc herniation at the C4-5 level in a 56-year-old man. The preoperative sagittal T1- and T2- weighted images revealed an intradural iso-intensity lesion, with the spinal cord behind the posterior longitudinal ligament at the C4-5 disc level. The post-contrast T1-weighted image revealed a peripheral enhanced intradural lesion. We report here on a case of an intradural cervical disc herniation that was diagnosed by radiological examination, and we include a review of the related literature.

  17. The Actual Level of Symptomatic Soft Disc Herniation in Patients with Cervical Disc Herniation.

    Science.gov (United States)

    Choi, Su Yong; Lee, Sang Gu; Kim, Woo Kyung; Son, Seong; Jeong, Tae Seok

    2015-09-01

    The aim of this study was to predict the relationship between the symptomatic disc herniation level and the osteophyte level or decreased disc height in patients with cervical disc herniation. Between January 2011 and December 2012, 69 patients with an osteophyte of the cervical spine underwent surgery at a single center due to soft cervical disc herniation. Data including soft disc herniation level, osteophyte level in the posterior vertebral margin, Cobb's angle, and symptom duration were retrospectively assessed. The patients were divided into three groups according to the relationship between the degenerative change level and the level of reported symptoms. Among the 69 patients, 48 (69.6%) showed a match between osteophyte level and soft disc herniation level. Disc herniation occurred at the adjacent segment to degenerative osteophyte level in 12 patients (17.4%) and at both the adjacent and the osteophyte level in nine (13.0%). There was no significant difference in Cobb's angle or duration among the three groups. Osteophyte type was not significant. The mean disc height of the prominent degenerative change level group was lower than the adjacent segment level, but this was not significant. Soft cervical disc herniation usually occurs at the level an osteophyte forms. However, it may also occur at segments adjacent to that of the osteophyte level. Therefore, in patients with cervical disc herniation, although a prominent osteophyte alone may appear on plain radiography, we must suspect the presence of soft disc herniation at other levels.

  18. Percutaneous treatment of cervical and lumbar herniated disc.

    Science.gov (United States)

    Kelekis, A; Filippiadis, D K

    2015-05-01

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4-6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75-94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Percutaneous treatment of cervical and lumbar herniated disc

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    Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D.K., E-mail: dfilippiadis@yahoo.gr

    2015-05-15

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4–6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75–94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine.

  20. Natural course of lumber disc herniation

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    Tokioka, Takamitsu; Shimada, Kimio; Tanaka, Yuzo; Oshige, Toshihisa; Miyakoshi, Koichi [Okayama Rosai Hospital (Japan)

    1998-09-01

    Thirty-two cases of lumbar disc herniation were sequentially followed by MR imagings in order to ascertain its natural course. Herniation consisted of protrusion in 6 cases, extrusion in 13 cases, and sequestration in 13 cases. We analysed the durations until the herniation regressed more than 50% of its A-P diameter. The mean duration was 8.2 months for extrusion, and 5.3 months for sequestration. Only 2 cases of protrusion regressed within 12 months. Huge disc herniations with central protrusion in particular showed slight spontaneous regression. (author)

  1. Spontaneous Regression of Lumbar Herniated Disc

    Directory of Open Access Journals (Sweden)

    Chun-Wei Chang

    2009-12-01

    Full Text Available Intervertebral disc herniation of the lumbar spine is a common disease presenting with low back pain and involving nerve root radiculopathy. Some neurological symptoms in the majority of patients frequently improve after a period of conservative treatment. This has been regarded as the result of a decrease of pressure exerted from the herniated disc on neighboring neurostructures and a gradual regression of inflammation. Recently, with advances in magnetic resonance imaging, many reports have demonstrated that the herniated disc has the potential for spontaneous regression. Regression coincided with the improvement of associated symptoms. However, the exact regression mechanism remains unclear. Here, we present 2 cases of lumbar intervertebral disc herniation with spontaneous regression. We review the literature and discuss the possible mechanisms, the precipitating factors of spontaneous disc regression and the proper timing of surgical intervention.

  2. Surface image of herniated disc on three-dimensional CT

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    Chung, Kyung Il; Jeon, Chang Hoon; Kim, Sun Yong; Kim, Ok Hwa; Suh, Jung Ho [Ajou Univ. College of Medicine, Suwon(Korea, Republic of)

    1996-03-01

    To evaluate surface configuration of herniated disc on three-dimensional CT. Three dimensional surface images reconstructed from CT scans(1 mm thick) of 24 surgically confirmed herniated discs in 23 patients were reviewed. Disc surface was classified into peripheral and central zones in contact with consecutive peripheral ring and central endplate. Surface irregularity was categorized into two types(local and general). The incidence, size, and extent of local irregularity were observed. General irregularity incidence and severity ranges in 4 grades, and peripheral width were evaluated. The findings were correlated with discography. Local irregularity compatible with anulus tear in discography was shown in all. It was large(13/24) and mainly peripheral tract extending to disc margin in protrusion(3/5) and sequestration(5/7), and cleft encompassing central zone to disc margin in extrusion(9/12). General irregularity was predominantly grade 3(15/22) and was shown in all except in 2 protrusions. Peripheral width was 0.56 of central radius. Extrusion in herniated disc shows characteristic cleft encompassing central zone to disc margin whereas sequestration or protrusion displays tract extending from peripheral zone to disc margin. Thus, three dimensional surface imaging may aid the diagnosis, follow-up, prediction, and treatment of herniated disc.

  3. Local up-regulation of interferon-γ (IFN-γ) following disc herniation is involved in the inflammatory response underlying acute lumbar radicular pain.

    Science.gov (United States)

    Moen, Gunn-Helen; Moen, Aurora; Schistad, Elina I; Gjerstad, Johannes

    2017-09-01

    Lumbar radicular pain after disc herniation may be associated with release of pro-inflammatory cytokines from nucleus pulposus (NP) tissue. In the present study we examined the role of interferon-γ (IFN-γ) and cluster of differentiation 68 (CD68) in the acute phase of this process. First, in an animal model mimicking the clinical situation after disc herniation, the role of IFN-γ close to the dorsal nerve roots was studied. Next, in patients with lumbar radicular pain due to disc herniation, we examined how two single nucleotide polymorphisms (SNPs; rs2069705 and rs2069718) are important for the IFN-γ expression influenced the pain behavior. The animal data demonstrated a significant increase in the nociceptive activity at the spinal level after local application of NP and IFN-γ onto the dorsal nerve roots. A positive correlation between IFN-γ and CD68 in the NP tissue was also demonstrated. In the patients, a significant increase in Oswestry Disability Index (ODI) score was observed in carriers of the IFN-γ SNPs; rs2069705 A and rs2069718 G alleles. The present data suggest that IFN-γ close to the dorsal nerve roots may contribute to the pathogenesis, the nociceptive activity and the pain behavior following lumbar disc herniation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Transradicular lumbar disc herniation: An extreme variant of intraradicular disc herniation.

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    Kasliwal, Manish K; Shimer, Adam L

    2015-01-01

    Intradural or intraradicular lumbar disc herniation (IDH) is a relatively rare condition often diagnosed intraoperatively. We encountered an extreme variant of IDH - a transradicular herniation as the disc material extruded through the lumbar nerve root through a split essentially transecting the nerve root. While failure to recognize intradural and intraradicular disc herniation can lead to failed back surgery, the variant described in the present case could lead to iatrogenic injury and complication if not recognized. A unique case of transradicular lumbar disc herniation in a 25-year-old patient is presented with the depiction of intraoperative images supplementing the text.

  5. Transradicular lumbar disc herniation: An extreme variant of intraradicular disc herniation

    Directory of Open Access Journals (Sweden)

    Manish K Kasliwal

    2015-01-01

    Full Text Available Intradural or intraradicular lumbar disc herniation (IDH is a relatively rare condition often diagnosed intraoperatively. We encountered an extreme variant of IDH - a transradicular herniation as the disc material extruded through the lumbar nerve root through a split essentially transecting the nerve root. While failure to recognize intradural and intraradicular disc herniation can lead to failed back surgery, the variant described in the present case could lead to iatrogenic injury and complication if not recognized. A unique case of transradicular lumbar disc herniation in a 25-year-old patient is presented with the depiction of intraoperative images supplementing the text.

  6. CT findings of calcified herniated lumbar disc

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    Lim, Hyo Kun; Lee, Jun Hyung [Chang Dong Armed Forces Evacuation Hospital, Seoul (Korea, Republic of)

    1987-12-15

    Computed tomography (CT) of 10 calcified herniated lumber discs among 46 operated cases were analysed at the aspects of incidence, location, shape, etc. The results are as follows: 1. The incidence of calcification is 22% (10/46). 2. Among 10 cases, 3 cases are at the level of L4-5 disc space and 7 cases are at the level of L5-S1 disc space. 3. Central herniation (8 cases) are more common than posterolateral herniation (2 cases). 4. Linear or band-like calcifications in the periphery of herniated disc (annulus fibrosus type) are 6 cases and dense patchy calcification in the central portion of herniated disc (nucleus pulposus type) are 4 cases. 5. Two cases (50%) of 4 cases with nucleus pulposus type calcification were found to be ruptured at operation, but none of 6 annulus fibrous calcification types showed rupture. 6. Because more wide operation field and invasive exploration were required in calcified cases than non-calcified cases, it is suggested to evaluate the presence, location, and type of calcification in herniated disc in detail.

  7. [Imaging study of lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation].

    Science.gov (United States)

    Yu, Qing-yang; Yang, Cun-rui; Yu, Lang-tao

    2009-04-01

    Using regional assignment to forked method to study lumbar intervertebral disc hemiation (bugle, hernia, prolapse) dependablity and reason of lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation. From March 2005 to October 2006, 120 patients of match condition from orthopaedics dept and rehabilitative dept of the Boai hospital of Longyan were studied. All patients were equally divided into two groups according to whether or not accompany with symptom of lumbar intervertebral disc herniation. There was not statistical difference in sex, age, course of disease, segment of intervertebral disc between two groups. Sixty patients of symptomatic lumbar intervertebral disc herniation were equally divided into three groups according to (bugle, hernia, prolapse) image on CT. Sixty patients of asymptomatic lumbar intervertebral disc herniation were equally divided into three groups according to (bugle, hernia, prolapse) image on CT. The age was 20-59 years old with an average of 38.5 years. Using regional assignment to give a mark respectively for every group. The sagittal diameter index (SI), anterior diastema of flaval ligaments, the width of superior outlet of latero-crypt, anteroposterior diameter of dura sac were respectively measured by sliding caliper. CT value and protrusible areas were respectively evaluated by computer tomography. Adopting mean value to measure three times. (1) There were not statistical difference in SI, CT value, hernia areas, anteroposterior diameter of dura sac between two groups (symptomatic lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation). There were statistical difference in the width of superior outlet of latero-crypt, anterior diastema of flaval ligaments between two groups (symptomatic lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation). (2) There were statistical difference in protrusible type,protrusible segment

  8. Spontaneous resolution of a herniated fragment cervical disc

    OpenAIRE

    METE, Mesut; SAVRAN, Mehmet; DEMİRÇİVİ ÖZER, Füsun; DURANSOY, Yusuf Kurtuluş

    2012-01-01

    ABSTRACT Although the spontaneous resolution of herniated nucleus pulposus is a well known phe¬nomenon in lumbar disc herniations, it is rarely encountered in the cervical region. The spontaneous resolution of a herniated cervical disc in a woman is reported to describe a rare occurrence of spontaneous regression of a cervical herniated nucleus pulposus and to discuss its mechanism. A woman with a large and fragment herniated cervical disc refused to undergo operation and was followed-up ...

  9. Local irrigation of the surgical field with antibiotics in the end of procedure reduces the infection rate in herniated lumbar disc surgery.

    Science.gov (United States)

    Kërveshi, Armend; Halili, Nehat; Kastrati, Bujar; Qosja, Faik; Kabashi, Serbeze; Muçaj, Sefedin

    2014-12-01

    Reported rate of infections after lumbar discectomy is 1%-15 %. This complication may result in disability or even the death. The aim of the study is to assess the rate of infection associated with lumbar discectomies when combined systemic and local antibiotic prophylaxis was employed. In this retrospective study we analyzed all patients operated for herniated lumbar disc from 2009 -2012 in our institute. Beside of receiving systemic prophylaxis with 2g of Cefazoline, all patients had their operative field irrigated at the end of operation with Amikacin sulfate injection. Wound was considered infected when local and systemic signs of infection were revealed and were associated with elevated ESR, leukocytosis and elevated CRP. Assessment of infection is done by neurosurgeon during the hospitalization and later at outpatient's clinic along postoperative course of three months. A total of 604 patients were operated, of those 285 patients (47.2 %) females and 319 males (52.8 %), 12 patients were operated on two levels (1.98 %). Average patient age was 32.5 years (range 20-65 years) Localization of herniated disc was: in L/2-L/3 20 patients or 3.3 %, the L/3-L/4 level 42 patients or 7 % , the L/4 -L /5 262 patients or 43.3 % at the level L/V- S/1 280 patients or 46.3 %. Three patients (0.49%) developed wound infection, two of them superficial infection only with local signs: local pain, redness and leakage. They were treated with oral antibiotics. One with deep wound infection. He presented with local and systemic signs and treated with i.v antibiotics. All the cultures from wound swab revealed staphylococcus aureus. Prophylaxis with systemic antibiotic (Cefazoline 2.0) intravenous administration 30 minutes before the incision and irrigation of operative field with local antibiotic Amikacine sulfate at the end of procedure reduces the infection rate in patients operated for herniated lumbar disc when compared with systemic antibiotic prophylaxis only.

  10. Intervertebral disc herniation: prevalence and association with ...

    African Journals Online (AJOL)

    Method: A total of 120 adult patients who came for magnetic resonance imaging scan of the lumbosacral spine for a period of 1year in the department of Radiology University of Port-Harcourt Teaching Hospital. The end plates of 600 lumbar interspaces were graded for type, size and site of lumbar disc herniation. Results: ...

  11. Computed tomography in lumbar herniated disc

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Chul Soon; Chang, Kee Hyun; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1984-09-15

    197 spine CTs were performed from 29th , March 1982 to 7th March, 1984. Among them, 39 patients preoperatively diagnosed as herniated nucleus pulposus or bulging disc with CT and myelography were operated. 43 disc spaces of disc disease are analysed in true positive and false negative cases. Finally the accuracy, sensitivity and specificity of spine CT and myelography are calculated. The results are as follows: 1. The CT findings of disc diseases are in order of frequency, asymmetrical obliteration of epidural fat (82%) , ventral indentation or compression on dural sac (72%), focal protrusion of disc (64%), root changes - obliteration, displacement, compression, non-filling of metrizamide - (54%), diffuse disc bulging (36%), disc at body level (31%), disc calcifications (26%), disc vacuum (10%) and other associated findings - spinal stenosis, foraminal stenosis, ligament flavum thickening, facet joint hypertrophy (26%). 2. Sensitivities of spine CT and myelography are 95% and 94%, specificities are 67%, 50% and overall accuracies 93%, 87%, respectively. 3. Therefore, it is recommended that the spine CT be used as a primary diagnostic method and the myelography as a secondary complementary study when the CT gives no conclusive findings.

  12. [Treatment of thoracic disc herniation. Case report].

    Science.gov (United States)

    Picado-Baca, Mauricio Leonardo; Mireles-Cano, José Nicolás; León-Meza, Víctor Manuel; García-González, Oscar Guillermo; Ramos-Trujillo, Alejandro

    2016-01-01

    Herniated thoracic intervertebral disc is a rare cause of spinal cord compression. Its frequency varies from 0.15% to 1.7% of all disc herniations, and produces symptoms in 0.5% to 0.8%. Case 1. A 50-year-old woman, with pain and burning sensation in left hemithorax of four months of onset. It was treated as a herpetic syndrome, with no improvement. She was seen after thirteen days of exacerbation of clinical symptoms. The physical examination showed asymmetric paraparesis, lower left pelvic limb 1/5, and right pelvic limb 3/5¸ sensory level T8, with left Babinski positive. A thoracic disc herniation in space T8-T9 was diagnosed. A 55-year-old patient with a history of presenting pain in lumbar area of 5 years onset. She also had radicular pain that radiated to the right pelvic limb, with intensity 10/10 on a Visual Analogue Scale. Her physical examination showed muscle strength 5/5, with normal sensitivity in all dermatomes and tendon reflexes, and a positive right Babinski. Thoracic disc herniation T7-T8 level was diagnosed. Due to anatomical conditions that define this type of hernia, the extracavitary posterolateral approach should be the recommended surgical procedure when the simultaneously performed anterior decompression and fixation with posterior instrumentation are the treatments proposed. Despite the different anatomical structures of this special area, it was possible to obtain satisfactory results for both clinical cases. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  13. Hypokalemia mimicking a herniated vertebral disc.

    Science.gov (United States)

    Delhey, Patrick Roman; Holzapfel, Boris Michael; Kanz, Karl-Georg; Mayer-Wagner, Susanne

    2015-06-01

    A herniated vertebral disc is a common cause of paralysis. Other causes include infections, tumors, and neurologic diseases. A rare and dangerous but in most cases easily treatable cause is hypokalemia. Clinically, the acute symptoms may resemble a herniated vertebral disc, but hypokalemia per se is life-threatening by causing heart arrest through ventricular tachycardia or fibrillation. A patient with back pain and neurologic deficit in the lower extremities after a history of a herniated vertebral disc presented, who finally receives the diagnosis of hypokalemia. Case report. A 25-year-old female patient presenting after a fall with muscle weakness in both legs was followed clinically and radiographically. Neurological examination showed a lower extremity muscle weakness with three-fifths muscular strength of the quadriceps and tibialis anterior muscle on both sides. Reflexes were diminished bilaterally, anal sphincter tone was normal. Plain radiography suggested a posterior rim fracture of L5, but computed tomography did not confirm this diagnosis. The laboratory investigation revealed a hypokalemia of 1.7 mEq/L. On electrolyte replacement, the patient recovered immediately. This report describes a misleading diagnostic case of back pain and neurologic deficit after a trauma and sensitizes for the possible life-threatening diagnosis hypokalemia, which is rare but easily treatable. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Acupuncture and Spontaneous Regression of a Radiculopathic Cervical Herniated Disc

    Directory of Open Access Journals (Sweden)

    Kim Sung-Ha

    2012-06-01

    Full Text Available The spontaneous regression of herniated cervical discs is not a well-established phenomenon. However, we encountered a case of a spontaneous regression of a severe radiculopathic herniated cervical disc that was treated with acupuncture, pharmacopuncture, and herb medicine. The symptoms were improved within 12 months of treatment. Magnetic resonance imaging (MRI conducted at that time revealed marked regression of the herniated disc. This case provides an additional example of spontaneous regression of a herniated cervical disc documented by MRI following non-surgical treatment.

  15. Acupuncture and spontaneous regression of a radiculopathic cervical herniated disc.

    Science.gov (United States)

    Kim, Sung-Ha; Park, Man-Young; Lee, Sang-Mi; Jung, Ho-Hyun; Kim, Jae-Kyoun; Lee, Jong-Deok; Kim, Dong-Woung; Yeom, Seung-Ryong; Lim, Jin-Young; Park, Min-Jung; Park, Se-Woon; Kim, Sung-Chul

    2012-06-01

    The spontaneous regression of herniated cervical discs is not a well-established phenomenon. However, we encountered a case of a spontaneous regression of a severe radiculopathic herniated cervical disc that was treated with acupuncture, pharmacopuncture, and herb medicine. The symptoms were improved within 12 months of treatment. Magnetic resonance imaging (MRI) conducted at that time revealed marked regression of the herniated disc. This case provides an additional example of spontaneous regression of a herniated cervical disc documented by MRI following non-surgical treatment.

  16. Spontaneous regression of a lumbar disc herniation: case report

    Directory of Open Access Journals (Sweden)

    Mostarchid Brahim El

    2016-12-01

    Full Text Available Lumbar disc herniation is a common disease that induces back pain and radicular pain. Some cases require conservative treatment or at times relived spontaneously. Spontaneous regression of disc herniation is an atypical clinical presentation, and it has been recognized with the advancement of recent advances in imaging techniques. We present a 35-year-old woman presented a spontaneous regression of a lumbar disc herniation with good outcome after intensive physical therapy program. Spontaneous regression of disc herniation is thought to occur via an inflammatory reaction with molecular mechanisms of phagocytic processes.

  17. Episodic cauda equina compression from an intradural lumbar herniated disc: a case of 'floppy disc'.

    Science.gov (United States)

    Nagaria, J; Chan, Cc; Kamel, Mh; McEvoy, L; Bolger, C

    2011-09-01

    Intradural disc herniation (IDDH) is a rare complication of intervertebral disc disease and comprises 0.26-0.30% of all herniated discs, with 92% of them located in the lumbar region (1). We present a case of IDDH that presented with intermittent symptoms and signs of cauda equina compression. We were unable to find in the literature, any previously described cases of intermittent cauda equina compression from a herniated intradural disc fragment leading to a "floppy disc syndrome". © JSCR.

  18. Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level

    OpenAIRE

    Hakan, Tayfun; G?rcan, Serkan

    2016-01-01

    Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain ...

  19. Lumbar herniated disc: spontaneous regression.

    Science.gov (United States)

    Altun, Idiris; Yüksel, Kasım Zafer

    2017-01-01

    Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3-L4, L4-L5 or L5-S1 were enrolled. The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Laségue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3-L4, L4-L5, and L5-S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5-22). It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery.

  20. Risk Factors for Recurrent Lumbar Disc Herniation

    Science.gov (United States)

    Huang, Weimin; Han, Zhiwei; Liu, Jiang; Yu, Lili; Yu, Xiuchun

    2016-01-01

    Abstract Recurrent lumbar disc herniation (rLDH) is a common complication following primary discectomy. This systematic review aimed to investigate the current evidence on risk factors for rLDH. Cohort or case-control studies addressing risk factors for rLDH were identified by search in Pubmed (Medline), Embase, Web of Science, and Cochrane library from inception to June 2015. Relevant results were pooled to give overall estimates if possible. Heterogeneity among studies was examined and publication bias was also assessed. A total of 17 studies were included in this systematic review. Risk factors that had significant relation with rLDH were smoking (OR 1.99, 95% CI 1.53–2.58), disc protrusion (OR 1.79, 95% CI 1.15–2.79), and diabetes (OR 1.19, 95% CI 1.06–1.32). Gender, BMI, occupational work, level, and side of herniation did not correlate with rLDH significantly. Based on current evidence, smoking, disc protrusion, and diabetes were predictors for rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. More evidence provided by high-quality observational studies is still needed to further investigate risk factors for rLDH. PMID:26765413

  1. Spontaneous and complete regression of a thoracic disc herniation

    International Nuclear Information System (INIS)

    Coevoet, V.; Benoudiba, F.; Doyon, D.; Lignieres, C.; Said, G.

    1997-01-01

    Spontaneous regression of disc herniation is well known but the mechanism is not clear. Some hypotheses have been made. We present here a large thoracic disc herniation diagnosed by MRI which completely regressed one year after a medical treatment with complete amendment of symptoms. (authors)

  2. Spontaneous regression of lumbar herniated disc Case presentation

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-12-01

    Full Text Available Intervertebral disc herniation is a common disease that usually requires surgical intervention. However, in some cases, neurological symptoms may improve with conservative treatment. In this article, we present a case with spontaneous regression of extruded lumbar herniated disc correlated with clinical improvement and documented with follow up MRI studies.

  3. Percutaneous treatment of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Leonardi, M.; Resta, F.; Bettinelli, A. [Ospedale Maggiore di Milano (Italy); Lavaroni, A.; Fabris, G. [Ospedale Civile di Udine (Italy); Abelli, F. [Fondazione Clinica del Lavorno, Pavia (Italy)

    1994-12-31

    918 patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels. Chemonucleolysis was carried out on 733 patients (79.8%). Automated discectomy has been carried out in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy has proved to be an effective method in 74.6% of cases. (author). 7 refs, 6 figs, 1 tab.

  4. Clinical study of CT discography for the lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Sakamoto, Tadashi (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1990-08-01

    The purpose of this clinical study was to introduce technique for correct positioning of the needle into the center of the disc for discography by means of CT analysis and also to clarify usefulness of CT discography for diagnosis of the lumbar disc herniation. We have taken CT analysis in order to determine correct place and the angle of inserting the needle. This measurement provides easy needle insertion. Unless the needle tip places center of disc, discogram false positive or negative will occur as a result. The materials of this study are 222 discs of 105 cases with the lumbar disc herniation. Comparative study of the findings among myelography, discography and CT discography was investigated. The results indicated that CT discography demonstrates the most clear findings and is useful in the diagnosis of lumbar disc herniation, especially in obtaining detailed observation of herniated discs. (author).

  5. Magnetic Resonance Imaging in the Diagnostics of Spinal Disc Herniations

    OpenAIRE

    Katsiaryna, A.; Dmitry, A.

    2015-01-01

    BACKGROUND Currently the preoperative detection of degenerative disc diseases does not always correlate with neurological symptoms and present status of a patient. This paper outlines the possibilities of using magnetic resonance imaging in evaluation of thethe grade of severity of intervertebral disc herniations. METHODS A total 20 patients of the disc herniations with age group between 20 to 81 y were diagnosed and studied on «Avanta» highfield Magnetic Resonance Imaging machine by «Siemens...

  6. Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level.

    Science.gov (United States)

    Hakan, Tayfun; Gürcan, Serkan

    2016-01-01

    Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain due to disc herniation caudally immigrating at L4-5 level three years ago. He refused the surgical intervention that was offered and was treated conservatively at that time. He had no neurological deficit and a history of spontaneous regression of the extruded lumbar disc; so, a conservative therapy, including bed rest, physical therapy, nonsteroidal anti-inflammatory drugs, and analgesics, was advised. In conclusion, herniated lumbar disc fragments may regress spontaneously. Reports are prone to advise conservative treatment for extruded or sequestrated lumbar disc herniations. However, these patients should be followed up closely; new herniation at adjacent/different level may occur. Furthermore, it is important to know which herniated disk should be removed and which should be treated conservatively, because disc herniation may cause serious complications as muscle weakness and cauda equine syndrome.

  7. Diagnostic accuracy of magnetic resonance imaging of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Takashi; Nakamura, Takafumi; Kikuchi, Taro; Watanabe, Hiroyuki; Takagi, Katsumasa; Yoshizumi, Kazuhiro; Katahira, Kazuhiro [Kumamoto Univ. (Japan). School of Medicine

    2000-03-01

    We studied the accuracy of MRI in lumbar disc herniation, comparing the results with the operative findings in the assessment of the rupture of the posterior longitudinal ligament (PLL), and type of herniation. The MRI findings in 47 subjects who were operated on for lumbar disc herniation were retrospectively studied. The accuracy rate was 75.2% for the rupture of the PLL and 40.4% for the type of herniation respectively. It was hard to differentiate subligamentous extrusion from transligamentous extrusion on MRI. (author)

  8. Migration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation.

    Science.gov (United States)

    Daghighi, Mohammad Hussein; Pouriesa, Masoud; Maleki, Mirjalil; Fouladi, Daniel Fadaei; Pezeshki, Mohammad Zakaria; Mazaheri Khameneh, Ramin; Bazzazi, Amir Mohammad

    2014-09-01

    Herniated disc fragments are known to migrate in various directions within the spinal canal. To date, no comprehensive studies have been undertaken to examine the migration patterns of herniated disc material using a standard nomenclature and classification system. To report migration patterns of extruded lumbar disc fragments. A review of magnetic resonance (MR) images. A total of 1,020 consecutive Azeri patients with symptomatic extruded lumbar intervertebral disc herniation. Migration patterns of extruded lumbar disc fragments in vertical and horizontal planes and their association with age, gender, body mass index (BMI), and the level of herniation. High-quality axial and sagittal MR images of the lumbar spine were used. Disc material that was displaced away from the site of extrusion, regardless of continuity, was considered "migrated." The migration patterns observed were rostral or caudal in the vertical plane and central, paracentral, subarticular, foraminal, or extraforaminal in the horizontal plane. In the vertical plane, rostral and caudal migrations were observed in 27.8% and 72.2% of the patients, respectively. The number of rostral migrations increased significantly with increasing age and in higher levels in the lumbar spine (pherniation and migration pattern in the horizontal plane. Caudal and paracentral migrations are the most common patterns of migration in patients with extruded lumbar disc herniation in the vertical and horizontal planes, respectively. Age and the level of herniation may affect the migration patterns of herniated lumbar disc material. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Spinal canal dimensions affect outcome of adolescent disc herniation.

    Science.gov (United States)

    Linkoaho, O; Kivisaari, R; Ahonen, M

    2017-10-01

    Small spinal canal dimensions play a role in symptomatic adult disc herniation, but its role in adolescent disc herniation has not been investigated with MRI. The goal of this study was to examine retrospectively if there is a correlation with dimensions of osseous spinal canal and need of discectomy in an adolescent population suffering from disc herniation. A retrospective review of child and adolescent patients who were treated in our institution for back or back--related leg pain was conducted. Patients were divided in three groups; group 1: lumbar disc herniation requiring operative treatment; group 2: lumbar disc herniation treated with observation; and group 3: back pain and no disc herniation on MRI. MRI images and radiographs were studied for spinal canal dimensions and compared between groups. The discectomy group presented considerably smaller spinal canal dimensions measured from the MRI images than the two other groups. Adolescent patients requiring operative treatment for symptomatic disc herniation have smaller osseous spinal canals than patients who are managed non-operatively.

  10. Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy.

    Science.gov (United States)

    Abdul Jalil, Muhammad Fahmi; Lam, Miu Fei; Wang, Yi Yuen

    2014-05-07

    Herniated lumbar disc may be asymptomatic or associated with lower limb radiculopathy. Most spinal surgeons would offer surgery following a period of conservative measures if the radiological and clinical findings correlate. However, the existing dictum that lumbar radiculopathy should correlate with ipsilateral lumbar disc herniation may not be accurate as it can rarely present with contralateral sciatica. Literature regarding this phenomenon is scarce. Therefore, we report a patient with herniated lumbar disc presenting with predominantly contralateral motor weakness radiculopathy, which resolved after discectomy.

  11. Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

    Science.gov (United States)

    O'Connell, Grace D.; Leach, J. Kent; Klineberg, Eric O.

    2015-01-01

    Abstract The intervertebral disc is a critical part of the intersegmental soft tissue of the spinal column, providing flexibility and mobility, while absorbing large complex loads. Spinal disease, including disc herniation and degeneration, may be a significant contributor to low back pain. Clinically, disc herniations are treated with both nonoperative and operative methods. Operative treatment for disc herniation includes removal of the herniated material when neural compression occurs. While this strategy may have short-term advantages over nonoperative methods, the remaining disc material is not addressed and surgery for mild degeneration may have limited long-term advantage over nonoperative methods. Furthermore, disc herniation and surgery significantly alter the mechanical function of the disc joint, which may contribute to progression of degeneration in surrounding tissues. We reviewed recent advances in tissue engineering and regenerative medicine strategies that may have a significant impact on disc herniation repair. Our review on tissue engineering strategies focuses on cell-based and inductive methods, each commonly combined with material-based approaches. An ideal clinically relevant biological repair strategy will significantly reduce pain and repair and restore flexibility and motion of the spine. PMID:26634189

  12. Demographical Aspects of Central Large Lumbar Disc Herniation.

    Science.gov (United States)

    Topuz, Kivanc; Eroglu, Ahmet; Simsek, Hakan; Atabey, Cem; Cetinkal, Ahmet; Colak, Ahmet

    2016-01-01

    The purpose of this study was to investigate the risk factors for the development of the central large disc herniations and to compare the demographic data between central mass prolapse and broad-based central disc herniation. Between 2002 and 2007, 1630 patients underwent surgery and a large disc herniation was the main problem in 59 patients (3.6%). We performed a retrospective analysis of the demographic data of these patients. Magnetic resonance (MR) images were evaluated according to the disc type and level. Variables were evaluated both at baseline and follow-up, with special emphasis on physical job characteristics, sports activities, and MR - based morphologic findings. Central large disc herniation was diagnosed in 59 patients consisting of 41 males and 18 females. The average age was 34.7 years. 36 patients had a central mass prolapse that occupied more than 50% of the spinal canal. Intraoperative observations confirmed that 29 out of 36 central disc prolapse patients (80.5%) had intact posterior longitudinal ligaments. Interestingly, the condition in these 29 patients was found to have a direct relation with age and occupation or other body training sports activities. The size of the large central disc herniation, physical activity, age and gender are major factors in the development of disc herniation.

  13. The value of MRI in the preoperative diagnosis of cervical disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Kuroki, Takefusa; Kumano, Kiyoshi; Hirabayashi, Shigeru; Takahashi, Ryuji; Inasaka, Riki (Kanto Rosai Hospital, Tokyo (Japan))

    1991-12-01

    To determine whether or not magnetic resonance (MR) imaging would become an alternative to conventional myelography in the preoperative diagnosis of cervical disc herniation, MR images of 13 patients were retrospectively reviewed. MR imaging revealed herniated one disc, 2 discs, and 3 discs in 4, 6, and 3 patients, respectively. When herniation confined to one disc was consistent with clinical manifestations, MR imaging alone was capable of determining the disc involved in herniation. MR imaging was, however, of limited value in determining the responsible disc for herniation when there were two or more herniated discs on MR images. (N.K.).

  14. Magnetic resonance imaging for each type of herniated cervical intervertebral disc

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham Gyum [Ansan 1 College, Ansan (Korea, Republic of)

    2000-04-15

    The classification of herniated intervertebral cervical disc types are clinically important, as treatment methods would be slightly different according to the specific type of the herniated disc. 423 patients who suffered from herniated intervertebral cervical discs were tested with Magnetic Resonance Imaging (MRI), to distinguish the type of the herniated discs. The following are the results: The age of the patients tested ranged from 16 to 75 years old and the mean age of the patients was 41.4 years of age. There were twice as many male patients with a ratio of 288: 135 men to women. 101 patients suffered from single herniated discs while 322 patients suffered from multi-herniated discs. Of single herniated disc injuries. 52 patients had protruded discs (52%) while 25 patients had extruded discs (25%). 21 Patients (21%) had herniated intervertebral discs between C{sub 4} {approx} C{sub 5} and 51 patients (50%) and had the same injury between C{sub 5} and C{sub 6}. Of multi-herniated disc injuries. 140 patients had protruded discs (44%). while 45 patients had extruded discs (14%). 54 patients had both protruded and extruded discs (17%). 36 patients (11%). herniated discs C{sub 3} {approx} C{sub 6}: 69 patients (21%). herniated discs C{sub 3} {approx} C{sub 7}: 47 patients (15%) herniated discs C{sub 4} {approx} C{sub 6} and 67 patients (20%) herniated discs C{sub 5} {approx} C{sub 7}.

  15. Minimally invasive transmuscular approach for the treatment of lumbar herniated disc: far lateral lumbar disc herniation: a clinical study. Applications for cervical and thoracic disc herniation.

    Science.gov (United States)

    Peltier, E; Blondel, B; Dufour, H; Fuentes, S

    2013-06-01

    In this study, we are using a recently developed method: a minimally invasive retractor system and an operating microscope to treat far lateral lumbar herniated disc. This method decreases tissue dissection and blood loss, and improves postoperative recovery. This is a retrospective study of 46 patients, there was 25 female and 21 male. They all underwent minimal invasive surgery. The average age was 56 years old (19-83 years). Lumbar disc herniation is a common pathology. Far lateral disc herniation accounts for 2.6% to 11.2% of all lumbar disc herniation. A few surgical techniques have been describes to treat this type of disc pathology. All patients were operated under general anesthesia. The fluoroscopic guidance was absolutely necessary. A 12-15 mm skin incision was made on the side of the disc herniation (30 mm from the midline). Then, we inserted a tubular retractor system (muscle splitting approach) followed by a 14 mm diameter-working channel. Under operating microscope the pars interarticularis was dreamed to expose the nerve root and the disc. After removing the intertransverse ligament, we removed the herniated disc. The average time of surgery was 55 min. The operating time decreased with the experience of the surgical team. Postoperatively the radicular pain was around 2 (using an analogical visual scale), over 7 preoperatively. The length of hospitalization was 3 days. There were no complications in our study. The average follow-up was 2 years (6-36 months). There was no complication, no postoperative infection. This technique combines the advantages of endoscopic surgery and microscope guided surgery (3D vision) and provides good functional results in this study.

  16. Spinal Neurofibroma Masquerading as a Herniated Disc: A case report.

    Science.gov (United States)

    Lamki, Tariq; Ammirati, Mario

    2012-11-01

    We present the only case in English medical literature of a spinal neurofibroma misdiagnosed as a herniated disc using magnetic resonance imaging (MRI). This case presented with typical symptoms and radiological findings of a herniated disc. Intraoperatively, an abnormality was noted at the S1 nerve root sleeve. Further exploration revealed a spinal neurofibroma which was completely resected, resulting in an improvement in the patient's symptoms. Currently, there is heavy reliance on MRI as a highly sensitive and specific tool used in the diagnosis of herniated lumbar discs. Although there have been occasional reports of misdiagnoses using MRI, there are no reported cases of a spinal neurofibroma being misdiagnosed as a herniated lumbar disc. Despite great advances in radiological diagnostic imaging, surgical surprises do still occur. Ultimately, instinct is still essential in intraoperative surgical decisions.

  17. Statistical shape model reconstruction with sparse anomalous deformations: Application to intervertebral disc herniation.

    Science.gov (United States)

    Neubert, Aleš; Fripp, Jurgen; Engstrom, Craig; Schwarz, Daniel; Weber, Marc-André; Crozier, Stuart

    2015-12-01

    Many medical image processing techniques rely on accurate shape modeling of anatomical features. The presence of shape abnormalities challenges traditional processing algorithms based on strong morphological priors. In this work, a sparse shape reconstruction from a statistical shape model is presented. It combines the advantages of traditional statistical shape models (defining a 'normal' shape space) and previously presented sparse shape composition (providing localized descriptors of anomalies). The algorithm was incorporated into our image segmentation and classification software. Evaluation was performed on simulated and clinical MRI data from 22 sciatica patients with intervertebral disc herniation, containing 35 herniated and 97 normal discs. Moderate to high correlation (R=0.73) was achieved between simulated and detected herniations. The sparse reconstruction provided novel quantitative features describing the herniation morphology and MRI signal appearance in three dimensions (3D). The proposed descriptors of local disc morphology resulted to the 3D segmentation accuracy of 1.07±1.00mm (mean absolute vertex-to-vertex mesh distance over the posterior disc region), and improved the intervertebral disc classification from 0.888 to 0.931 (area under receiver operating curve). The results show that the sparse shape reconstruction may improve computer-aided diagnosis of pathological conditions presenting local morphological alterations, as seen in intervertebral disc herniation. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  18. A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Yoshinori Kadono

    2015-01-01

    Full Text Available Spinal epidural arachnoid cyst (EAC is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.

  19. Clinical evaluation of CT discography in the diagnosis of lumbar disc herniation

    International Nuclear Information System (INIS)

    Maehara, Tadayuki; Katsumata, Yasushi; Noda, Masanobu; Tanaka, Mariko; Shirouzu, Ichirou

    1988-01-01

    The CT discographic findings of 56 discs in 43 patients with low-back and/or leg pain were evaluated mainly from the clinical standpoint including pain provocation during the injection of the contrast material, correlation between the type of the herniation and symptoms and clinical course after the examination. The clinical value of CT discography is controversial, but it is well recognized that CT discography is the diagnostic method of choice for equivocal situations as patients showing negative myelography and significant symptoms and for the preoperative evaluation of patient thought to have the extreme lateral disc herniation. Exact provoked pain response was noted in 72 % of 43 pathologic discs and almost all discs especially in patients showing positive SLR test at less than 70 deg. So this pain response seems to provide additional information indicating the true pathologic disc level. Sciatic pain in the legs was much more frequently seen in the paramedian or lateral type herniation, but there was no relation between low-back pain and central type herniation. Majority of either type of disc herniation showed both low-back and leg pains. This suggests that clinical symptoms are based on not only disc herniation but also disc degeneration itself. We injected steroid (4 mg of Decadron) and local anesthetic (1 ml of 1 % Carbocain) into the disc after the examination for the purpose of improving the clinical symptoms as the first attempt. Definite improvement of various degree was noted in 56 % of total 43 cases after the procedure and CT discography was thought to be a valuable method of diagnosis in proper indications despite risky needle puncture. (author)

  20. Asthma and early herniated intervertebral disc disease.

    Science.gov (United States)

    Chiu, Cheng-Di; Chen, Hsuan-Ju; Saw, Hean-Pat; Yao, Nai-Wei; Yen, Hung-Rong; Kao, Chia-Hung

    2017-11-01

    The etiology of herniated intervertebral disc (HIVD) disease in children and adolescents is multifactorial and not merely related to disc degeneration. Therefore, in the present study, we investigated the relationship between young asthma patients and the risk of early HIVD disease in a population under 30 years of age. Data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective longitudinal cohort study. The study cohort comprised 23,470 patients with asthma (asthma group) and 23,470 patients without asthma (non-asthma group), who were selected through frequency matching on the basis of sex, age, and the index year. The study patients were followed until HIVD disease occurrence, withdrawal from the National Health Insurance program, or 31 December 2013. Cox proportional hazards regression analysis was conducted to assess the risk of HIVD disease in the asthma group after adjustment for sex, age, and comorbidities. After adjustment for sex, age, and comorbidities, the asthma group had a 1.69-fold (95% confidence interval [CI] = 1.29-2.23) higher risk of HIVD disease than did the non-asthma group. In addition, the asthma group had a higher risk of cervical and lumbar HIVD diseases than did the non-asthma group (adjusted hazard ratio [HR] = 2.38; 95% CI = 1.25-4.57 and adjusted HR = 1.56; 95% CI = 1.15-2.12, respectively). Young patients with asthma are at a significantly higher risk of early cervical or lumbar HIVD disease.

  1. Surgical treatment of foraminal herniated disc of the lumbar spine

    OpenAIRE

    Halikov Shavkatbek; Abduhalikov Alimjon Karimjanovich

    2017-01-01

    Herniated lumbar intervertebral disc have a significant impact on both the patient’s life as well, and because of the high prevalence and economic impact on society as a whole. Designed scheduling algorithm foraminal hernia surgical treatment of lumbar intervertebral disc, based on the preoperative detection of compressing factors allows to define differentiated indications for decompressive or decompressive-stabilizing surgery.

  2. Concomitance of fibromyalgia syndrome and cervical disc herniation.

    Science.gov (United States)

    Güler, Mustafa; Aydın, Teoman; Akgöl, Erdal; Taşpınar, Özgür

    2015-03-01

    [Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2-3, 16.6% C5-6, 16.6% C6-7, 33.3% C4-5, C5-6 (two levels in two patients) and 16.6% C4-5, C5-6, C7-1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population.

  3. Concomitance of fibromyalgia syndrome and cervical disc herniation

    Science.gov (United States)

    Güler, Mustafa; Aydın, Teoman; Akgöl, Erdal; Taşpınar, Özgür

    2015-01-01

    [Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2–3, 16.6% C5–6, 16.6% C6–7, 33.3% C4–5, C5–6 (two levels in two patients) and 16.6% C4–5, C5–6, C7–1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population. PMID:25931731

  4. Significance of cartilage endplate within herniated disc tissue.

    Science.gov (United States)

    Lama, Polly; Zehra, Uruj; Balkovec, Christian; Claireaux, Henry A; Flower, Luke; Harding, Ian J; Dolan, Patricia; Adams, Michael A

    2014-09-01

    Disc herniations sometimes contain hyaline cartilage fragments, but their origins and significance are uncertain. Herniations were removed surgically from 21 patients (aged 35-74 years) whose main symptom was sciatica (10 patients) or back pain (11 patients). Frozen sections, 5 µm thick, were examined histologically, and antibodies were used to label the matrix-degrading enzyme MMP 1, pro-inflammatory mediator TNFα, and cell proliferation marker Ki-67. Proportions of each tissue type were quantified by image analysis. Cartilage and bone components of the endplate were examined in 7-µm frozen sections from 16 cadaveric spines, aged 61-98 years. Cartilage fragments were found in 10/21 herniations. They averaged 5.0 mm in length, comprised 25 % of the herniation area, and two had some bone attached. Hyaline cartilage was more common in herniations from patients with sciatica (7/10) than with back pain (3/11, P = 0.050), and the area (%) of the herniation occupied by the cartilage was greater in sciatica patients (P Disc herniations often include hyaline cartilage pulled from the vertebral endplates. Cartilage fragments show little swelling or proteoglycan loss, and may be slow to resorb, increasing the risk of persisting sciatica. Loss of cartilage will increase endplate permeability, facilitating endplate inflammation and disc infection.

  5. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; Design of a prospective randomized controlled trial

    NARCIS (Netherlands)

    P.A. Brouwer (Patrick); W.C. Peul (Wilco); R. Brand (René); M.P. Arts (Mark); B.W. Koes (Bart); A.A. van den Berg (Annette); M.A. van Buchem (Mark)

    2009-01-01

    textabstractBackground. The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser

  6. Disc herniation, occult on preoperative imaging but visualized microsurgically, as the cause of idiopathic thoracic spinal cord herniation.

    Science.gov (United States)

    Ulrich, Christian T; Fung, Christian; Piechowiak, Eike; Gralla, Jan; Raabe, Andreas; Beck, Jürgen

    2018-03-01

    Idiopathic spinal cord herniation (ISCH) through an anterior dural defect is rare and the cause is uncertain. Recently, through interpreting imaging studies, disc herniation was proposed to be a major cause for ISCH. We describe the case of a 50-year-old woman with progressive myelopathy who was diagnosed with a thoracic spinal cord herniation. Microsurgical exploration revealed an anterior vertical dural defect and a small concomitant disc herniation, occult on the preoperative imaging, which caused the dural defect and led to ISCH. This intraoperative finding corroborates the emerging notion that disc herniation is the underlying cause of ISCH.

  7. The Specific Sagittal Magnetic Resonance Imaging of Intradural Extra-Arachnoid Lumbar Disc Herniation

    OpenAIRE

    Sasaji, Tatsuro; Horaguchi, Kiyoshi; Yamada, Noboru; Iwai, Kazuo

    2012-01-01

    Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral du...

  8. Posterior transdural discectomy : a new approach for the removal of a central thoracic disc herniation

    NARCIS (Netherlands)

    Coppes, Maarten H; Bakker, Nicolaas A; Metzemaekers, Jan D M; Groen, Rob J M

    BACKGROUND: The optimal surgical approach for thoracic disc herniation remains a matter of debate, especially for central disc herniation. In this paper, we present a new technique to remove central thoracic disc herniation, the posterior transdural approach, and report a series of 13 cases operated

  9. A radiological study on lumbar disc herniation in Korean

    Energy Technology Data Exchange (ETDEWEB)

    Seol, Hae Young; Park, In Sik; Suh, Won Hyuk; Lee, Min Jae [Korea University College of Medicine, Seoul (Korea, Republic of)

    1979-12-15

    Among the patients operated because of lumbar disc herniation from January 1973 to May 1979 at Korea University Hospital, 154 cases were analyzed radiologically and the following conclusions were obtained. 1. The ratio of male to female was 1.96 : 1. 2. The incidences of single and multiple involvement were 74.7% and 25.3%. 3. Most frequent level of lumbar disc herniation was L4-5 interspace. 4. The incidences of left, central and bilateral defects were 45.45%, 33.76%, 12.33% and 8.44% respectively. 5. The incidences of spina bifida and transitional vertebra were 24.04% and 9.09% respectively. 6. The overall mean of the lumbosacral angle was 33.97 .deg. 7. The overall mean depth of the lumbar lordosis was 8.48 mm. 8. The ratio of the height of L4-5 interspace to the shorter anteroposterior diameter of L-5 body was obtained by authors' idea. The mean ratios of male and female patients of L4-5 disc herniation which had no evidence of the narrowing of L4-5 interspace on simple radiologic finding were 0.3042 and 0.3064 respectively. So the ratio had a little value in the diagnosis of L4-5 disc herniation on simple radiologic study. 9. Myelography had high diagnostic accuracy, and the majority of the pseudonegative finding on lumbar disc herniation myelographically was seen at L4-5 disc herniation.

  10. Treatment of lumbar disc herniation by percutaneous laser disc decompression (PLDD) and modified PLDD

    Science.gov (United States)

    Chi, Xiao fei; Li, Hong zhi; Wu, Ru zhou; Sui, Yun xian

    2005-07-01

    Objective: To study the micro-invasive operative method and to compare the effect of treatment of PLDD and modified PLDD for Lumbar Disc Herniation. Method: Vaporized part of the nucleus pulposus in single or multiple point after acupuncture into lumbar disc, to reach the purpose of the decompression of the lumbar disc. Result: Among the 19 cases of the regular PLDD group, the excellent and good rate was 63.2%, and among the 40 cases of the modified PLDD group, the excellent and good rate was 82.5%. Conclusion: The modified PLDD has good effect on the treatment for lumbar disc herniation.

  11. Different Expression of Extracellular Matrix Genes : Primary vs. Recurrent Disc Herniation

    Science.gov (United States)

    Kuh, Sung-Uk; Kwon, Young-Min; Chin, Dong-Kyu; Jin, Byung-Ho; Cho, Yong-Eun

    2010-01-01

    Objective Recurrent lumbar disc herniation has been reported to occur in 5% to 15% of surgically treated primary lumbar disc herniation cases. We investigated the molecular biologic characteristics of primary herniated discs and recurrent discs to see whether the recurrent discs has the similar biological features with primary herniated discs. Methods Primary herniated disc and recurrent disc cells were obtained by discectomy of lumbar disc patients and cells were isolated and then taken through monolayer cultures. We compared chondrogenic and osteogenic mRNA gene expression, and western blot between the two groups. Results The mRNA gene expression of recurrent disc cells were increased 1.47* times for aggrecan, 1.38 times for type I collagen, 2.04 times for type II collagen, 1.22 times for both Sox-9 and osteocalcin, and 1.31 times for alkaline phosphatase, respectively, compared with the primary herniated lumbar disc cells (*indicates p herniated disc cells and recurrent disc cells. Conclusion These results indicate that the recurrent disc cells have similar chondrogenic and osteogenic gene expression compared to primary herniated disc cells. Therefore, we assumed that the regeneration of remaining discs could fill the previous discectomy space and also it could be one of the factors for disc recurrence especially in the molecular biologic field. PMID:20157374

  12. Serum cytokines, a diagnostic tool for herniated lumbar disc type ...

    African Journals Online (AJOL)

    Serum levels of IL-1α, IL-6 and TNFα may be applicable for preoperative diagnosis of the type of the herniated lumbar disc, especially TNFα, and IL-6 parameters which have a high sensitivity and specificity for differentiation between bulging and extrusion or sequestration discus. Key words: Intervertebral disk displacement, ...

  13. Gd-DTPA-enhanced MR in thoracic disc herniations

    Energy Technology Data Exchange (ETDEWEB)

    Parizel, P.M.; Rodesch, G.; Baleriaux, D.; Segebarth, C.; Zegers de Beyl, D.; Haens, J. d' ; Noterman, J.

    1989-03-01

    The Gd-DTPA-enhanced magnetic resonance findings in two patients with herniated thoracic intervertebral discs are reported. The first patient was a 56-year-old woman with a small subligamentous T6-7 disc herniation, slightly lateralized to the right. The second patient was a 51-year-old man with a central and right posterolateral disc herniation, including a large calcified fragment, at the T8-9 level. The nonenhanced MR examination revealed the presence of an extradural mass lesion in both patients, impinging upon the dural sac and compressing and displacing the spinal cord posteriorly. The lesion was slightly hypointense on both T1- and T2-weighted spin echo sequences. Following intravenous injection of Gd-DTPA in a dosage of 0.1 mmol/kg body weight, enhancement of the posterior longitudinal ligament was noted and triangular areas of contrast uptake were seen to occur in the epidural space above and below the herniated disc. At surgery, they were found to correspond to dilated and congested epidural veins.

  14. Regression of a symptomatic thoracic disc herniation with a calcified intervertebral disc component

    Directory of Open Access Journals (Sweden)

    Hidayet Sari

    2016-12-01

    Full Text Available There were only a few cases describing spontaneous regression of calcified thoracic disc herniation in the literature. We present a 38-year-old male office worker who had left paramedian-foraminal extruded disc at T7–T8 with calcifications of the T7–T8 and T8–T9 intervertebral discs. This case was unique in that the non-calcified extruded disc material regressed almost completely in 5 months while the calcified intervertebral discs remained the same during the process of regression. This report stresses that regression of the herniated material of the thoracic discs with subsidence of the symptoms is still possible even if the disc material is calcified.

  15. Do Turkish patients with lumbar disc herniation know body mechanics?

    Science.gov (United States)

    Topcu, Sacide Yildizeli

    2017-01-01

    Most common and important cause of the low back pain is lumbar disc herniation. Patients with lumbar disc herniation face with difficulties during daily activities due to the reduction of physical functions. In order to maintain daily activities without pain and discomfort, the patients should be informed about proper positions and body mechanics. The aim of the study was to determine the knowledge and the applications of the patients with lumbar disc herniation about body mechanics. This descriptive study was conducted with 75 patients with lumbar disc herniation in Edirne, Turkey. The population consisted of 75 patients who accepted to participate in the study. In the collection of data the questionnaire, which was developed according to literature by the researcher, was used. Descriptive statistics, student t-test, variance and correlation analysis were used for assessment of the data. The significance level was accepted at 0.05. It was found that 53.3% of the patients experienced awful/very severe pain. and there were some points that the patients have enough information about; mobilisation, standing, carrying the goods, leaning back while sitting, leaning somewhere while standing, getting support from the chair when standing up, avoiding sudden position changes, changing feet frequently while standing. It was detected that a statistical relation between educational level and knowledge about body mechanics exists. This study shows that individuals with lumbar disc herniation have not enough information about body mechanics and they experienced long-term severe pain. Nurses and other health care workers have important role in explaining the importance of body mechanics to the patients and should encourage them to use that in daily life.

  16. Lumbar disc herniation at high levels : MRI and clinical findings

    International Nuclear Information System (INIS)

    Paek, Chung Ho; Kwon, Soon Tae; Lee, Jun Kyu; Ahn, Jae Sung; Lee, Hwan Do; Chung, Yon Su; Jeong, Ki Ho; Cho, Jun Sik

    1999-01-01

    To assess the frequency, location, associated MR findings, and clinical symptoms of the high level lumbar disc herniation(HLDH). A total of 1076 patients with lunbar disc herniation were retrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms of frequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. The prevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in 14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to 72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated disc herniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variable involvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14 patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6 patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) with HLDH(n=41), there was a previous history of trauma. Patients with HLDH showed a relatively high incidence of associated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl's node, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous history of trauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relatively nonspecific and their incidence was low

  17. Lumbar disc herniation at high levels : MRI and clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Paek, Chung Ho; Kwon, Soon Tae; Lee, Jun Kyu; Ahn, Jae Sung; Lee, Hwan Do; Chung, Yon Su; Jeong, Ki Ho; Cho, Jun Sik [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1999-04-01

    To assess the frequency, location, associated MR findings, and clinical symptoms of the high level lumbar disc herniation(HLDH). A total of 1076 patients with lunbar disc herniation were retrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms of frequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. The prevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in 14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to 72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated disc herniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variable involvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14 patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6 patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) with HLDH(n=41), there was a previous history of trauma. Patients with HLDH showed a relatively high incidence of associated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl's node, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous history of trauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relatively nonspecific and their incidence was low.

  18. Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

    Science.gov (United States)

    Nie, Hong-Fei; Liu, Kai-Xuan

    2013-01-01

    Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery. PMID:24455232

  19. Fulminating septicemia secondary to oxygen-ozone therapy for lumbar disc herniation: case report.

    Science.gov (United States)

    Gazzeri, Roberto; Galarza, Marcelo; Neroni, Massimiliano; Esposito, Stefano; Alfieri, Alex

    2007-02-01

    A case report and clinical discussion. To describe a rare but fatal complication secondary to oxygen-ozone therapy for the treatment of herniated lumbar disc. Previously reported complications secondary to oxygen-ozone therapy are rarely reported. Septic discitis and epidural abscesses have been reported after myelography, lumbar puncture, paravertebral injections, epidural anesthesia, acupuncture, and intradiscal therapy with chymopapain. We report the first case of a local infection with systemic fatal dissemination secondary to this treatment. A 57-year-old man previously treated with oxygen-ozone therapy presented low back and bilateral pain. The lumbar computed tomography revealed the presence of L4-L5 and L5-S1 herniated discs. Three days after admission in the hospital, the patient developed a fulminant septicemia. An abdominal-pelvic and chest computed tomography and blood culture led to the diagnosis of pyogenic lumbar muscle involvement, accompanied with septic pulmonary embolism secondary to Escherichia coli infection. This case report identifies a rare and fatal complication of oxygen-ozone therapy in the treatment of a herniated lumbar disc. Acute fatal septicemia should be considered among the major complications of the oxygen-ozone therapy in the treatment of a herniated lumbar disc.

  20. Kinetic magnetic resonance imaging analysis of lumbar segmental motion at levels adjacent to disc herniation.

    Science.gov (United States)

    Lao, Lifeng; Daubs, Michael D; Takahashi, Shinji; Lord, Elizabeth L; Cohen, Jeremiah R; Zhong, Guibin; Wang, Jeffrey C

    2016-01-01

    A retrospective radiographic study was carried out to analyze the effect of lumbar disc herniation on the kinetic motion of adjacent segments. A total of 162 patients with low back pain or radicular pain in the lower limbs without a prior history of surgery were evaluated using kinetic magnetic resonance imaging. Translational motion, angular variation, and disc height were measured at each segment from L1-L2 to L5-S1. Other factors including the degree of disc degeneration, age, gender, and vertebral segment location were analyzed to determine any predisposing risk factors for segmental instability adjacent to disc herniations. Spinal levels above the disc herniation exhibited, on average, a 6.4 % increase in translational motion per mm of disc herniation (P = 0.496) and a 21.4 % increase in angular motion per mm herniation (P = 0.447). Levels below the herniation demonstrated a 5.2 % increase in translational motion per mm of disc herniation (P = 0.428) and a decrease of 10.7 % in angular motion per mm (P = 0.726). The degree of disc degeneration had no significant correlation with adjacent level motion. Similarly, disc herniation was not significantly correlated with disc height at adjacent levels, although there was a significant relationship between gender and adjacent segment disc height. Although disc height, translational motion, and angular variation are significantly affected at the level of a disc herniation, no significant changes are apparent in adjacent segments. Our results indicate that herniated discs have no effect on range of motion at adjacent levels regardless of the degree of disc degeneration or the size of disc herniation, suggesting that the natural progression of disc degeneration and adjacent segment disease may be separate, unrelated processes within the lumbar spine.

  1. ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

    Directory of Open Access Journals (Sweden)

    Jefferson Coelho de Léo

    2015-09-01

    Full Text Available Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the lumbar spine, the sacrum and the proximal femur. The affected segment was identified as the level and location of lumbar disc herniation in the axial plane with MRI scans.Results:Of 61 patients, 29 (47.5% had low lumbar lordosis; in this group 24 (82.8% had central disc herniation, 4 (13.8% had lateral recess disc herniation and 1 (3.4% had extraforaminal disc herniation (p<0.05. Of the 61 patients, 18 (29.5% had low sacral slope; of this group 15 (83.3% had central disc herniation and 3 (16.7% had disc herniation in lateral recess (p<0.05.Conclusions:There is a trend towards greater load distribution in the anterior region of the spine when the spine has hypolordotic curve. This study found an association between low lordosis and central disc herniation, as well as low sacral slope and central disc herniation.

  2. Enhanced MRI in lumbar disc herniation. Study on the types of herniation and histological findings

    International Nuclear Information System (INIS)

    Koh, Sadao; Okamura, Yuji; Honda, Eiichiro; Takazawa, Shunji; Ohno, Ryuichi; Yasuma, Tsuguo

    1999-01-01

    In the cases which had surgery after enhanced MRI, prolapsed form of hernia and the usefulness of enhanced MRI were examined. The patients were 13 males (14 intervertebral discs) and 5 females (6 intervertebral discs) with lumber disc herniation. The lumber disc herniation was classified into 3 types reference to Macnab's classification; SE (protrusion and subligamentous extrusion), TE (transligamentous extrusion) and SEQ (sequestration). Prolapsed forms were identified in 20 intervertebral discs. Enhanced MRI showed positive in 9 intervertebral discs (SE 1, TE 4 and SEQ 4) and showed negative in 11 discs (SE 10 and TE 1). As for the period from development to enhanced MRI, the significant difference wasn't recognized between positive group and negative group. The diagnostic rate of enhanced MRI was 88.9% (8/9) in sensitivity, 90.9% (10/11) in specificity and 90.0% (18/20) in accuracy. In enhanced MRI, engorged epidural venous plexus was also imaged, and minute change as only annular tear couldn't be detected. Looking from 2 directions crossing at right angles, the effect of contrast enhancement should be judged. (K.H.)

  3. Enhanced MRI in lumbar disc herniation. Study on the types of herniation and histological findings

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Sadao; Okamura, Yuji; Honda, Eiichiro; Takazawa, Shunji [Misato Junshin Hospital, Saitama (Japan); Ohno, Ryuichi; Yasuma, Tsuguo

    1999-06-01

    In the cases which had surgery after enhanced MRI, prolapsed form of hernia and the usefulness of enhanced MRI were examined. The patients were 13 males (14 intervertebral discs) and 5 females (6 intervertebral discs) with lumber disc herniation. The lumber disc herniation was classified into 3 types reference to Macnab's classification; SE (protrusion and subligamentous extrusion), TE (transligamentous extrusion) and SEQ (sequestration). Prolapsed forms were identified in 20 intervertebral discs. Enhanced MRI showed positive in 9 intervertebral discs (SE 1, TE 4 and SEQ 4) and showed negative in 11 discs (SE 10 and TE 1). As for the period from development to enhanced MRI, the significant difference wasn't recognized between positive group and negative group. The diagnostic rate of enhanced MRI was 88.9% (8/9) in sensitivity, 90.9% (10/11) in specificity and 90.0% (18/20) in accuracy. In enhanced MRI, engorged epidural venous plexus was also imaged, and minute change as only annular tear couldn't be detected. Looking from 2 directions crossing at right angles, the effect of contrast enhancement should be judged. (K.H.)

  4. COMPARATIVE STUDY ON THE TREATMENT OF DISC HERNIATIONS

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    María Luz Suárez-Huerta

    Full Text Available ABSTRACT Objective: To compare the results of treatment of patients with low back pain and radiculalgia resulting from disc herniation associated with disc degeneration through instrumentation with pedicle screws and dynamic rod, with root release and without diskectomy compared with other non-instrumented techniques (microdiskectomy with or without foraminotomy. Methods: This is a retrospective descriptive study of interventions for patients with herniated discs in the Traumatology and Neurosurgery that used the following variables: age, sex, type of technique, surgical time, time of evolution, degree of satisfaction, and complications. Two groups were formed: instrumentation with dynamic rods and non-instrumented techniques, comparing the results of each group. The software used was the SPSS v20.0. Results: We presented 142 interventions carried out between 2009 and 2012, 86 with dynamic instrumentation and 56 by other decompression techniques without instrumentation. No statistically significant differences were observed between age and sex groups and time elapsed until intervention. We found statistically significant differences (p=0.001 in surgical time, which was lower in the instrumented technique. No significant differences were found in complications between the techniques in both re-operations and in infections. Conclusions: In this study, we found no significant differences between the use of instrumentation with dynamic rods with respect to other non-instrumented surgical techniques in the treatment of herniated discs over 6 months of evolution or the complications and the degree of the patients' satisfaction.

  5. Changes in disc herniation after CT-guided Percutaneous Laser Disc Decompression (PLDD): MR findings

    Science.gov (United States)

    Brat, Hugues G.; Bouziane, Tarik; Lambert, Jean; Divano, Luisa

    2004-09-01

    The aim of Percutaneous Laser Disc Decompression (PLDD) is to vaporize a small portion of the nucleus pulposus. Clinical efficacy of this technique is largely proven. However, time-evolution of intervertebral disc and its hernia after PLDD is not known. This study analyses changes in disc herniation and its native intervertebral disc at a mean follow-up of 7.5 months after PLDD in asymptomatic patients. Main observations at MRI are appearance of a high signal on T2WI in the hernia in 59%, shrinking of the hernia in 66% and overall stability of disc height.

  6. 'Hard discs' associated with lumbar disc herniation: CT analysis

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    Yang, Il Kwon; Bang, Dae Hong; Yim, Jung Ik; Lee, Jae Mun; Bahk, Yong Whee [Catholic University Medical College, Seoul (Korea, Republic of)

    1989-02-15

    Thirty cases showing hard discs were collected from 206 consecutive cases of posterior disk herniation during the past one and a half years period. According to the shape of hard disk and the presence of marginal bone defect (MBD) of vertebral end plate, 30 cases could be categorized into 4 distinct groups. They were small hard disc with focal MBD (group 1), large hard disc with broad based MBD (group 2), hard disc separated from vertebral body without MBD (group 3) and hard disc fused with vertebral body without MBD (group 4). There were 14 patients in group 1. In all but one case, the hard disc and MBDs were located at the paramedial aspect of the posterior margin of the end plate. Ten (76.9%) of these had Schmorl's nodes and these were considered to represented an avulsion from the weakened bone margin as the disk herniated acutely. The posterior longitudinal ligament seemed to have prevented detachment of the bony fragment. Group 2 included 2 patients and CT findings as well as plain X-ray features were identical to a limbus vertebra. This was considered to represent passive displacement of bony fragment by the intravertebral herniation of the disk. Nine patients belonged to group 3 and represent dystrophic calcifications of herniated disk. Group 4 included 5 patients and was disclosed as a simple osteophyte. From our study, it was concluded; (1) that the hard disc seen in lumbar CT scan was probably the results of the detachment of a bone fragment from the vertebral end plate which has an underlying weak area due to the herniated disc as well as a calcification or osteophyte formation and (2) specific terms (avulsed fragment, limbus vertebra, calcification or spur formation) is more preferable to use than hard disc which is inaccurate.

  7. Adolescent lumbar disc herniation: Impact, diagnosis, and treatment.

    Science.gov (United States)

    Karademir, Mustafa; Eser, Olcay; Karavelioglu, Ergün

    2017-01-01

    Symptomatic lumbar intervertebral disc herniation (LDH) is rare in children and adolescents. To date, the treatments available for child and adolescent LDH, and the effect of each treatment, have not been fully reviewed. The purpose of this retrospective study is to report the etiology, familial history, presenting symptoms, level of herniation, duration of symptoms, radiological findings, as well as treatment methods and outcome. We retrospectively reviewed medical records of all patients with inclusion criteria of being younger than 20 years. (10-19 years); we used magnetic resonance imaging (MRI) to confirm lumbar disc herniations between 2013 and 2016. All patients were followed up for a minimum of 12 months and discharged if they remained almost asymptomatic for 6 months. All patients were treated conservatively and 6 patients they have progressive neurological deficit and persistent back pain, were treated with surgical procedures. The Visual Analogue Scale (VAS), as well as the Oswestry Disability Scale (ODS) and the modified Ashworth Scale (AS) were used to analyze physical examination findings both before and after treatment. To detect lumbar disc degeneration, we used the modified Pfirrmann grading system with MRI. All statistical analyses were performed with commercially available SPSS 15.0 software, while p ≤ 0.05 was considered statistically significant. A total of 70 cases with lumbar disc herniation have been treated. The mean age was 17.14 ± 2.15 years (range 9-19 years). The male to female ratio was 35:35. The mean duration of symptoms was 7.21 ± 1.69 months. The follow-up duration was 17.31 ± 4.17 months. The most common level was L4-5 in 38 (54%) patients and the second was L5-S1 in 24 (34%) patients. Subligamentous protruded discs were found in 42 (60%), extruded in 6 (9%), and disc bulge with intact annulus in 22 (31%) cases. VAS before treatment was 6.05 ± 0.83, while at 6 months after treatment it was 3.1 ± 0.6. However, at the first

  8. Cervical disc herniation manifesting as a Brown-Sequard syndrome

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    Kunio Yokoyama

    2012-01-01

    Full Text Available Brown-Sequard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm. The clinical picture reflects hemisection of the spinal cord. We report a rare case of Brown-Sequard syndrome caused by a large cervical herniated disc. A 63-year-old man presented with progressive right hemiparesis and disruption of pain and temperature sensation on the left side of the body. Magnetic resonance imaging showed large C3-C4 disc herniation compressing the spinal cord at that level, with severe canal stenosis from C4 through C7. Decompressive cervical laminoplasty was performed. After surgery, complete sensory function was restored and a marked improvement in motor power was obtained.

  9. Huge Intracanal lumbar Disc Herniation: a Review of Four Cases

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    Farzad Omidi-Kashani

    2016-01-01

    Full Text Available Lumbar disc herniation (LDH is the most common cause of sciatica and only in about 10% of the affected patients, surgical intervention is necessary. The side of the patient (the side of most prominent clinical complaints is usually consistent with the side of imaging (the side with most prominent disc herniation on imaging scans. In this case series, we presented our experience in four cases with huge intracanal LDH that a mismatch between the patient’s side and the imaging’s side was present. In these cases, for deciding to do the operation, the physicians need to rely more on clinical findings, but for deciding the side of discectomy, imaging characteristic (imaging side may be a more important criterion.

  10. Surgical management for lumbar disc herniation in pregnancy.

    Science.gov (United States)

    Kapetanakis, S; Giovannopoulou, E; Blontzos, N; Kazakos, G; Givissis, P

    2017-12-01

    Lumbar disc herniation is a common surgical spine pathology that may be presented during pregnancy. The state of pregnancy complicates the diagnosis and therapeutical management of this entity. Specific considerations rule the decision for surgical intervention, the optimal timing of it and the type of selected procedure in a pregnant patient, due to the potential risks for the fetus. In the last 30 years, evolution in the field of spine surgery has provided options other than open standard discectomy. The well-established concept of "minimal intervention" has led to the development of microdiscectomy and other innovative, full-endoscopic techniques for lumbar discectomy. The aim of the present study is to review the surgical management of lumbar disc herniation in pregnancy and investigate the potential role of minimally invasive spine surgery in this specific population. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Automatic diagnosis of lumbar disc herniation with shape and appearance features from MRI

    Science.gov (United States)

    Alomari, Raja'S.; Corso, Jason J.; Chaudhary, Vipin; Dhillon, Gurmeet

    2010-03-01

    Intervertebral disc herniation is a major reason for lower back pain (LBP), which is the second most common neurological ailment in the United States. Automation of herniated disc diagnosis reduces the large burden on radiologists who have to diagnose hundreds of cases each day using clinical MRI. We present a method for automatic diagnosis of lumbar disc herniation using appearance and shape features. We jointly use the intensity signal for modeling the appearance of herniated disc and the active shape model for modeling the shape of herniated disc. We utilize a Gibbs distribution for classification of discs using appearance and shape features. We use 33 clinical MRI cases of the lumbar area for training and testing both appearance and shape models. We achieve over 91% accuracy in detection of herniation in a cross-validation experiment with specificity of 91% and sensitivity of 94%.

  12. The Specific Sagittal Magnetic Resonance Imaging of Intradural Extra-Arachnoid Lumbar Disc Herniation

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    Tatsuro Sasaji

    2012-01-01

    Full Text Available Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral dural line on T2-weighted sagittal images is a characteristic finding of intradural extra-arachnoid lumbar disc herniation. The division of ventral dural line seemed to be a “Y,” and, thus, we called it the “Y sign.” The “Y sign” may be useful for diagnosing intradural extra-arachnoid lumbar disc herniation.

  13. The Specific Sagittal Magnetic Resonance Imaging of Intradural Extra-Arachnoid Lumbar Disc Herniation

    Science.gov (United States)

    Sasaji, Tatsuro; Horaguchi, Kiyoshi; Yamada, Noboru; Iwai, Kazuo

    2012-01-01

    Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral dural line on T2-weighted sagittal images is a characteristic finding of intradural extra-arachnoid lumbar disc herniation. The division of ventral dural line seemed to be a “Y,” and, thus, we called it the “Y sign.” The “Y sign” may be useful for diagnosing intradural extra-arachnoid lumbar disc herniation. PMID:22431932

  14. Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears

    Science.gov (United States)

    Yang, Hao; Liu, Hui; Li, Zemin; Zhang, Kuibo; Wang, Jianru; Wang, Hua; Zheng, Zhaomin

    2015-01-01

    Lumbar disc herniation is one of the most common spinal degenerative disorders which may lead to low back pain (LBP) and radicular leg pain. However, it remains difficult to diagnose a degenerative herniated disc as the LBP generator in clinical practice. The purpose of this study is to explore the characteristic changes of a herniated disc causing LBP on MRI and to clarify the underlying role of inflammatory mediators and annulus fibrous (AF) tears in LBP generation associated with disc herniation. We prospectively collected intervertebral disc specimens and MRI from 57 single-segment disc herniation patients with radiculopathy. All subjects were grouped according to LBP occurrence or disc degeneration severity for the comparison of inflammatory mediators’ expression and AF tears occurrence (High Intensity Zone, HIZ, on MRI). LBP incidence under circumstances of different degeneration severity with or without HIZ was further analyzed. Both LBP incidence and Inflammatory mediators expression in moderately degenerated group was higher than mildly and severely degenerative groups. HIZ incidence was higher in moderately and severely degenerated groups. LBP incidence in the patients with both moderately degenerated discs and HIZ was 86.7%, much higher than the rest of the patient population. In conclusion, the high expression of inflammatory mediators with AF tears causes LBP associated with disc herniation. Moderately degenerative disc with HIZ is MRI morphological change of herniated disc causing LBP, which can be applied to diagnose LBP. PMID:25932092

  15. Spontaneous Remission of a Big Subligamentous Extruded Disc Herniation: Case Report and Review of the Literature

    OpenAIRE

    ?iti?li, Veli; ?brahimo?lu, Muhammet

    2015-01-01

    Spontaneous Regression of a Big Subligamentous Extruded Disc Herniation: Case Report And Review of The Literature The most efficient method for the treatment of lumbar disc herniation is still controversial. The most important aspect is the application of the suitable conservative or surgical treatment to the right patient at the right time. In lumbar disc herniation patients, one must not precipitate except for cases that require surgical indications as in cauda equina syndrome, evolutive mo...

  16. Fluoroscopic-guided intradiscal oxygen-ozone injection therapy for thoracolumbar intervertebral disc herniations in dogs.

    Science.gov (United States)

    Han, Hyun-Jung; Kim, Joon-Young; Jang, Ha-Young; Lee, Bora; Yoon, Jung-Hee; Jang, Sang-Keun; Choi, Seok Hwa; Jeong, Soon-Wuk

    2007-01-01

    To investigate the effect of oxygen-ozone (O2-O3) injection on thoracolumbar intervertebral disc herniation (IVDH) in dogs. Ten herniated discs of five dogs were treated with percutaneous injection of an O2-O3 gas mixture with O3 concentration of 32 microg/microl intradiscally (1.5-2 microl) under fluoroscopy guidance. Five weeks after treatment, the mean size of herniated discs was measured by computed tomography and showed significant reduction of disc volumes in all animals (8.8%+/-3.82%). The degree of shrinkage was negatively linearly correlated with disc mineralization (correlation coefficient=-0.636) and statistically significant at pdiscs by disc shrinkage.

  17. Aggravation and subsequent disappearance of cervical disc herniation after cervical open-door laminoplasty: A case report.

    Science.gov (United States)

    Meng, Yang; Wang, Xiaofei; Wang, Beiyu; Wu, Tingkui; Liu, Hao

    2018-03-01

    Cervical open-door laminoplasty can enlarge the volume of the cervical vertebral canal and thus has become an effective and safe treatment for multilevel cervical disc herniation and cervical stenosis. Some post-surgery complications exist, such as reduction of cervical alignment and local kyphosis. However, aggravation of cervical disc herniation at the surgical level during short-term follow-up has not been discussed. Additionally, spontaneous disappearance of herniated disc pulposus is a common phenomenon in the lumbar region but is relatively rare in the cervical region. A 42-year-old female presented with a 7-year history of neck pain and a 2-year history of paresthesia and weakness in the upper and lower limbs. The sensations and muscle strength of both upper and lower limbs were decreased. The radiological findings showed that the Pavlov ratios from C3-7 were decreased obviously. Osteophytes as well as spinal cord compression were observed at C4/5, C5/6, and C6/7. Considering the symptoms and clinical examinations, the patient was diagnosed with cervical stenosis. We performed cervical open-door laminoplasty at C3-7 to enlarge the space of the cervical vertebral canal. At the 6-month post-surgery follow-up, the patient showed obvious improvement in paresthesia and weakness in the upper limbs. The cervical disc herniation at C3/4 was aggravated. However, at the 18-month follow-up, the symptoms were relieved, and the herniated cervical disc at C3/4 spontaneously disappeared without any special treatment. We suggest that the attachment points of deep muscles in the neck region should be carefully protected during this surgery. Patients who undergo cervical open-door laminoplasty should pay attention to their cervical position and perform neck exercises to train their neck muscles. MRI is an important imaging method to observe dynamic changes in herniated discs for patients with cervical disc herniation.

  18. The probability of spontaneous regression of lumbar herniated disc: a systematic review.

    Science.gov (United States)

    Chiu, Chun-Chieh; Chuang, Tai-Yuan; Chang, Kwang-Hwa; Wu, Chien-Hua; Lin, Po-Wei; Hsu, Wen-Yen

    2015-02-01

    To determine the probability of spontaneous disc regression among each type of lumbar herniated disc, using a systematic review. Medline, Cochrane Library, CINAHL, and Web of Science were searched using key words for relevant original articles published before March 2014. Articles were limited to those published in English and human studies. Articles had to: (1) include patients with lumbar disc herniation treated conservatively; (2) have at least two imaging evaluations of the lumbar spine; and (3) exclude patients with prior lumbar surgery, spinal infections, tumors, spondylolisthesis, or spinal stenosis. Two reviewers independently extracted study details and findings. Thirty-one studies met the inclusion criteria. Furthermore, if the classification of herniation matched the recommended classification of the combined Task Forces, the data were used for combined analysis of the probability of disc regression of each type. Nine studies were applicable for probability calculation. The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs. Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc sequestration had a significantly higher rate of complete regression than did disc extrusion. © The Author(s) 2014.

  19. Percutaneous thoracic intervertebral disc nucleoplasty: technical notes from 3 patients with painful thoracic disc herniations

    NARCIS (Netherlands)

    Chua Hai Liang, N.; Gultuna, I.; Riezebos, P.; Beems, T.; Vissers, K.C.P.

    2011-01-01

    Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic

  20. Computed tomography in the diagnosis of cervical disc herniation with radiculopathy

    International Nuclear Information System (INIS)

    Isu, Toyohiko; Iwasaki, Yoshinobu; Abe, Hiroshi; Miyasaka, Kazuo; Tashiro, Kunio

    1984-01-01

    Computed tomography (CT) is an accurate method of diagnosing cervical disc herniation in patients with radiculopathy. We evaluated 7 patients for the treatment of radiculopathy. The CT features of lateral cervical disc herniation include: (1) plain CT reveals a soft tissue mass compatible with laterally herniated disc material within the intervertebral foramen; (2) plain CT shows a soft tissue mass, which implies a fragmented disc, in the lateral recess; (3) CT with the intravenous administration of the contrast medium shows no delineation of the nerve root in the intervertebral foramen; and (4) CT metrizamide myelography demonstrates the filling defect of the root sleeve and hypertrophy of the nerve root. In those seven patients, all CT examinations were interpreted as positive for lateral disc herniation. There was a good correlation between the results of the neurologic examination and the CT findings. We wish to stress the usefulness of CT in the diagnosis of lateral cervical disc herniation. (author)

  1. Computed tomography in the diagnosis of cervical disc herniation with radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Isu, Toyohiko; Iwasaki, Yoshinobu; Abe, Hiroshi; Miyasaka, Kazuo; Tashiro, Kunio (Hokkaido Univ., Sapporo (Japan). School of Medicine)

    1984-02-01

    Computed tomography (CT) is an accurate method of diagnosing cervical disc herniation in patients with radiculopathy. We evaluated 7 patients for the treatment of radiculopathy. The CT features of lateral cervical disc herniation include: (1) plain CT reveals a soft tissue mass compatible with laterally herniated disc material within the intervertebral foramen; (2) plain CT shows a soft tissue mass, which implies a fragmented disc, in the lateral recess; (3) CT with the intravenous administration of the contrast medium shows no delineation of the nerve root in the intervertebral foramen; and (4) CT metrizamide myelography demonstrates the filling defect of the root sleeve and hypertrophy of the nerve root. In those seven patients, all CT examinations were interpreted as positive for lateral disc herniation. There was a good correlation between the results of the neurologic examination and the CT findings. We wish to stress the usefulness of CT in the diagnosis of lateral cervical disc herniation.

  2. Three-dimensional analysis of volumetric changes in herniated discs of the lumbar spine: does spontaneous resorption of herniated discs always occur?

    Science.gov (United States)

    Seo, Jun-Yeong; Roh, Young-Ho; Kim, Young-Hoon; Ha, Kee-Yong

    2016-05-01

    To investigate volumetric changes in lumbar disc herniation (LDH) using three-dimensional measurements obtained by magnetic resonance imaging (MRI) and to identify possible factors affecting such changes. Between January 2004 and December 2011, 43 patients who underwent conservative treatment for LDH were enrolled. In all, 56 disc levels were investigated. MRI was performed on two or more occasions (minimally, at the initial visit and 6 months later). The volume of each herniated disc was determined. For each patient, disc migration, morphology, initial LDH size, and clinical outcome were evaluated. The mean volumes of herniated discs at the initial and follow-up visits were 1,304.57 ± 837.99 and 993.84 ± 610.04 mm(3), respectively. The mean change in volume from the initial to the follow-up visit was 310.73 ± 743.60 mm(3). Volumes decreased at 35 disc levels and increased at 21 levels. The disc containment, the extent of LDH, the initial size of the herniated disc, and the degree of intactness of the posterior longitudinal ligament were significantly correlated with disc resorption and an increase in disc volume (p = 0.01, p = 0.018, p = 0.001, and p disc volumetric change and clinical outcome. We observed that LDH is a dynamic disease and that a herniated disc is not always spontaneously resorbed, in contrast to what has been reported previously. Alleviation of clinical symptoms can be achieved via conservative treatment even if the volume of the herniated disc changes. Spinal surgeons should not only present an option of initial non-surgical treatment to LDH patients but should also inform them that the LDH may change in size during daily activity or exercise.

  3. MR imaging of herniated lumbar disc : morphologic change between supine and flexed-prone position

    Energy Technology Data Exchange (ETDEWEB)

    Seong, Jin Yong; Lee, Seung Ro; Moon, Won Jin; Park, Dong Woo; Hahm, Chang Kok [Hanyang Univ., Seoul (Korea, Republic of); Kim, Sung Tae [Sungnam Inha Hospital, Sungnam (Korea, Republic of)

    1997-12-01

    The purpose of this study is to determine morphologic change in a herniated lumbar disc, as seen on MR imaging according to position change (supine and flexed-prone positions). A hundred and twenty-two patients with herniated lumbar discs, as seen on supine MR imaging, underwent repeat MR imaging in the flexed-prone position; 100 patients, who showed more than 2 deg of flexion angle difference, were included in this study. Sixty-two were men and thirty-eight were women, and their ages ranged from 13 to 59 (mean, 30) years. Disc degeneration was graded as 1,2 or 3, depending on the area of decreased signal intensity seen on a T2-weighted MR image. Difference in the angle of flexion is defined as the angle difference of lumbar curvature, calculated by the Begg-falconer method in supine and flexed-prone positions. Morphologic changes in herniated discs in difference positions were analysed on the basis of shape change of anterior epidural spaces, thecal sacs and posterior margins of herniated discs, and classified as either A (not changed) or B (changed). Group B was subtyped as type I (decreased herniation without change of shape), type II (decreased herniation with change of shape) or type III (increased disc herniation). We statistically analysed correlations between a patient`s age, morphologic change in a herniated disc in different positions, and degree of degeneration in such a disc, as well as the correlation between morphologic change in a herniated disc in different positions and the degree of the flexion angle. In the flexed-prone position, which is similar to that used during surgery, MRI can reveal various morphologic changes in a herniated lumbar disc, mainly decreased herniation, and is helpful in making decisions related to surgery. (author). 12 refs., 2 tabs., 4 figs.

  4. Posteriorly migrated thoracic disc herniation: a case report

    Directory of Open Access Journals (Sweden)

    Miyakoshi Naohisa

    2013-02-01

    Full Text Available Abstract Introduction Posterior epidural migration of thoracic disc herniation is extremely rare but may occur in the same manner as in the lumbar spine. Case presentation A 53-year-old Japanese man experienced sudden onset of incomplete paraplegia after lifting a heavy object. Magnetic resonance imaging revealed a posterior epidural mass compressing the spinal cord at the T9-T10 level. The patient underwent emergency surgery consisting of laminectomy at T9-T10 with right medial facetectomy, removal of the mass lesion, and posterior instrumented fusion. Histological examination of the mass lesion yielded findings consistent with sequestered disc material. His symptoms resolved, and he was able to resume walking without a cane 4 weeks after surgery. Conclusions Pre-operative diagnosis of posterior epidural migration of herniated thoracic disc based on magnetic resonance imaging alone may be overlooked, given the rarity of this pathology. However, this entity should be considered among the differential diagnoses for an enhancing posterior thoracic extradural mass.

  5. Surgical techniques for sciatica due to herniated disc, a systematic review

    NARCIS (Netherlands)

    Jacobs, Wilco C H; Arts, Mark P.; van Tulder, Maurits W; Rubinstein, Sidney M; van Middelkoop, Marienke; Ostelo, Raymond W; Verhagen, Arianne P; Koes, Bart W; Peul, Wilco C.

    2012-01-01

    INTRODUCTION: Disc herniation with sciatica accounts for five percent of low-back disorders but is one of the most common reasons for spine surgery. The goal of this study was to update the Cochrane review on the effect of surgical techniques for sciatica due to disc herniation, which was last

  6. Depression and anxiety in patients undergoing herniated disc surgery: relevant but underresearched - a systematic review.

    Science.gov (United States)

    Zieger, M; Schwarz, R; König, H-H; Härter, M; Riedel-Heller, S G

    2010-02-01

    An association between depression and anxiety and musculoskeletal disorders has been consistently reported in the past years. This article provides a systematic overview of the literature on the prevalence rates of depression and anxiety in patients undergoing surgery for a herniated disc. A systematic literature search was conducted in the following electronic databases: PubMed, PsycINFO, Web of Science, Cochrane Library and PSYNDEXplus. The identified articles were evaluated for prevalence rates of depression and anxiety, methodological issues, change of depression and anxiety over time, and major findings on the impact of depression and anxiety on patients undergoing disc surgery. Fourteen studies were identified. Prevalence rates for depression and anxiety in patients undergoing disc surgery varied between 21.5% and 49.3% before and between 4.1% and 79.6% after disc surgery. The study designs, the use of assessment instruments and cut-off values varied greatly. Depression and anxiety decreased within the population of disc surgery patients over time. Depression and anxiety were found to have a great impact on the postoperative outcome of surgery, return to work, analgesia abuse, pain experience, and abnormal illness behaviour. Little research has been done to investigate depression and anxiety in patients undergoing surgery for a herniated disc. Evidently disc surgery patients are at higher risk of suffering from depression and anxiety than the general population. The review outlines the importance for clinicians to be more sensitive to psychological concerns in patients undergoing disc surgery. Psychological assessment and assistance from mental health professionals should be considered during the hospital stay and rehabilitation period, depending on local feasibility. Further investigations are necessary to examine whether the implementation of a multidisciplinary in-patient treatment program will improve postoperative outcome in patients undergoing

  7. CT findings of lumbar intervertebral disc: II. Disc herniation (HNP)

    International Nuclear Information System (INIS)

    Yang, W. J.; Lee, J. M.; Bahk, Y. W.

    1984-01-01

    In lumbar region the epidural fat pad is relatively abundant so that CT can provides sufficient information in diagnosis of lumbar HNP. Many authors have reported on the CT findings of HNP such as focal nodular protrusion of the posterior disc margin, obliteration of epidural fat pad, impingement of dural sac and nerve root, swelling of nerve root, soft tissue density in the spinal canal and calcification of disc. However there was so previous report describing incidence and reliability of the findings. It is the purpose of the present study to survey the frequency, reliability, and limitation of these CT findings. The clinical material was consisted of 30 operatively proven cases of HNP of the lumbar spine. Each lumbar CT scan was reviewed retrospectively and the findings were analysed by two radiologists independently. There were 20 males and 10 females and the mean age was 36.7 years. Involvement of L4-S5 level was 2.3 times more frequent than that of L5-S1 level. Of 30 cases, 22 were unilateral posterolateral types and 8 cases central or unilateral far lateral types. CT findings observed were nodular protrusion of the posterior margin of the disc, obliteration of epidural fat pad, impingement of dural sac or nerve root, soft tissue density in the spinal canal and calcification in the posterior portion of the protruded disc, in order of decreasing frequency. The conclusions are follows: 1. Nodular protrusion of the posterior disc margin accompanied by obliteration of epidural fat pad was observed in every case. The former findings was designated as direct sign and the latter indirect. 2. Obliteration of the epidural fat appears to be significant in lateral recesses especially when it occurs unilaterally. This was not true, however, in the centrally located fat pad. 3. Impingement of the dural sac and nerve root were observed in 90% and 67%, respectively, and were very helpful in establishing HNP diagnosis when the direct and indirect signs were equivocal

  8. [Clinical observation of post-extension pulling massage in treating lumbar disc herniation].

    Science.gov (United States)

    Lü, Li-Jiang; Ke, Xue-Ai; Mao, Xu-Dan; Chen, Xiao-Jie; Wu, Fang-Chao; Tong, Hong-Jie

    2010-10-01

    To observe the clinical effect of post-extension pulling massage in treating lumbar disc herniation. From January 2008 to December 2008, 61 patients with lumbar disc herniation, 34 males and 27 females, ranging in age from 17 to 67 years with an average of 42.6 years, were treated with post-extension pulling massage after continued traction for 30 minutes (on alternate days one time, 3 times as a course of treatment). There was bulging type in 9 cases, hernia type in 22, free type in 30. After a course of treatment, the clinical effects were evaluated according to standard of Macnab, the items included pain, lumbar activity, normal work and life of patients. All patients were followed up from 1 to 9 months with an average of 4.6 months. After treatment, the symptoms and signs of patients had obviously improved in above aspects. According to standard of Macnab, 48 cases got excellent result, 10 good, 2 fair, 1 poor. The post-extension pulling massage in treating lumbar disc herniation can obtain satisfactory results, which have localized site of action, small compression for vertebral body and can reduce accidental injury.

  9. Myelopathy associated with age-related cervical disc herniation: a retrospective review of magnetic resonance images.

    Science.gov (United States)

    Al-Ryalat, Nosaiba Tawfik; Saleh, Saif Aldeen; Mahafza, Walid Sulaiman; Samara, Osama Ahmad; Ryalat, Abdee Tawfiq; Al-Hadidy, Azmy Mohammad

    2017-01-01

    Cervical intervertebral disc herniation can lead to myelopathy. Aging is an established variable related to spondylotic myelopathy. Studying this association will help in controlling the increase in spondylotic myelopathy with age. To study the association between cervical disc level, its direction, and the frequency of my-elopathy with age, and to assess the epidemiology of age-related cervical disc herniation and myelopathy. Retrospective review of magnetic resonance (MR) images. Tertiary referral hospital. We studied the MR images of adults patients ( > 18 years of age) referred to our department between 2001 and 2012 for suspected cervical spondylopathy. The direction and severity of herniation and the presence of myelopathy was determined for spinal levels C2 to C7. Relationship between age-related cervical disc herniation and myelopathy. We studied 6584 patient MR images, which included 2402 males (39.1%) and 3737 females (60.9%). The frequency of myelopathy increased with age from 0.6% in patients 70 years of age. The most common level affected by myelopathy was C5-C6. In elderly patients ( > 60 years), the C3-C4 level became the predominant level affected by myelopathy. Likewise, the frequency of central disc herniation increased significantly (P disc herniation than lower cervical levels in the elderly. The increased frequency of central disc herniation with age suggest an important, and probably a cause-effect relationship, between herniation and myelopathy. We were unable to access clinical data or electrophysiological studies to correlate with MR image findings.

  10. Effect of Age and Lordotic Angle on the Level of Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Ghassan S. Skaf

    2011-01-01

    Full Text Available It has been previously suggested in the literature that with aging, degenerative changes as well as disc herniation start at the lower lumbar segments, with higher disc involvement observed in an ascending fashion in older age groups. We conducted a study to investigate this correlation between age and level of disc herniation, and to associate it with the magnitude of the Lumbar Lordotic Angle (LLA, as measured by Cobb’s method. We followed retrospectively lumbosacral spine MRI’s of 1419 patients with symptomatic disc herniation. Pearson’s correlation was used in order to investigate the relationship between LLA, age, and level of disc herniation. Student’s -test was applied to assess gender differences. Young patients were found to have higher LLA (=0.44, <0.0001 and lower levels of disc herniation (=0.302, <0.0001, whereas older patients had higher level herniation in lower LLA group (mean LLA 28.6° and 25.4° and lower level herniation in high LLA group (mean LLA 33.2°. We concluded that Lumbar lordotic Cobb’s angle and age can be predictors of the level of lumbar disc herniation. This did not differ among men and women (=0.341, <0.0001.

  11. Inflammatory Processes Associated with Canine Intervertebral Disc Herniation

    Science.gov (United States)

    Monchaux, Marie; Forterre, Simone; Spreng, David; Karol, Agnieszka; Forterre, Franck; Wuertz-Kozak, Karin

    2017-01-01

    Intervertebral disc herniation (IVDH) is an important pathology in humans and also in dogs. While the molecular disease mechanisms are well investigated in humans, little is known about the inflammatory mediators in naturally occurring canine IVDH. The objective of this study was to investigate whether the involved proinflammatory cytokines in human IVDH are also key cytokines in canine IVDH and thus to elucidate the suitability of the dog as a model for human trials. 59 samples from 25 dogs with surgically confirmed thoracolumbar IVDH were collected and classified in three subgroups: herniated (H), affected non-herniated (NH) disc, and adjacent non-affected (NA) disc. Discs from 11 healthy dogs acted as controls (C). Samples were analyzed for IL-1, IL-6, IL-8, and TNF-α expression (qPCR/ELISA) as well as cell infiltration and activation of the MAP kinase pathways (immunohistochemistry). Gene and protein expression of all key cytokines could be detected in IVDH affected dogs. Canine IVDH was significantly associated with a higher gene expression of IL-6 (H > C, NH > C) and TNF-α (H > C, NH > C, NA > C) and a significant down-regulation of IL-1β (H  NA, NH > NA). IL-8 (H > C, NA > C) and TNF-α (NH > C) protein levels were significantly increased in diseased dogs while inversely, IL-6 protein levels were significantly higher in patients with better clinical outcome. Aside from resident IVD cells, mostly monocytes and macrophages were found in extruded material, with concomitant activation of extracellular signal-regulated kinase p38 in the majority of samples. Dogs with spontaneous IVDH might provide a useful model for human disc diseases. Although the expression of key cytokines found in human IVDH was also demonstrated in canine tissue, the inflammatory mechanisms accompanying canine IVDH diverges partially from humans, which will require further investigations in the future. In dogs, IL-6 seems to play an important

  12. Significance of Vertebral Endplate Failure in Symptomatic Lumbar Disc Herniation

    Science.gov (United States)

    Sahoo, Madan Mohan; Kaur, Sheetal; Sarangi, Jitendra; Mohapatra, Manoranjan

    2017-01-01

    Study Design: Prospective cohort study. Objective: Endplate lesions though have been implicated in the genesis of lumbar disc herniation (LDH), very little is known regarding their clinical course. Thus, the present study is aimed to investigate the incidence and types of endplate failure (EPF) in LDH and its correlation with the clinical symptoms and prognosis. Methods: Clinical and magnetic resonance imaging (MRI) features of 66 patients with isolated single level LDH were studied. Three-dimensional fast spoiled gradient (3D FSPGR) MRI and computed tomography scans were used to identify the bony and cartilaginous EPF. Twenty-five patients were operated on and 41 patients were treated conservatively. Changes in the pain score, function and neurology were noted at 3, 6, 12, 24, and 36 weeks. Results: Endplate lesions were observed in 64 patients (96.9%), including bony endplate failure (bony failure) in 47 patients (71.2%) and isolated cartilaginous endplate lesions in 17 patients (25.7%). Bony failure group had similar pain and functional scores but more severe neurological deficit at the initial evaluation. Clinical parameters improved in all groups, but the recovery was lesser in conservatively treated bony failure patients. Conclusion: Endplate lesions are commonly associated with symptomatic LDH. Presence of bony failure can increase neurological deficit and reduce the chance of recovery with conservative management. The 3D FSPGR sequence of MRI can be successfully used for detection of the endplate lesions in the herniated disc. PMID:28660105

  13. Predictors of vocational prognosis after herniated lumbar disc

    DEFF Research Database (Denmark)

    Jensen, Lone Donbæk; Frost, Poul; Schiøttz-Christensen, Berit

    2011-01-01

    Study Design. A register study with 2 years of follow up. Objective. To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD). Summary of Background Data. There is sparse information about vocational prognosis among HLD patients diagnose...... with discectomy, ethnicity, and gender had a negative influence. There seems to be a need for actions addressing these patient categories to avoid long-term sick leave and premature withdrawal from the labor market.......Study Design. A register study with 2 years of follow up. Objective. To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD). Summary of Background Data. There is sparse information about vocational prognosis among HLD patients diagnosed...... at hospital. Methods. We followed all in- and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfer Payments (n = 2039). Clinical data were obtained from the Danish National Patient Register. The outcome...

  14. The occurrence and regional distribution of DR4 on herniated disc cells: a potential apoptosis pathway in lumbar intervertebral disc.

    Science.gov (United States)

    Zhang, Liang; Niu, Tao; Yang, Shang-You; Lu, Zhenhua; Chen, Bohua

    2008-02-15

    Intervertebral discs surgically obtained from 60 herniated patients and 5 normal individuals were examined to correlate the regional distribution of DR4-receptor and apoptosis. To explore the role of a tumor necrosis factor superfamily member DR4 and the TRAIL/DR4 mediated apoptosis in the human lumbar intervertebral disc. The pathogenesis of lumbar degenerative intervertebral discs remains not completely understood. In herniated lumbar disc tissues, increased apoptosis and higher expression of Fas/Fas ligand and caspase-3 have been reported, suggesting a pivotal role of apoptotic mechanisms in intervertebral disc degeneration. However, it is not clear that apoptosis mediators such as TRAIL and Death Receptor 4 (DR4), which often represent different apoptosis signal pathways, contribute to the apoptosis process during the development of the degenerated intervertebral discs. Apoptosis was determined by poly(ADP-ribose) polymerase (PARP) p85 immunohistochemistry. Expression of DR4 was revealed by immunohistochemistry analysis. Statistical difference among groups was analyzed using one-way ANOVA with LSD post hoc multiple comparisons and the bivariate correlations. Apoptotic cells were detected in the nucleus pulposus and anulus fibrosus of all samples. However, the number of apoptotic cells was significantly higher in the nucleus compared with the anulus. Further, there were significantly more apoptotic cells in the herniated discs compared with the normal discs. Within herniated discs, a remarkably higher percentage of positive staining cells were detected in the uncontained discs than the contained ones. Strong expression of DR4 was detected in all samples of degenerative herniated discs, whereasmuch weaker expression was sporadically identified in normal discs. In addition, the prevalence of apoptosis positively correlated with the severity of disc degeneration. The concomitant increase of DR4 expression in the regions of heavy apoptotic cell aggregation suggests

  15. CT-discography; diagnostic accuracy in lumbar disc herniation and significance of induced pain during procedure

    Energy Technology Data Exchange (ETDEWEB)

    Jin, En Hao [Yan Bian Medical College, Beijing (China); Chung, Tae Sub; Jeong, Mi Gyoung; Kim, Young Soo; Roh, Sung Woo [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To evaluate the usefulness and the accuracy of CT-discography in lumbar disc disease by analyzing the findings of CT-discogram and types of evoked pain during the procedure. CT-discograms were retrospectively evaluated in 47 intervertebral discs of 20 patients with multilevel involvement of lumbar disc diseases. In 28 herniated discs confirmed at surgery, the findings of CT-discogram (28 disc levels/20 patients), MRI(23/16) and CT(21/15) were comparatively analysed. The type of pain after infusion of contrast media during CT-discography was compared with that prior to the procedure. The accuracy for determining types of the herniated lumbar disc when compared with post-operative results was 96.4%(27 discs/28 discs) in the CT-discogram, 82.6%(19 discs/23 discs) in MRI and 71.4%(15 discs/21 discs) in the CT scan. Pains encountered during discography were radiating pain in 12 discs and back pain in 24 discs. CT-discography was especially helpful in 10 patients with multilevel involvement of the lumbar disc diseases to evaluate the exact location of diseased disc(s) that provoked the pain. CT-discography is a highly accurate method in diagnosis of the herniated lumbar intervertebral discs and is very useful in determining the precise location related to the development of pain in such cases.

  16. CT-discography; diagnostic accuracy in lumbar disc herniation and significance of induced pain during procedure

    International Nuclear Information System (INIS)

    Jin, En Hao; Chung, Tae Sub; Jeong, Mi Gyoung; Kim, Young Soo; Roh, Sung Woo

    1996-01-01

    To evaluate the usefulness and the accuracy of CT-discography in lumbar disc disease by analyzing the findings of CT-discogram and types of evoked pain during the procedure. CT-discograms were retrospectively evaluated in 47 intervertebral discs of 20 patients with multilevel involvement of lumbar disc diseases. In 28 herniated discs confirmed at surgery, the findings of CT-discogram (28 disc levels/20 patients), MRI(23/16) and CT(21/15) were comparatively analysed. The type of pain after infusion of contrast media during CT-discography was compared with that prior to the procedure. The accuracy for determining types of the herniated lumbar disc when compared with post-operative results was 96.4%(27 discs/28 discs) in the CT-discogram, 82.6%(19 discs/23 discs) in MRI and 71.4%(15 discs/21 discs) in the CT scan. Pains encountered during discography were radiating pain in 12 discs and back pain in 24 discs. CT-discography was especially helpful in 10 patients with multilevel involvement of the lumbar disc diseases to evaluate the exact location of diseased disc(s) that provoked the pain. CT-discography is a highly accurate method in diagnosis of the herniated lumbar intervertebral discs and is very useful in determining the precise location related to the development of pain in such cases

  17. Study of Frequency of Low Back Pain and Lumbar Disc Herniation in Patients of Hamadan MRI Center in 2002

    Directory of Open Access Journals (Sweden)

    M. Jabbari

    2004-07-01

    Full Text Available Low back pain is one of the prevalent diseases of the world. In this research, with helping of MRI the incidence of disc herniation in patients of low back pain in our living area was studied. Survey of the specifications of disc herniation was carried out and data was compared with some performed studies in other parts of the world. In this study, for 600 patients referred to HAMEDAN MRI CENTER, who had complaint of low back pain, MRI study was performed. Then, MRI Images of the patients who had disc hernition, studied for number, form, severity and anatomic position of the herniated disc and family history of low back pain. 83.7% of the studied cases was pathologic and 16.3% was normal. Among the pathologic cases, 70.12% had disc herniation. The most common age group in both sex for disc herniotion was 30-50 years. Disc herniation in men was more common than women. The most common anatomic position of the herniated disc was L4- L5 disc, mostly was one herniated disc and centrolateral form. There was not any meaningful relation between family history of the low back pain and lumbar disc herniation. This study showed that lumbar disc herniation is one of the common causes of the low back pain in our living area and MRI is the choice imaging modality for diagnosis and survey of low back pain and disc herniation.

  18. Suspected herniated lumbar disc - computed tomography in differential diagnosis of non-disc-related sciatica

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, T.; Koehler, D.; Treisch, J.; Claussen, C.; Felix, R.

    1984-07-01

    The most common reason a patient is referred for spinal CT examination is to exclude a ruptured intervertebral disc. Besides nerve root entrapment due to herniated disc, a number of unusual or unexpected conditions have been encountered in the course of CT lumbar spine studies. These include spondylolisthesis, spinal dysraphism, Paget's disease, and inflammatory, neoplastic, or metastatic lesions. The application of spinal (small-circle) target imaging includes the risk of overlooking soft tissue lesions that extend beyond the reconstruction circle. Therefore, complete (large-circle) circumferential abdominal scanning is recommended in case of a suspected extraspinal cause of sciatica.

  19. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Y.; Lee, S.H.; Shin, S.W. [Wooridul Spine Hospital, Department of Neurosurgery, Kangnam-gu (Korea); Chung, S.E.; Park, H.S. [Wooridul Spine Hospital, Department of Radiology, Kangnam-gu (Korea)

    2005-12-01

    A discogenic cervical headache is a subtype of cervicogenic headache (CEH) that arises from a degenerative cervical disc abnormality. The purpose of this study was to evaluate the clinical outcome of percutaneous endoscopic cervical discectomy (PECD) for patients with chronic cervical headache due to soft cervical disc herniation. Seventeen patients underwent PECD for intractable headache. The inclusion criteria were soft disc herniation without segmental instability, proven by both local anesthesia and provocative discography for headache unresponsive to conservative treatment. The mean follow-up period was 37.6 months. Fifteen of the 17 patients (88.2%) showed successful outcomes based on the Macnab criteria. Pain scores on a visual analog scale (VAS) improved from a preoperative mean of 8.35{+-}0.79 to 2.12{+-}1.17, postoperatively (P<0.01). The mean disc height decreased from 6.81{+-}1.08 to 5.98{+-}1.07 mm (P<0.01). There was no newly developed segmental instability or spontaneous fusion on follow-up radiography. In conclusion, PECD appears to be effective for chronic severe discogenic cervical headache under strict inclusion criteria. (orig.)

  20. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation

    International Nuclear Information System (INIS)

    Ahn, Y.; Lee, S.H.; Shin, S.W.; Chung, S.E.; Park, H.S.

    2005-01-01

    A discogenic cervical headache is a subtype of cervicogenic headache (CEH) that arises from a degenerative cervical disc abnormality. The purpose of this study was to evaluate the clinical outcome of percutaneous endoscopic cervical discectomy (PECD) for patients with chronic cervical headache due to soft cervical disc herniation. Seventeen patients underwent PECD for intractable headache. The inclusion criteria were soft disc herniation without segmental instability, proven by both local anesthesia and provocative discography for headache unresponsive to conservative treatment. The mean follow-up period was 37.6 months. Fifteen of the 17 patients (88.2%) showed successful outcomes based on the Macnab criteria. Pain scores on a visual analog scale (VAS) improved from a preoperative mean of 8.35±0.79 to 2.12±1.17, postoperatively (P<0.01). The mean disc height decreased from 6.81±1.08 to 5.98±1.07 mm (P<0.01). There was no newly developed segmental instability or spontaneous fusion on follow-up radiography. In conclusion, PECD appears to be effective for chronic severe discogenic cervical headache under strict inclusion criteria. (orig.)

  1. History of lumbar disc herniation with Gd-DPTA enhanced MRI

    Energy Technology Data Exchange (ETDEWEB)

    Iwahara, Toshihito; Satou, Toshikazu [Wakkanai Municipal Hospital, Hokkaido (Japan)

    1995-09-01

    The pathological changes of primary lumbar disc herniation was monitored on T1-weighted and Gd-weighted MR imagings. The subjects were 11 patients whose symptoms improved solely by conservative therapy. Herniated area on T1-weighted images (whole herniated area), enhanced herniated area on Gd-MRI (enhanced area), and non-enhanced herniated area on Gd-MRI (non-enhanced area) were calculated, and each proportion to the vertebral canal was assessed. Changes in herniated area was correlated with changes of enhanced area. Gd-MRI was found to be useful in predicting the prognosis of primary herniation, as well as in differentiating recurrent herniation and cicatricial tissues. (S.Y.).

  2. OUTCOMES OF TRANSFORAMINAL ENDOSCOPIC DISCECTOMY FOR LUMBOSACRAL DISC HERNIATION

    Directory of Open Access Journals (Sweden)

    I. V. Volkov

    2017-01-01

    Full Text Available Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED in comparison with microdiscectomy (MD and to specify factors determining complications and failures.Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9% which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic

  3. Residual herniated disc material following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease.

    Science.gov (United States)

    Roach, W J; Thomas, M; Weh, J M; Bleedorn, J; Wells, K

    2012-01-01

    To evaluate the presence of residual disc material within the vertebral canal following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease. Forty dogs were treated by hemilaminectomy. Computed tomography was performed preoperatively and immediately postoperatively. The vertebral canal height, width, area, and herniated disc material area were measured. Maximum filling percentage (MFP), residual disc percentage (RDP), maximum residual filling percentage (MRFP), and residual filling percentage (RFP) were calculated. Clinical outcome was determined by telephone interviews. Residual disc material was present in 100% of the dogs. Mean MFP = 55.4% (range 25.9-82.3%; median 56.9%). Mean RDP = 50.3% (range 2.6-155.8%; median 47.9%). Mean MRFP = 30.8% (range 4.9-60%; median 30.1%). Mean RFP = 19.8% (range 4.8-45%; median 19.0%). All dogs were ambulatory with voluntary urination at the long-term follow-up (range: 88-735 days). Residual disc was present in all dogs following hemilaminectomy for intervertebral disc disease. Residual disc was not associated with failure to achieve functional recovery in these cases.

  4. The Clinical Analysis on 32 Cases of Herniated Lumbar Disc Patients according to Lumbar CT scan

    Directory of Open Access Journals (Sweden)

    Jeong-ho Kim

    2010-06-01

    Full Text Available Objective : This study is to evaluate the effectiveness of the oriental medicine treatment on lumbar disc herniation. Subjects and Methods : The clinical analysis was done on 32 cases of patients with lumbar disc herniation diagnosed by lumbar CT scan. Patients who admitted in Cheongju Oriental Medicine Hospital from April 2007 to April 2008 were analyzed according to the distribution of sex, age, the period of disease, condition on admission, the symptom on admission, Admission day, the treatment efficacy at discharge day. Results : 1. The forties was the most, the acutest phase the most, the day of 8-14 days the most. 2. Multiple bulging disc in 37.5% of CT scan was the most common, followed by a single HNP was 28.1%. 3. Almost 81% patients showed effective efficacy under VAS 3 at discharge day. 4. Single bulging and herniated disc were more short admission days than multiple bulging and herniated disc.

  5. Disappearing large calcified thoracic disc herniation in a patient with thalassaemia

    Science.gov (United States)

    Ahmad, Faiz U; Schallert, Erica; Bregy, Amade; Post, Judith D; Vanni, Steven

    2016-01-01

    Regression of herniated disc fragments with subsequent improvement in clinical symptoms has been reported in the lumbar and cervical spine. Such regressions in the thoracic spine are extremely rare. We report a case of a 38-year-old patient with thalassaemia who had regression of a large calcified herniated thoracic disc causing cord compression, with subsequent herniation of a second calcified disc at a different level and discuss the possible aetiopathogenesis. This is the first such case reported in the thalassaemia population. PMID:26823353

  6. Horner Syndrome associated with a Herniated Cervical Disc: A Case Report.

    Science.gov (United States)

    Ma, Hyunjin; Kim, Insoo

    2012-06-01

    Horner syndrome (HS) occurs when there is interruption of the oculosympathetic pathway. The causes of HS are various, but HS originated from herniated cervical disc is very few. HS attributable to the lesion of the first-order neuron of cervical spinal cord is extremely rare. A 41-year old male was admitted for sudden onset of left ptosis and right side numbness. Neurological examination revealed ptosis, miosis and facial anhidrosis on the left side. MRI and CT scans demonstrated large left paramedian disc herniation with cord compression at the C4-5 level. The herniated disc was removed through anterior approach and his symptoms were improved after the operation.

  7. Nursing care for patients receiving percutaneous lumbar discectomy and intradiscal electrothermal treatment for lumbar disc herniation

    International Nuclear Information System (INIS)

    Mou Ling

    2009-01-01

    Objective: To summarize the nursing experience in caring patients with lumbar intervertebral disc herniation who received percutaneous lumbar discectomy (PLD) together with intradiscal electrothermal treatment (IDET) under DSA guidance. Methods: The perioperative nursing care measures carried out in 126 patients with lumbar intervertebral disc herniation who underwent PLD and IDET were retrospectively analyzed. Results: Successful treatment of PLD and IDET was accomplished in 112 cases. Under comprehensive and scientific nursing care and observation, no serious complications occurred. Conclusion: Scientific and proper nursing care is a strong guarantee for a successful surgery and a better recovery in treating lumbar intervertebral disc herniation with PLD and IDET under DSA guidance. (authors)

  8. CT of lumbar disc herniation: correlation with surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Suk Yl; Lee, Dong Jin; Sung, Kyu Bo; Woo, Won Hyung [Korea General Hospital, Seoul (Korea, Republic of)

    1986-10-15

    CT from forty nine patients with 53 surgical disc explorations were reviewed and correlated with surgical findings. The results were as follows: 1. Frequent locations of HNP were in L4-5 (65%) and L5-S1 (31%). The most common type of HNP was paramidine type (71%). 2. Focal protrusion of the posterior margin of disc and obliteration of epidural fat pad were observed in all of cases (100%) and other common findings were indentation of epidural sac in 46 cases (96%) and compression of nerve root sleeve in 33 cases (69%). 3. Cephalad and caudad extension of protruded soft tissue density in the spinal canal was observed in 15 cases (31%) with variable degree. And more than 6mm extension were provided to be extruded disc in 9 cases. 4. Vacuum phenomenon was demonstrated in 5 cases (10%) and was accompanied with bulging annulus. 5. Forty eight herniated nucleus (HNP) were confirmed surgically in 44 patients. Misinterpretations were made in 4 instances (4 patients); 1 because of lumbar scoliosis, 1 because of spondylolisthesis, and the other 2 because of calcified posterior longitudinal ligament and bulging annulus. One case of true negative examination was central and foraminal stenosis in spinal CT. Thus, sensitivity, specificity and overall accuracy of lumbar spine CT in HNP were 92%, 100% and 92%, respectively.

  9. Sequencing and bioinformatics analysis of the differentially expressed genes in herniated discs with or without calcification.

    Science.gov (United States)

    Shao, Jia; Yu, Miao; Jiang, Liang; Wu, Fengliang; Liu, Xiaoguang

    2017-01-01

    The purpose of this study was to detect the differentially expressed genes between ossified herniated discs and herniated discs without ossification. In addition, we sought to identify a few candidate genes and pathways by using bioinformatics analysis. We analyzed 6 samples each of ossified herniated discs (experimental group) and herniated discs without ossification (control group). Purified mRNA and cDNA extracted from the samples were subjected to sequencing. The NOISeq method was used to statistically identify the differentially expressed genes (DEGs) between the 2 groups. An in-depth analysis using bioinformatics tools based on the DEGs was performed using Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, and protein-protein interaction network analysis. The top 6 DEGs were verified using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). A total of 132 DEGs was detected. A total of 129 genes in the ossified group were upregulated and 3 genes were found to be downregulated as compared to the control group. The top 3 cellular components in GO ontologies analysis were extracellular matrix components. GO functions were mainly related to the glycoprotein in the cell membrane and extracellular matrix. The GO process was related to completing response to stimulus, immune reflex and defense. The top 5 KEGG enrichment pathways were associated with infection and inflammation. Three of the top 20 DEGs [sclerostin (SOST), WNT inhibitory factor 1 (WIF1) and secreted frizzled related protein 4 (SFRP4)] were related to the inhibition of the Wnt pathway. The ossified discs exhibited a higher expression of the top 6 DEGs [SOST, joining chain of multimeric IgA and IgM (IGJ; also known as JCHAIN), defensin alpha 4 (DEFA4), SFRP4, proteinase 3 (PRTN3) and cathepsin G (CTSG)], with the associated P-values of 0.045, 0.000, 0.008, 0.010, 0.015 and 0.002, respectively, as

  10. Fractalkine receptor chemokine (CX3CR1) influences on cervical and lumbar disc herniation

    Science.gov (United States)

    Oh, In-Soo; Suh, Dong-Whan; Park, Sung-Ryeoll; Ha, Kee-Yong

    2015-01-01

    Background: Herniation of nuclear or disc material along with, inflammatory chemokines such as prostaglandin E2, interleukin-6, matrix metalloproteinase and nitric oxide has definite correlation, possibly they are over produced. CX3CL1 and its receptor (CX3CR1) are part of chemokine system involved in leukocyte recruitment and adhesion in chronic inflammatory disease, but its role in spinal herniated nucleus pulposus (HNP) is unknown. We evaluated the expression of CX3CL1 and CX3CR1 in patients with disc herniation to clarify the role of CX3CL1 and CX3CR1 in the disc degeneration and to compare between cervical and lumbar HNP. Materials and Methods: The mRNA concentrations of CX3CL1/CX3CR1 chemokine were analyzed in the surgically obtained disc specimens from C-HNP (n = 13) and L-HNP (n = 13) by real-time polymerase chain reaction (PCR). The localization of CX3CL1/CX3CR1 chemokine in the disc of C-HNP and L-HNP patients was determined using immunohistochemical study. Blood samples from patients with C-HNP and L-HNP patients were stained for CX3CR1 with flow cytometric analysis. Results: The CX3CL1 positive cell ratio in the discs was observed in both groups by immunohistochemical study. CX3CR1 was strongly expressed on endothelial cells in C-spine disc, but sparely expressed in L-spine disc. There was greater CX3CR1 mRNA expression in C-HNP patients than in L-HNP patients as quantified by reversal transcription-PCR (P = 0.010). CX3CR1 positive cell frequencies and CX3CR1 expression levels were increased in CD4 (+) T-cells and natural killer (NK) cells from patients with C-HNP (P = 0.210 and P = 0.040). Conclusions: This study identified that increases in CX3CL1 and CX3CR1-expressing cells are significantly related to pathomechanism of HNP for the first time. Especially, CD4 (+) T-cells and NK cells expressing CX3CR1 may play an important role in developing C-HNP. PMID:26015616

  11. Anterior or posterior approach of thoracic disc herniation? A comparative cohort of mini-transthoracic versus transpedicular discectomies

    NARCIS (Netherlands)

    Arts, M.P.; Bartels, R.H.M.A.

    2014-01-01

    BACKGROUND CONTEXT: The optimal surgical treatment of thoracic disc herniations remains controversial and depends on the consistency of the herniation and its location related to the spinal cord. PURPOSE: To compare the outcomes of patients with symptomatic thoracic disc herniations treated with

  12. Analysis of crucial molecules involved in herniated discs and degenerative disc disease

    Directory of Open Access Journals (Sweden)

    Zhigang Qu

    2013-01-01

    Full Text Available OBJECTIVES: Herniated discs and degenerative disc disease are major health problems worldwide. However, their pathogenesis remains obscure. This study aimed to explore the molecular mechanisms of these ailments and to identify underlying therapeutic targets. MATERIAL AND METHODS: Using the GSE23130 microarray datasets downloaded from the Gene Expression Omnibus database, differentially co-expressed genes and links were identified using the differentially co-expressed gene and link method with a false discovery rate ,0.25 as a significant threshold. Subsequently, the underlying molecular mechanisms of the differential co-expression of these genes were investigated using Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. In addition, the transcriptional regulatory relationship was also investigated. RESULTS: Through the analysis of the gene expression profiles of different specimens from patients with these diseases, 539 differentially co-expressed genes were identified for these ailments. The ten most significant signaling pathways involving the differentially co-expressed genes were identified by enrichment analysis. Among these pathways, apoptosis and extracellular matrix-receptor interaction pathways have been reported to be related to these diseases. A total of 62 pairs of regulatory relationships between transcription factors and their target genes were identified as critical for the pathogenesis of these diseases. CONCLUSION: The results of our study will help to identify the mechanisms responsible for herniated discs and degenerative disc disease and provides a theoretical basis for further therapeutic study.

  13. Analysis of crucial molecules involved in herniated discs and degenerative disc disease.

    Science.gov (United States)

    Qu, Zhigang; Miao, Weiwei; Zhang, Qi; Wang, Zhenyu; Fu, Changfeng; Han, Jinhua; Liu, Yi

    2013-01-01

    Herniated discs and degenerative disc disease are major health problems worldwide. However, their pathogenesis remains obscure. This study aimed to explore the molecular mechanisms of these ailments and to identify underlying therapeutic targets. Using the GSE23130 microarray datasets downloaded from the Gene Expression Omnibus database, differentially co-expressed genes and links were identified using the differentially co-expressed gene and link method with a false discovery rate ,0.25 as a significant threshold. Subsequently, the underlying molecular mechanisms of the differential co-expression of these genes were investigated using Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. In addition, the transcriptional regulatory relationship was also investigated. Through the analysis of the gene expression profiles of different specimens from patients with these diseases, 539 differentially co-expressed genes were identified for these ailments. The ten most significant signaling pathways involving the differentially co-expressed genes were identified by enrichment analysis. Among these pathways, apoptosis and extracellular matrix-receptor interaction pathways have been reported to be related to these diseases. A total of 62 pairs of regulatory relationships between transcription factors and their target genes were identified as critical for the pathogenesis of these diseases. The results of our study will help to identify the mechanisms responsible for herniated discs and degenerative disc disease and provides a theoretical basis for further therapeutic study.

  14. PERCUTANEOUS DISCECTOMY: A CURRENT TREATMENT FOR LUMBAR DISC HERNIATION

    Directory of Open Access Journals (Sweden)

    Pablo Gerardo Lima-Ramírez

    Full Text Available ABSTRACT Objective: Describe the functional outcomes of patients with contained lumbar disc herniation (L4-L5, L5-S1 treated with manual percutaneous nucleotomy (MPN and demonstrate that it remains a technique with good results. Methods: A prospective, longitudinal study with 110 patients contained with lumbar disc herniation (LDH treated with (MPN. The evaluation was pre-surgical and 4, 30, 180 and 365 days after the surgery. We used Numeric Pain Scale (NPS, Oswestry Disability Index (ODI and Macnab criteria. Descriptive and inferential statistics for differences. Results: N=110: 58 (52.72% men, 52 (47.27% women; average age 37.95 years (14-56 ± 10.60; most affected level: L4-L5 in 63 (57.14% patients. NPS preoperative average: 7.75 (5-9 ± 1.12, and at 365 days: 2.14 (0-7 ± 2.37. The mean preoperative ODI was 37% (28%-40% + 3.06, and at 365 days 9.52% (0%-40% + 13.92. The prognosis (ODI was good to 79 (71.81% patients at 365 days, regular in 26 (23.63% and poor in 5 (4.57%, corresponding respectively to patients with no, mild, moderate and severe disability. The Macnab criteria showed similar results (p = 0.00, 95% CI 0.00 to 0.13 - Student's t. Conclusions: The results were good at one-year follow-up (p = 0.00, demonstrating that the MPN is still a good option for lumbosciatic pain relief.

  15. Adequacy of herniated disc tissue as a cell source for nucleus pulposus regeneration.

    Science.gov (United States)

    Hegewald, Aldemar A; Endres, Michaela; Abbushi, Alexander; Cabraja, Mario; Woiciechowsky, Christian; Schmieder, Kirsten; Kaps, Christian; Thomé, Claudius

    2011-02-01

    The object of this study was to characterize the regenerative potential of cells isolated from herniated disc tissue obtained during microdiscectomy. The acquired data could help to evaluate the feasibility of these cells for autologous disc cell transplantation. From each of 5 patients (mean age 45 years), tissue from the nucleus pulposus compartment as well as from herniated disc was obtained separately during microdiscectomy of symptomatic herniated lumbar discs. Cells were isolated, and in vitro cell expansion for cells from herniated disc tissue was accomplished using human serum and fibroblast growth factor-2. For 3D culture, expanded cells were loaded in a fibrin-hyaluronan solution on polyglycolic acid scaffolds for 2 weeks. The formation of disc tissue was documented by histological staining of the extracellular matrix as well as by gene expression analysis of typical disc marker genes. Cells isolated from herniated disc tissue showed significant signs of dedifferentiation and degeneration in comparison with cells from tissue of the nucleus compartment. With in vitro cell expansion, further dedifferentiation with distinct suppression of major matrix molecules, such as aggrecan and Type II collagen, was observed. Unlike in previous reports of cells from the nucleus compartment, the cells from herniated disc tissue showed only a weak redifferentiation process in 3D culture. However, propidium iodide/fluorescein diacetate staining documented that 3D assembly of these cells in polyglycolic acid scaffolds allows prolonged culture and high viability. Study results suggested a very limited regenerative potential for cells harvested from herniated disc tissue. Further research on 2 major aspects in patient selection is suggested before conducting reasonable clinical trials in this matter: 1) diagnostic strategies to predict the regenerative potential of harvested cells at a radiological or cell biology level, and 2) clinical assessment strategies to elucidate the

  16. Transition of a herniated lumbar disc to lumbar discal cyst: A case report.

    Science.gov (United States)

    Bansil, Rohit; Hirano, Yoshitaka; Sakuma, Hideo; Watanabe, Kazuo

    2016-01-01

    Another rare cause of lower back pain with radiculopathy is the discal cyst. It is believed to arise from degeneration of a herniated disc, although many other theories of its origin have been proposed. Here, we report a patient with lower back pain/radiculopathy attributed originally to a herniated lumbar disc, which transformed within 6 months into a discal cyst. A 42-year-old male had a magnetic resonance (MR) documented herniated lumbar disc at the L4-5 level. It was managed conservatively for 6 months, after which symptoms recurred and progressed. The follow-up MR study revealed a discal cyst at the L4-5 without residual herniated disc. Of interest, the cyst communicated with the L4-5 intervertebral disc, which was herniated under the posterior longitudinal ligament and the disc space. During surgery, the cyst was completely removed, and his symptoms/signs resolved. A discal cyst develops as pathological sequelae of a degenerated herniated disc. Although rare, these lesions must be considered among the differential diagnoses in young patients with radicular back pain. MR study clearly documents these lesions, and surgical excision of the cyst is the treatment of choice.

  17. Spontaneous remission of a big subligamentous extruded disc herniation: case report and review of the literature.

    Science.gov (United States)

    Çitişli, Veli; İbrahimoğlu, Muhammet

    2015-03-01

    Spontaneous Regression of a Big Subligamentous Extruded Disc Herniation: Case Report And Review of The Literature The most efficient method for the treatment of lumbar disc herniation is still controversial. The most important aspect is the application of the suitable conservative or surgical treatment to the right patient at the right time. In lumbar disc herniation patients, one must not precipitate except for cases that require surgical indications as in cauda equina syndrome, evolutive motor deficit and persistence of pain in spite of the narcotics. However, the spontaneous regression mechanism has not been completely determined yet. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed.

  18. Percutaneous treatment of lumbar disc herniation by oxygen-ozone injection -clinical study with indication

    International Nuclear Information System (INIS)

    Wang Zhuying; Jiang Caimei; Wang Zhimin

    2006-01-01

    Objective: To study the clinical effect and the range of indications of oxygen-ozone treatment for lumber disc herniation. Methods: 6-15 ml of oxygen-ozone (35-45 μg/ml) were injected percutaneously into lumbar disc. In case of multiple disc herniations, the procedure could be taken with two discs for once. Results: 323 patients with 433 discs were treated by oxygen-ozone injection procedure. Total effective rate was 77.7%. Conclusions: The treatment of lumber disc herniation by oxygen-ozone injection is simple, safe and effective with mild trauma. Oxygen-ozone not only can oxidize the proteoglycan in the nucleus leading to the contraction of nucleus, but also provide anti-inflammation effect with pain relief and without complication yet. (authors)

  19. Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 consecutive cases.

    Science.gov (United States)

    Gu, Yu-Tong; Cui, Zhan; Shao, Hong-Wei; Ye, Yun; Gu, Ai-Qun

    2017-02-08

    We designed an easy posterolateral transforaminal endoscopic decompression technique, termed PTES, for radiculopathy secondary to lumbar disc herniation. The purpose of the study is to describe the technique of PTES and evaluate the efficacy and safety for treatment of lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation and to report outcome and complications. PTES was performed to treat 209 cases of intracanal or extracanal herniations with or without extruding or sequestrated fragment, high iliac crest, scoliosis, calcification, or cauda equina syndrome including recurrent herniation after previous surgical intervention at the index level or adjacent disc herniation after decompression and fusion. Preoperative and postoperative leg pain was evaluated using the 10-point visual analog scale (VAS) and the results were determined to be excellent, good, fair, or poor according to the MacNab classification at 2-year follow-up. The patients were followed for an average of 26.3 ± 2.3 months. The VAS score of leg pain significantly dropped from 9 (6-10) before operation to 1 (0-3) (P disc herniation is an effective and safe method with simple orientation, easy puncture, reduced steps, and little X-ray exposure, which can be applied in almost all kinds of lumbar disc herniation, including L5/S1 level with high iliac crest, herniation with scoliosis or calcification, recurrent herniation, and adjacent disc herniation after decompression and fusion. The learning curve is no longer steep for surgeons.

  20. Imaging features of traumatic dislocation of the lumbosacral joint associated with disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Tohme-Noun, C.; Krainik, A.; Menu, Y. [Department of Radiology, Hopital Beaujon, AP HP, Universite Paris 7, Faculte de Medecine Bichat-Beaujon, Paris (France); Rillardon, L.; Guigui, P. [Department of Orthopedic Surgery, Hopital Beaujon, AP HP, Universite Paris 7, Faculte de Medecine Bichat-Beaujon, Paris (France); Feydy, A. [Department of Radiology, Hopital Beaujon, AP HP, Universite Paris 7, Faculte de Medecine Bichat-Beaujon, Paris (France); Department of Radiology, Hopital Beaujon, 100 avenue du General Leclerc, 92118, Clichy (France)

    2003-06-01

    Bilateral facet dislocation of the lumbosacral joint is an uncommon injury. We report on the imaging findings in a patient who had an acute disc herniation associated with a bilateral traumatic lumbosacral dislocation. (orig.)

  1. Coexistence of intervertebral disc herniation with intradural schwannoma in a lumbar segment: a case report.

    Science.gov (United States)

    Pan, Jianjiang; Wang, Yue; Huang, Yazeng

    2016-04-18

    Lumbar intervertebral disc herniation and spinal tumor are major pathologies that may cause back pain and radiculopathy. Neurological symptoms resulting from disc herniation and intradural spinal tumor together, however, are very rare. We report a case of lumbar disc herniation which coexists with intradural schwannoma at the same spinal level in a 67-year-old man. The patient presented with persistent low back pain, sciatica, and weakness of the lower limbs. Contrast lumbar spine magnetic resonance (MR) imaging clearly delineated an intradural lesion and an extradural herniated disc at L3/4 level. Using a single posterior approach, both pathologies were addressed. Pathological studies confirmed the intradural lesion was schwannoma. The case report highlights a rare concomitance of two symptomatic pathologies in a lumbar spine, which deserves clinical attention. Complete history, careful physical examination, and investigative measures, such as contrast MR imaging, are helpful to establish throughout diagnoses.

  2. Genotypic and antimicrobial characterisation of Propionibacterium acnes isolates from surgically excised lumbar disc herniations

    DEFF Research Database (Denmark)

    Rollason, Jess; McDowell, Andrew; Albert, Hanne B

    2013-01-01

    The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised...... from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence of P. acnes in their excised herniated disc tissue. Using recA and mAb typing methods...... isolate collection (63%) suggests that the role of P. acnes in lumbar disc herniation should not be readily dismissed....

  3. Experimental Disc Herniation in the Rat Causes Downregulation of Serotonin Receptor 2c in a TNF-dependent Manner.

    Science.gov (United States)

    Jonsson, Daniel; Finskas, Oscar; Fujioka, Yuki; Ståhlberg, Anders; Olmarker, Kjell

    2015-06-01

    During recent decades, the knowledge of the pathophysiology of disc herniation and sciatica has drastically improved. What previously was considered a strict biomechanical process is now considered a more complex interaction between leaked nucleus pulposus and the tissue in the spinal canal. An inflammatory reaction, with tumor necrosis factor (TNF) playing an essential role, has been demonstrated. However, the exact mechanisms of the pathophysiology of disc herniation remain unknown. In this study we use an animal model to investigate (1) if and/or how experimental disc herniation affects gene expression in the early phase (24 hours postsurgery) in the dorsal root ganglion; and (2) if TNF inhibition can reduce any observed changes. A rat model of disc herniation was used. Twenty rats were evenly divided into four groups: naïve, sham, disc herniation, and disc herniation with TNF inhibition. The dorsal root ganglion of the affected nerve root was harvested 24 hours after surgery and analyzed with a TaqMan Low Density Array(®) quantitative polymerase chain reaction assay. Gene expression levels in sham were compared with disc herniation to assess question 1 and disc herniation to disc herniation with TNF inhibition to assess question 2. Experimental disc herniation caused a decrease in the expression of the serotonin receptor 2c gene (p = 0.022). TNF inhibition was found to reduce the observed decrease in expression of serotonin receptor 2c (p = 0.037). Our results suggest that a decrease in the expression of the serotonin receptor 2c gene may contribute to the pathophysiology of disc herniation. Further research on its involvement is warranted. This pilot study gives a brief insight into cellular changes that may contribute to the pathophysiology of disc herniation. This knowledge may contribute to the development of more and better treatment options for patients with disc herniation and sciatica.

  4. Cervical Disc Herniation Causing Brown-Séquard's Syndrome: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Tarush Rustagi

    2011-01-01

    Full Text Available Brown-Séquard's syndrome (BSS is caused by hemisection or hemicompression of the cord leading to ipsilateral motor deficit and contralateral sensory loss. Cervical disc herniation has been reported to be a rare cause of Brown-Séquard's syndrome. We describe a rare case of multilevel cervical disc herniation presenting as BSS. The condition was confirmed by MRI scan. Cervical corpectomy, decompression, and fusion gave a satisfying result. Pertinent literature has been reviewed.

  5. Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

    OpenAIRE

    Korse, Nina S.; Kruit, Mark C.; Peul, Wilco C.; Vleggeert-Lankamp, Carmen L. A.

    2017-01-01

    Introduction Correlation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar...

  6. CT of adult lumbar disc herniations mimicking posterior apophyseal ring fractures

    Energy Technology Data Exchange (ETDEWEB)

    Gomori, J.M. (Hadassah Univ. Hospital, Jerusalem (Israel). Dept. of Radiology); Floman, Y.; Liebergall, M. (Hadassah Univ. Hospital, Jerusalem (Israel). Dept. of Orthopedics)

    1991-10-01

    This report concerns 35 adult patients with lumbar or sciatic pain and axial CT findings reportedly associated with posterior apophyseal ring fractures. Review of the CT images suggested two pathophysiologic categories. (1) Posterior Schmorl - A posterior intravertebral disc herniation with posterior displacement of a fractured or remodelled vertebral margin. (2) Calcified subligamentous - Reactive annular and or posterior longitudinal ligament calcification at the periphery of a herniated disc with or without remodelling and anterior displacement of the posterior vertebral margin. (orig.).

  7. ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

    OpenAIRE

    Léo, Jefferson Coelho de; Léo, Álvaro Coelho de; Cardoso, Igor Machado; Jacob Júnior, Charbel; Batista Júnior, José Lucas

    2015-01-01

    Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the ...

  8. Diagnosis of disc herniation based on classifiers and features generated from spine MR images

    Science.gov (United States)

    Koh, Jaehan; Chaudhary, Vipin; Dhillon, Gurmeet

    2010-03-01

    In recent years the demand for an automated method for diagnosis of disc abnormalities has grown as more patients suffer from lumbar disorders and radiologists have to treat more patients reliably in a limited amount of time. In this paper, we propose and compare several classifiers that diagnose disc herniation, one of the common problems of the lumbar spine, based on lumbar MR images. Experimental results on a limited data set of 68 clinical cases with 340 lumbar discs show that our classifiers can diagnose disc herniation with 97% accuracy.

  9. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher.

    Science.gov (United States)

    Kato, Kinshi; Yabuki, Shoji; Otani, Koji; Nikaido, Takuya; Otoshi, Ken-Ichi; Watanabe, Kazuyuki; Kikuchi, Shin-Ichi; Konno, Shin-Ichi

    2016-06-08

    Symptomatic thoracic disc herniation is clinically rare. There are few cases of disc herniation of the thoracic spine in top athletes described in the literature. We herein present a rare case of chest wall pain due to thoracic disc herniation in a professional baseball pitcher. A 30-year-old, left-handed pitcher complained of left-sided chest wall pain in the region of his lower ribs during a game. Neurological examination revealed hypoesthesia of the left side of the chest at the level of the lower thoracic spine. Magnetic resonance imaging (MRI) of the thoracic spine showed a left-sided paramedian disc herniation at the T9-T10 level. The player was initially prescribed rest, administration of pregabalin (150 mg twice a day), and subsequent physical rehabilitation. He was able to resume full training and pitching without medication 6 months after the onset. A follow-up MRI of the thoracic spine showed a reduction in the size of the herniated disc compared to the initial findings. Though relatively rare, thoracic disc herniation should be considered in cases of chest wall pain in athletes.

  10. Modified eggshell procedure via posterior approach for sclerosing thoracic disc herniation: a preliminary study.

    Science.gov (United States)

    Yang, Si-Dong; Chen, Qian; Ning, Sheng-Hua; Ding, Wen-Yuan; Yang, Da-Long

    2016-09-20

    Clinically, sclerosing thoracic disc herniation is a disease with high surgical risk and various complications. Eggshell procedure is a surgical method used by surgeons to treat sclerosing thoracic disc herniation. The aim of this study was to report a modified eggshell procedure to treat sclerosing thoracic disc herniation. Medical records of 25 patients with sclerosing thoracic disc herniation were collected between 2007/01 and 2010/08, including 14 males and 11 females, with an average age of 51.7 years old. Modified eggshell procedure was performed to treat the patients with sclerosing thoracic disc herniation. All patients were followed up. Japanese Orthopaedic Association (JOA) score was used to evaluate the clinical outcomes. All operations were performed successfully with complication rate of 12 %. There were 2 cases of dural laceration and 1 subdural hematoma. All included patients were followed up for at least 5 years, with the median of 6 years. JOA score of preoperation was 5 (IQR = 1) while it was 8 (IQR = 2) at final follow-up, with significant difference (Mann-Whitney U test, Z = -4.891, P disc herniation in the clinical practice.

  11. Three dimensional analysis of spino-pelvic alignment in individuals with acutely herniated lumbar intervertebral disc.

    Science.gov (United States)

    Khallaf, Mohamed Elsayed

    2017-01-01

    Lumbar intervertebral disc herniation affects a large number of patients annually and are the most common cause of sciatica. This study was aimed at measuring the spino-pelvic alignment and its relation to the functional limitations in subjects with acutely herniated lumbar disc. Sixteen patients with acute Lumbar Disc Herniation (LDH group) and 16 healthy matched volunteers (healthy group) represented the sample of the study. The patients were recently diagnosed as lumbar disc herniation (L4-5 or L5-S1) with acute sciatica and antalgic posture using magnetic resonance imaging. Spino-pelvic alignment was measured via Rasterstereography. Functional disability among patients was assessed using Oswestry Disability Index Arabic version. Trunk inclination, trunk imbalance, pelvic obliquity, pelvic torsion, lordotic and scoliotic angles were significantly different between groups (P ≤ 0.05). A non-significant difference in kyphotic angle was found between the patients and healthy controls. There was no association between the measured postural changes and functional disabilities in patients with lumbar disc herniation (P ≤ 0.05). There are significant postural changes in patients with acutely herniated lumbar disc which has no relation to functional disability. These results support the concept of staying active during acute stage.

  12. Comparison between cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs.

    Science.gov (United States)

    Gaitero, Luis; Nykamp, Stephanie; Daniel, Rob; Monteith, Gabrielle

    2013-01-01

    Cranial thoracic intervertebral disc herniations have been reported to be rare in dogs due to the presence of the intercapital ligament, however some studies have proposed they may not be uncommon in German Shepherd dogs. The purpose of this retrospective study was to compare cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs (control group). Medical records at the Ontario Veterinary College were searched for German Shepherd dogs and other large breed dogs that had magnetic resonance imaging studies including the T1-T9 region. For each dog and each disc space from T1-T9, three variables (compression, disc degeneration, and herniation) were recorded and graded based on review of sagittal T2-weighted images. Twenty-three German Shepherd dogs and 47 other large breed dogs met inclusion criteria. The German Shepherd dog group had higher scores than the control group for compression (P = 0.0099) and herniation (P Shepherd dog group, intervertebral discs T2-T3 and T4-T5 had an increased risk for compression and T3-T4 had an increased risk for compression and herniation. Findings from this study indicated that German Shepherd dogs may be more likely than other large breed dogs to have spinal cord compression due to cranial thoracic disc herniations. Imaging of the cranial thoracic spine, including T2-T3, is recommended for German Shepherd dogs with T3-L3 neurological signs. © 2012 Veterinary Radiology & Ultrasound.

  13. Significance of sciatic scoliotic list in operated patients with lumbar disc herniation.

    Science.gov (United States)

    Matsui, H; Ohmori, K; Kanamori, M; Ishihara, H; Tsuji, H

    1998-02-01

    The authors retrospectively reviewed the relation between the location of disc herniation and pre- and postoperative changes in sciatic scoliotic list in 40 patients with surgically confirmed lumbar disc herniation who had sciatic scoliotic list with postoperative recovery. Clinical factors associated with scoliosis also were included. To evaluate the significance and pathomechanism of sciatic scoliotic list. The proposed causes of lumbar sciatic scoliosis mainly imply an alleviation of nerve root irritation in relation to the anatomic location of disc herniation relative to the nerve root. The pre- and postoperative serial Cobb angle between L1 and L5 in anteroposterior lumbar radiographs in the standing position were measured. The relation between the convex side of scoliosis and clinical parameters in terms of the side of symptoms, age, gender, duration of low back pain or leg pain, the angle of a positive straight leg raising test, and the time required for recovery of sciatic scoliosis were investigated. In addition, magnetic resonance imaging also was performed in five recent cases from 40 patients. The average Cobb angle decreased from 10.7 degrees to 2.7 degrees within an average of 7.5 months after surgery. The preoperative Cobb angle of patients with disc herniation medial to the nerve root was significantly higher than that just beneath or lateral to the nerve root. Thirty-two of 40 patients (80.0%) had a lumbar disc herniation at the convex side of scoliosis, irrespective of the transverse location of the herniation. The time required for scoliosis disappearance in disc herniation located lateral to the nerve root tended to be longer than that for other types of disc herniation. Magnetic resonance imaging through the paramedian planes showed enlargement of the intervertebral foramen at the convex side of scoliosis, compared with that at the concave side in five recent cases from the current study. These results suggest that sciatic scoliotic list is not

  14. MR findings of degenerative changes of nucleus pulposus in lumbar spine: sequential changes after disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Joon [Choong-Ang Gil Hospital, Seoul (Korea, Republic of); Cha, Yoo Mi; Hwang, Hee Young [College of Medicine, Dankook University, Chenoan (Korea, Republic of)

    1994-04-15

    To evaluate the relationship between MR changes of the nucleus pulposus and the time interval after traumatic disc herniation. T2-weighted MR images of 132 patients with back pain and/or sciatica were reviewed. The changes of signal intensity, central cleft and height of the nucleus pulposus were used as criteria of disc degeneration and they were graded as normal, mild, moderate and severe degree of degeneration. Putting these criteria together we provided integrated grade of degeneration of the nucleus pulposus(grade 0-3). To get the preliminary data for normal and age-related disc degeneration, we measured the disc height by age groups and disc levels and analyzed the relationship between the age of the patients and the signal intensity, cleft and height in normal disc levels of the 132 patients. In 68 patients of 88 levels disc herniation, we analyzed the relationship between symptom duration and the degree of degeneration. Among these 68 patients we selected 14 patients(16 levels) who were under 30 years of age and had history of recent trauma to minimize data distortion from age related degeneration and ambiguity of initiation point of degeneration. In this group we analyzed the relationship between the time period after traumatic disc herniation and the degree of degeneration. The age of the patient had close relationship with the grade of signal intensity, central cleft, and disc height and grade of degeneration of the nucleus pulposus in normal discs. In 88 levels of herniated discs, the duration of symptom and degree of degeneration showed moderate correlation. In 14 patients of disc herniation who were under 30 years old and had trauma history in recent 2 years, grade 1 disc degeneration occurred in average 3.7 months after trauma. Although it was difficult to proceed statistical analysis in the last group because of small patients number, the degree of degeneration of nucleus pulposus had close relationship with the duration after traumas or duration of

  15. MR findings of degenerative changes of nucleus pulposus in lumbar spine: sequential changes after disc herniation

    International Nuclear Information System (INIS)

    Kim, Sang Joon; Cha, Yoo Mi; Hwang, Hee Young

    1994-01-01

    To evaluate the relationship between MR changes of the nucleus pulposus and the time interval after traumatic disc herniation. T2-weighted MR images of 132 patients with back pain and/or sciatica were reviewed. The changes of signal intensity, central cleft and height of the nucleus pulposus were used as criteria of disc degeneration and they were graded as normal, mild, moderate and severe degree of degeneration. Putting these criteria together we provided integrated grade of degeneration of the nucleus pulposus(grade 0-3). To get the preliminary data for normal and age-related disc degeneration, we measured the disc height by age groups and disc levels and analyzed the relationship between the age of the patients and the signal intensity, cleft and height in normal disc levels of the 132 patients. In 68 patients of 88 levels disc herniation, we analyzed the relationship between symptom duration and the degree of degeneration. Among these 68 patients we selected 14 patients(16 levels) who were under 30 years of age and had history of recent trauma to minimize data distortion from age related degeneration and ambiguity of initiation point of degeneration. In this group we analyzed the relationship between the time period after traumatic disc herniation and the degree of degeneration. The age of the patient had close relationship with the grade of signal intensity, central cleft, and disc height and grade of degeneration of the nucleus pulposus in normal discs. In 88 levels of herniated discs, the duration of symptom and degree of degeneration showed moderate correlation. In 14 patients of disc herniation who were under 30 years old and had trauma history in recent 2 years, grade 1 disc degeneration occurred in average 3.7 months after trauma. Although it was difficult to proceed statistical analysis in the last group because of small patients number, the degree of degeneration of nucleus pulposus had close relationship with the duration after traumas or duration of

  16. Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients.

    Science.gov (United States)

    Korse, Nina S; Kruit, Mark C; Peul, Wilco C; Vleggeert-Lankamp, Carmen L A

    2017-01-01

    Correlation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar herniated disc patients with CES versus lumbar herniated disc patients without CES, operated because of sciatica. MRIs of CES patients were assessed for the following features: level of disc lesion, type (uni- or bilateral) and severity of caudal compression. Pre- and postoperative clinical features (micturition dysfunction, defecation dysfunction, altered sensation of the saddle area) were retrieved from the medical files. In addition, anteroposterior (AP) lumbar spinal canal diameters of CES patients were measured at MRI. AP diameters of lumbar herniated disc patients without CES, operated for sciatica, were measured for comparison. 48 CES patients were included. At MRI, bilateral compression was seen in 82%; complete caudal compression in 29%. MRI features were not associated with clinical presentation nor outcome. AP diameter was measured for 26 CES patients and for 31 lumbar herniated disc patients without CES, operated for sciatica. Comparison displayed a significant smaller AP diameter of the lumbar spinal canal in CES patients (largest p = 0.002). Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021). This is the first study demonstrating differences in lumbar spinal canal size between lumbar herniated disc patients with CES and lumbar herniated disc patients without CES, operated for sciatica. This finding might imply that lumbar herniated disc patients with a

  17. Conservative treatment of lumbar disc herniation. Epidural steroid injection and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Ohmura, Munehisa; Sakanaka, Hideki; Wada, Eiji; Inaoka, Masahiro; Yonenobe, Sakuo [Kansai Rosai Hospital, Amagasaki, Hyogo (Japan)

    1996-01-01

    A study was made on the efficacy of the epidural injection of steroids in 65 patients of lumbar disc herniation. It was recognized that epidural steroids were effective in 49 cases (75 percent) and the effect was closely correlated with the prognosis of lumbar disc herniation. On follow-up MRI studies, a definite decrease in the size of the herniated nucleus pulposus was observed in six patients of the sequestration type: disappearance in five. No definite change was observed except for one patient in the protrusion type. (author).

  18. Symptomatic gas-containing herniated disc with the vacuum phenomenon: mechanism and treatment. Case report.

    Science.gov (United States)

    Lee, Chang-Hyun; Cho, Jae Hoon; Hyun, Seung-Jae; Yoon, Sang Hoon; Kim, Ki-Jeong; Kim, Hyun-Jib

    2012-01-01

    A 76-year-old woman presented with an extremely rare case of symptomatic gas-containing disc herniation manifesting as left posterolateral thigh pain and ankle dorsiflexion motor weakness. The diagnosis was L3-4 vacuum disc associated with epidural pneumorrhachis. The patient underwent partial hemilaminectomy and cyst incision. After incising the cyst, the thecal sac and root were decompressed sufficiently. Vacuum disc is a common phenomenon in the elderly rarely associated with pneumorrhachis and is usually asymptomatic. Symptomatic epidural gas-containing herniated discs with the vacuum phenomenon are very rare. Gas aspiration should be considered, but excision of the gas-containing herniated disc should be performed in patients with neurological deficits, frequent recurrence, or difficult location to approach.

  19. Role of interleukin-17 in chondrocytes of herniated intervertebral lumbar discs

    Science.gov (United States)

    TIAN, PENG; LI, ZHI-JUN; FU, XIN; MA, XIN-LONG

    2015-01-01

    Lumbar disc herniation (LDH) is a common cause of lumbosacral radiculopathy. An autoimmune response to a herniated nucleus pulposus (NP) has been suggested to play an important role in the initiation of radiculopathy. Interleukin-17 (IL-17) is a cytokine associated with inflammation and autoimmunity. The presence of IL-17 has been studied in patients with LDH; however, extensive investigation into the expression of IL-17 in different disc pathologies of LDH has not yet been conducted. The aim of the present study was to investigate the role of neovascularization and hypertrophic chondrocytes in herniated intervertebral lumbar discs. Fifty-two intervertebral lumbar disc specimens were extracted from 46 patients with LDH and were subsequently classified as either contained or non-contained disc herniation (CDH and NCDH, respectively). The specimens were stained with hematoxylin and eosin or toluidine blue, or were immunostained with polyclonal antibodies to IL-17 using the streptavidin-peroxidase method. The neovascular tissue and staining results were graded to establish the histological differences between the two herniation types. The intervertebral discs (IVDs) obtained from patients with NCDH showed significantly more neovascularization and granulation tissue than the discs obtained from patients with CDH (Pherniated IVDs. PMID:26170916

  20. Treatment of Recurrent Disc Herniation: A Systematic Review

    Science.gov (United States)

    Ugiliweneza, Beatrice; Al-Khouja, Lutfi; Yang, Dongyan; Johnson, Patrick; Kim, Terrence; Boakye, Maxwell

    2016-01-01

    Intervertebral disc herniation is one of the most common causes of back and extremity pain. The most commonly used surgical treatment is lumbar discectomy. About 0.5-25% go on to develop recurrent disc herniation (rDH) after a successful first discectomy. Currently, there aren’t any guidelines to assist surgeons in determining which approach is most appropriate to treat rDH. A recent survey showed significant heterogeneity among surgeons regarding treatment options for rDH. It remains unclear which methods lead to better outcomes, as there are no comparative studies with a sufficient level of evidence. In this study, we aimed to perform a systematic review to compare treatment options for rDH and determine if one intervention provides better outcomes than the other; more specifically, whether outcome differences exist between discectomy alone and discectomy with fusion. We applied the PICOS (participants, intervention, comparison, outcome, study design) format to develop this systematic review through PubMed. Twenty-seven papers from 1978-2014 met our inclusion criteria and were included in the analysis. Nine papers reported outcomes after discectomy and seven of them showed good or excellent outcomes (70.60%-89%). Ten papers reported on minimally invasive discectomy. The percent change in visual analog scale (VAS) ranged from -50.77% to -86.57%, indicating an overall pain reduction. Four studies out of the ten reported good or excellent outcomes (81% to 90.2%). Three studies looked at posterolateral fusion. Three studies analyzed posterior lumbar interbody fusion. For one study, we found the VAS percentage change to be -46.02%. All reported good to excellent outcomes. Six studies evaluated the transforaminal lumbar interbody fusion. All reported improvement in pain. Four used VAS, and we found the percent change to be -54% to -86.5%. The other two used the Japanese Orthopedic Association (JOA) score, and we found the percent change to be 68.3% to 93.3%. We

  1. Hérnia discal lombar Lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Luis Roberto Vialle

    2010-01-01

    Full Text Available A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar (acomete 2 a 3% da população e a principal causa de cirurgia de coluna na população adulta. O quadro clínico típico inclui lombalgia inicial, seguida de lombociatalgia e, finalmente, de dor ciática pura. A história natural da hérnia de disco é de resolução rápida dos sintomas (quatro a seis semanas. O tratamento inicial deve ser conservador, com manejo medicamentoso e fisioterápico, podendo ser acompanhado ou não por bloqueios percutâneos radiculares. O tratamento cirúrgico está indicado na falha do controle da dor, déficit motor maior que grau 3, dor radicular associada à estenose óssea foraminal ou síndrome de cauda equina, sendo esta última uma emergência médica. Uma técnica cirúrgica refinada, com remoção do fragmento extruso, e preservação do ligamento amarelo, resolve a sintomatologia da ciática e reduz a possibilidade de recidiva em longo prazo.Lumbar disc herniation is the most common diagnosis amongst the degenerative conditions of the lumbar spine (affecting around 2 to 3% of the population, and is the principal cause of spine surgery in the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (from 4-6 weeks. Early treatment should be conservative, with pain management and physiotherapy, sometimes associated with selective nerve root block. Surgery should be considered if pain management is unsuccessful, if there is a motor deficit (strength grade 3 or less, where there is radicular pain associated with foraminal stenosis, or in the presence of cauda equina syndrome, the latter representing a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces

  2. A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Yang Zhang

    2017-02-01

    Conclusion: Patients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.

  3. Value of a new pathological classification of lumbar intervertebral disc herniation based on transforaminal endoscopic observations.

    Science.gov (United States)

    Yang, Lin; Lu, Hong-Hui

    2017-05-01

    Removal of herniated disc materials based on an imaging only method may not relieve symptoms in many patients. Therefore, the aim of the present study was to develop a transforaminal endoscopic method of classifying the pathological type of lumber intervertebral disc herniation and to compare the outcomes of surgery based on the pathological type with those of conventional endoscopic disc removal. The records of patients who received endoscopic transforaminal nucleotomy with foraminoplasty for symptomatic lumbar disc herniation between 2009 and 2013 were retrospectively reviewed. Patients were then divided into two groups: Group A, which consisted of 275 patients who received conventional endoscopic transforaminal nucleotomy with foraminoplasty between 2009 and 2011 and group B, which consisted of 316 patients who received 'targeted' endoscopic transforaminal nucleotomy with foraminoplasty between 2011 and 2013 (based on the pathological type of disc herniation identified at surgery, including fresh, calcified and scar type based on intraoperative observations). The results showed that there were no significant differences in age, gender, body mass index, symptom duration, operated segments or previous invasive therapies between the two groups. Moreover, evaluation of visual analogue scale pain scores and Oswestry disability index scores revealed that the patients in group B had a greater improvement in symptoms than those in group A (P40 years and a longer symptom duration were associated with the calcified type, and previous invasive therapy was associated with the scar type. Therefore, specific surgical treatment based on the transforaminal endoscopic pathological type can result in better outcomes for patients with lumbar disc herniation.

  4. Postdural disc herniation at L5/S1 level mimicking an extradural spinal tumor.

    Science.gov (United States)

    Li, Kunpeng; Li, Zhong; Geng, Wei; Wang, Chenghu; Ma, Jinzhu

    2016-05-01

    Postdural disc herniation has been documented rarely and the pathogenesis is still unknown. The average age of postdural disc herniations is between 50 and 60 years, and the sites most frequently affected by postdural lumbar disc herniations are L3-L4 and L4-L5, only less than 10 % in L5-S1. Although magnetic resonance imaging (MRI) is a useful tool in the diagnosis of this disease, the postdural disc herniation is usually misdiagnosed as extradural spine tumor preoperatively. The definitive diagnosis is made during operation or according to the postoperative pathology. In this article, we described here a 48-year-old male patient who presented with intermittent pain in the low back and frequent urination for 4 years as well as hypesthesia and pain of the left lower extremity for 1 month. A standard total laminectomy was performed and the histopathological diagnosis was consistent with a degenerated intervertebral disc. The patient presented significant relief of the pain and of the neurological symptoms, but no improvement of frequent urination, in the postoperative period. The diagnosis of postdural disc herniations is very difficult and mainly based on intraoperative and histopathological results. Early surgical intervention is important to relieve symptoms and prevent severe neurological deficits.

  5. Lumbosacral morphology in lumbar disc herniation: a "chicken and egg" issue.

    Science.gov (United States)

    Coşkun Benlidayı, İlke; Başaran, Sibel; Seydaoğlu, Gülşah

    2016-01-01

    The aim of this study was to analyze the relationship, if any, between lumbar disc herniation and lumbosacral morphology. Intervertebral disc angles (IDA), lumbar lordosis angle (LLA), lumbosacral lordosis angle (LSLA), lumbosacral angle (LSA), and sacral tilt (ST) were measured on lumbar magnetic resonance imaging of 224 patients with LDH (n=151) and without LDH (n=73) and were then compared. Regarding LLA, LSLA, LSA and ST, there were no significant differences between the 2 groups. The smallest IDA of each level (except L2-L3) was detected at the same level with disc herniation. When the relationship between the grade of disc herniation and IDA was evaluated in patients with LDH, angles of L3-L4 and L4-L5 levels were significantly smaller in patients with extruded disc herniation (p=0.009 and p=0.013, respectively). Despite changes in IDA by grade and level of disc herniation, no relation was found between lumbosacral alignment and LDH.

  6. Practice patterns in the management of acute intervertebral disc herniation in dogs.

    Science.gov (United States)

    Moore, S A; Early, P J; Hettlich, B F

    2016-08-01

    Acute intervertebral disc herniation is commonly managed by veterinary neurologists and surgeons. Anecdote suggests that patterns of management vary considerably and there is controversy surrounding many aspects of treatment. The goal of this study was to document patterns in management of acute spinal cord injury caused by acute intervertebral disc herniation among these two groups to aid in future discussions on best practices. A survey querying diagnostic, medical and surgical practices for dogs with acute intervertebral disc herniation was distributed to diplomates on the databases of the American College of Veterinary Surgeons and the American College of Veterinary Internal Medicine (Neurology). Responses were received from 314 board-certified veterinary surgeons and neurologists. Both groups handled timing of decompression, surgical approach, and most postoperative recommendations in a similar fashion. Case volume differed between groups, with 77% of neurologists and 18% of surgeons managing ê50 cases of acute intervertebral disc herniation per year. MRI was used most frequently as a diagnostic tool by neurologists (75%), while CT was used most commonly by surgeons (58%). Corticosteroids were routinely administered as a neuroprotective strategy by 34% of surgeons and 11% of neurologists. Disc fenestration was performed "always" or "most of the time" by 69% of neurologists and 36% of surgeons. Understanding the common practices in the management of canine acute intervertebral disc herniation can provide a springboard for future discussions regarding the best practices in diagnosing and treating this disease. © 2016 British Small Animal Veterinary Association.

  7. Transforaminal Endoscopic Discectomy for Treatment of Central Disc Herniation: Surgical Techniques and Clinical Outcome.

    Science.gov (United States)

    Wang, Yapeng; Zhang, Wei; Lian, Lichao; Xu, Jiaxin; Ding, Wenyuan

    2018-03-01

    Though transforaminal endoscopic discectomy has achieved a satisfactory clinical outcome in the treatment of paracentral disc herniation, it has a high failure rate for treating central disc herniation. To explore the surgical techniques of transforaminal endoscopic discectomy in treating central disc herniation and the clinical outcome based on 2-year follow-up. A retrospective study. The Department of Spinal Surgery at the Third Hospital of Hebei Medical University in China. Sixty-nine consecutive patients (male:female = 14:9, mean age 38.8 ± 10.5 years) were enrolled in the study, all of whom underwent transforaminal endoscopic discectomy due to central disc herniation. The rod adjustment technique, apex technique, and posterior longitudinal ligament detection technique were adopted for intraoperative individualization. All of the patients were followed up for 24 months to assess the visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) scores. The postoperative segmental instability and recurrence were observed during the follow-up period as well. MacNab criteria scores were recorded both intraoperatively and at the final follow-up; postoperative complications and the surgical outcome and safety were also evaluated. The herniated disc tissues were successfully removed for all patients, without revision by open surgery. Twenty-one cases (30.43%) were rated excellent, 44 (63.77%) good, 4 (5.80%) fair, and 0 (0.00%) poor upon the final follow-up, with an overall excellent-to-good rate of 86.96%. The VAS scores of low back and leg pain were all significantly lower at 3, 6, 12, and 24 months postoperatively compared to preoperatively (all P disc herniations. Intraoperative individualized application of rod adjustment technique, apex technique, or posterior longitudinal ligament detection technique is the key to satisfactory clinical outcome. Central disc herniation, rod adjustment technique, transforaminal endoscopy

  8. Acute chest pain in a top soccer player due to thoracic disc herniation.

    Science.gov (United States)

    Baranto, Adad; Börjesson, Mats; Danielsson, Barbro; Hellström, Mikael; Swärd, Leif

    2009-05-01

    Case report. An unusual and previously not reported case of upper thoracic disc herniation combined with acute chest pain, is presented. Disc herniation in the thoracic spine is rare. There are only a few cases of thoracic disc herniation in top athletes presented in the literature. The clinical presentation of a thoracic disc herniation can vary widely depending on its location and morphologic characteristics. Clinically, the acute symptoms may be severe. A 24-year-old soccer player with acute left-sided chest pain that started in the middle of a soccer game has been followed clinically and with MRI examinations for 3 years. MRI of the thoracic spine showed a left-sided paramedial disc herniation at T2-T3 level and the right-sided paramedial disc herniation at T3-T4 level. The player was prescribed initial rest and subsequent physical rehabilitation. He had no further symptoms during rehabilitation to full training, and could resume play and remained symptom free for the rest of the season.The following season, the player experienced a similar sudden thoracic pain episode during training. This time the chest pain was right-sided. A new MRI of the thoracic spine showed unchanged findings. The initial rehabilitation was similar to the one used in the first episode. After 15 months with no symptoms during normal life the player was allowed to increase the intensity of training gradually and after 2 years the patient played soccer at elite level again. However, 3 years later the symptoms relapsed and the player ended his career after another rehabilitation period. In conclusion, it is important to consider thoracic disc herniation as acute chest pain in athletes and that the long-term prognosis of this entity is not always good.

  9. Experience in the treatment of thoracic herniated disc using image-guided thorascopy.

    Science.gov (United States)

    Bordon, G; Burguet Girona, S

    Thoracoscopic micro-discectomy is a treatment option for thoracic disc disease that combines the advantages of the anterior approach and the benefits of a minimally invasive technique. Adding a navigation system provides many advantages to the usual technique, as it allows accurate marking of the lesion level, improvement in the surgical approach, and precise control of herniated disc resection and vertebral osteotomy. The navigation system also reduces the learning curve for thoracoscopic technique. We report our experience in the treatment of thoracic disc herniation with image-guided thoracoscopy. Copyright © 2015 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Brown-Sequard syndrome produced by calcified herniated cervical disc and posterior vertebral osteophyte: Case report.

    Science.gov (United States)

    Guan, Dawei; Wang, Guanjun; Clare, Morgan; Kuang, Zhengda

    2015-12-01

    Brown-Sequard syndrome (BSS) produced by cervical disc disorders has rarely been seen clinically and only 50 cases have been reported in English literatures. However, most of which have resulted from acute disc herniation. Here, we report a case of BSS produced by calcified herniated C4-C5 disc and posterior vertebral osteophyte, in which decompression through anterior approach was performed. This case revealed the potential of cervical spondylopathy leading to BSS in a chronic manner. Once the diagnosis is established, it is advisable to perform decompression as early as possible.

  11. Gd-enhanced MR imaging of the herniated lumbar disc: patterns of enhancement

    Energy Technology Data Exchange (ETDEWEB)

    Kwag, Hyon Joo; Choi, Hye Young; Kim, Hyae Young; Kim, Yoo Kyung; Kim, Ah Young; Chung, Eun Chul [College of Medicine, Ewah Womans University, Seoul (Korea, Republic of)

    1995-07-15

    The purpose of this study is to describe the patterns of enhancement of the herniated lumbar disc with Gd-DTPA enhanced MR imaging. Out of 65 patients, 103 lumbar discs diagnosed to be herniated by MR image were retrospectively analyzed. The MR imaging was performed with 1.5 T MR unit, using T1-and T2-weighted sagittal and axial spin echo techniques. Contrast-enhanced T1 weighted sagittal and axial images were performed after intravenous injection of Gadopentetate-dimeglumine(Magnevist, Shering) (0.1 mmol/kg). Contrast enhancement was seen in 66 cases(64%). Thirteen cases of bulging disc were not enhanced. Twenty-eight cases of protruded disc showed intraannular enchantment in 23 cases, peripheral linear and irregular enhancement in each of one case, and nonenhancement in three cases. Fifty-seven cases of extruded disc showed irregular enhancement in 14 cases, peripheral linear enhancement in 12 cases, peripheral ring enhancement in five cases and intraannular enhancement in five cases. All five cases of sequestered disc showed peripheral ring enhancement. Protruded discs show intraannular enhancement frequently and sequestered discs usually show peripheral ring enhancement. Enhanced MR imaging may be helpful to evaluate the type of herniated lumbar disc and relationship among disc material, nerve root and thecal sac.

  12. Gd-enhanced MR imaging of the herniated lumbar disc: patterns of enhancement

    International Nuclear Information System (INIS)

    Kwag, Hyon Joo; Choi, Hye Young; Kim, Hyae Young; Kim, Yoo Kyung; Kim, Ah Young; Chung, Eun Chul

    1995-01-01

    The purpose of this study is to describe the patterns of enhancement of the herniated lumbar disc with Gd-DTPA enhanced MR imaging. Out of 65 patients, 103 lumbar discs diagnosed to be herniated by MR image were retrospectively analyzed. The MR imaging was performed with 1.5 T MR unit, using T1-and T2-weighted sagittal and axial spin echo techniques. Contrast-enhanced T1 weighted sagittal and axial images were performed after intravenous injection of Gadopentetate-dimeglumine(Magnevist, Shering) (0.1 mmol/kg). Contrast enhancement was seen in 66 cases(64%). Thirteen cases of bulging disc were not enhanced. Twenty-eight cases of protruded disc showed intraannular enchantment in 23 cases, peripheral linear and irregular enhancement in each of one case, and nonenhancement in three cases. Fifty-seven cases of extruded disc showed irregular enhancement in 14 cases, peripheral linear enhancement in 12 cases, peripheral ring enhancement in five cases and intraannular enhancement in five cases. All five cases of sequestered disc showed peripheral ring enhancement. Protruded discs show intraannular enhancement frequently and sequestered discs usually show peripheral ring enhancement. Enhanced MR imaging may be helpful to evaluate the type of herniated lumbar disc and relationship among disc material, nerve root and thecal sac

  13. Risk factors for the need of surgical treatment of a first recurrent lumbar disc herniation.

    Science.gov (United States)

    Yurac, Ratko; Zamorano, Juan J; Lira, Fernando; Valiente, Diego; Ballesteros, Vicente; Urzúa, Alejandro

    2016-05-01

    A recurrent lumbar disc herniation (RLDH) is the most prevalent cause for new radicular pain after surgery for disc herniation-induced sciatica. Reported risk factors include age, gender and smoking, while its surgical treatment is associated to a higher rate of complications and costs. The purpose of this study is to identify factors that increase the risk of requiring surgical treatment for a first RLDH in workers' compensation patients. Nested case-control: 109 patients operated for an RLDH (cases) between June 1st 1994 and May 31st 2011 (minimum follow-up 1 year) and 109 randomly selected patients operated for a first disc herniation with no recurrence during the study period (controls). Age, gender, smoking status, type of work and MRI characteristics of the index herniation were statistically evaluated as potential risk factors. Patient's age of less than 35 years (p = 0.001) and a subligamentous herniation (p disc herniation and patient's age inferior to 35 years at the time of the first surgery are risk factors for requiring surgical treatment of a first RLDH among workers' compensation patients.

  14. The impact of psychiatric comorbidity on quality of life in patients undergoing herniated disc surgery.

    Science.gov (United States)

    Stengler, K; Zieger, M; Luppa, M; Meisel, H J; Günther, L; Meixensberger, J; Toussaint, R; Angermeyer, M C; König, H-H; Riedel-Heller, S G

    2012-01-01

    Recent studies examined the role of psychiatric comorbidity in the process of rehabilitation in patients undergoing herniated disc surgery. These patients suffer from physical and psychosocial complaints or symptoms, which impact their everyday life negatively and the success of rehabilitation potentially. The objectives of this study are (1) to examine the quality of life (QoL) in disc surgery patients and to compare the findings with reference data from the general German population, and (2) to investigate the impact of psychiatric comorbidity on QoL of patients undergoing herniated disc surgery. This study consists of 305 patients aged between 18 and 55 years who took part in face-to-face interviews during their hospital stay. Psychiatric comorbidity was assessed with the Composite International Diagnostic Interview (CIDI-DIA-X). By means of the 36-Item Short-Form Health Survey (SF-36), QoL was assessed in patients undergoing herniated disc surgery with and without psychiatric comorbidity. These findings were compared with the QoL of a representative sample of the general German population. Compared with the general population, QoL in patients with herniated disc surgery was lower in all domains of the SF-36. Psychiatric comorbidity impacts the QoL in patients with herniated disc surgery in all SF-36 domains except "physical function". The patients with psychiatric comorbidity showed significantly lower levels of QoL in the domains "bodily pain", "vitality", "social function", "role emotional", and "mental health". Psychiatric comorbidity has a substantial adverse effect on QoL in patients undergoing disc surgery. Therefore, it will be necessary to diagnose psychiatric comorbidities at an early stage and to include psychosocial interventions in the treatment of herniated disc patients aimed at improving deficits in psychosocial functioning and QoL. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Experience in Nonsurgical Treatment of Patients with Intervertebral Disc Protrusions and Herniated Discs Combined with Lumbar Instability

    Directory of Open Access Journals (Sweden)

    O.Ye. Pashkov

    2014-10-01

    Full Text Available An analysis of the data from 40 patients with instability and herniated disc in the lumbar spine has been carried out. The short-term (1 month and long-term (1.5 years results of conservative treatment were analyzed, and also the nature and characteristics of their course in the early and late periods were examined. Combined use of manual therapy and traction is not allowed as a method of conservative treatment for disc herniation associated with instability. Rehabilitation of the patient (targeted recovery of reliability of the spine functioning under physiological, common and industrial loads is advisable.

  16. Percutaneous Treatment of Herniated Lumbar Discs with Ozone: Investigation of the Mechanisms of Action.

    Science.gov (United States)

    Murphy, Kieran; Elias, Gavin; Steppan, Jim; Boxley, Chett; Balagurunathan, Kuberan; Victor, Xylophone; Meaders, Thomas; Muto, Mario

    2016-08-01

    To elucidate the mechanism of action of intradiscal oxygen-ozone therapy for herniated intervertebral disc therapy. Ozone's mechanism of action was investigated using 3 approaches: mathematical models of intervertebral disc space to explore the relationship between disc pressure and volume; ozonolysis experiments using glycosaminoglycans (GAGs) from a Chinese hamster ovary cell line that were similar in composition to GAGs found in human nucleus pulposus; and experiments in which live Yucatan miniature pigs received various concentrations of percutaneous, image-guided intradiscal oxygen-ozone treatment and were examined (after sacrifice) with histology and semiquantitative analysis of disc cytokine concentrations. Engineering calculations support observations that a small (6%) disc volume reduction can result in considerable (9.84%) intradiscal pressure reduction. Porcine disc histology and Chinese hamster ovary GAG ozonolysis results showed that administered ozone reacted with and fragmented disc proteoglycans, reducing disc volume through disc dehydration. Cytokine analysis of porcine discs found that each of 4 cytokines measured (interleukin [IL]-1β, IL-6, IL-8, and tumor necrosis factor α) increased in concentration after 2 wt% ozone treatment. Oxygen-ozone therapy breaks down proteoglycan GAGs that maintain disc osmotic pressure, dehydrating the nucleus pulposus and reducing intervertebral disc volume. This is likely a primary mechanism by which ozone relieves nerve root compression and alleviates herniated disc-related pain. Additionally, 2 wt% ozone appears to interact with intradiscal cytokines, generating an antiinflammatory response that may contribute to symptom improvement. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  17. A new dynamic six degrees of freedom disc-loading simulator allows to provoke disc damage and herniation.

    Science.gov (United States)

    Wilke, Hans-Joachim; Kienle, Annette; Maile, Sebastian; Rasche, Volker; Berger-Roscher, Nikolaus

    2016-05-01

    The cause of disc herniation is not well understood yet. It is assumed that heavy lifting and extreme postures can cause small injuries starting either in the inner anulus or from the outside close to the endplate. Such injuries are accumulated over years until its structure is weakened and finally a single loading event leads to a sudden failure of the last few intact lamellae. This paper describes a novel, custom-developed dynamic 6-DOF disc-loading simulator that allows complex loading to provoke such disc damage and herniations. The machine's axes are driven by six independent servomotors providing high loads (10 kN axial compression, 2 kN shear, 100 Nm torque) up to 5 Hz. A positional accuracy test was conducted to validate the machine. Subsequently, initial experiments with lumbar ovine motion segments under complex loading were performed. After testing, the discs were examined in an ultra-high field MRI (11.7 T). A three-dimensional reconstruction was performed to visualise the internal disc lesions. Validation tests demonstrated positioning with an accuracy of ≤0.08°/≤0.026 mm at 0.5 Hz and ≤0.27°/≤0.048 mm at 3.0 Hz with amplitudes of ±17°/±2 mm. Typical failure patterns and herniations could be provoked with complex asymmetrical loading protocols. Loading with axial compression, flexion, lateral bending and torsion lead in 8 specimens to 4 herniated discs, two protrusions and two delaminations. All disc failures occurred in the posterior region of the disc. This new dynamic disc-loading simulator has proven to be able to apply complex motion combinations and allows to create artificial lesions in the disc with complex loading protocols. The aim of further tests is to better understand the mechanisms by which disc failure occurs at the microstructural level under different loading conditions. Visualisation with ultra-high field MRI at different time points is a promising method to investigate the gradual development of such lesions

  18. Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation.

    Science.gov (United States)

    Du, Jianwei; Tang, Xiangyu; Jing, Xin; Li, Ningdao; Wang, Yan; Zhang, Xifeng

    2016-06-01

    This study reports a new approach for percutaneous endoscopic lumbar iscectomy (PELD), especially for soft, highly down-migrated lumbar disc herniation. Seven patients with soft, highly down-migrated lumbar disc herniation who underwent PELD via a translaminar approach under local anaesthesia from January 2013 to June 2015, including five patients who underwent failed PELD in other hospitals, were retrospectively analyzed. Clinical outcomes were evaluated according to pre-operative and post-operative visual analogue scale (VAS) scores, Oswestry disability index (ODI) scores and post-operative magnetic resonance imaging (MRI). The highly down-migrated lumbar disc herniation was completely removed by PELD via a translaminar approach in seven patients, as confirmed by post-operative MRI. Leg pain was eased after removal of the disc migrations. The mean follow-up duration was 9.8 (range, 6-14) months. The mean pre-operative VAS was 7.6 ± 0.8 (range, 6-9), which decreased to 3.1 ± 1.5 (range, 2-5) at one week post-operatively and to 1.3 ± 0.8 (range, 0-3) by the last follow-up visit. The mean pre-operative ODI was 61.6 (range, 46-84), which decreased to 16.3 (range, 10-28) at the one month post-operative follow-up and to 8.4 (range, 0-14) by the last follow-up visit. No recurrence was observed in any of the seven patients during the follow-up period. PELD via a translaminar approach could be a good alternative option for the treatment of soft, highly down-migrated lumbar disc herniation.

  19. Comparison of preoperative neuroradiographic findings and surgical findings in lumbar disc herniation

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    Takahara, Kazuhiro; Sera, Keisuke; Nakamura, Masakazu; Uchida, Takeshi [Nagasaki Mitsubishi Hospital (Japan); Ito, Nobuyuki

    1997-09-01

    Surgical findings in lumbar disc hernia were compared to pre-operative MRI, CTM and myelogram findings. Ninety-one cases were studied using Love`s method. The accuracy of hernia diagnosis in MRI was 59.3%, 41.2% in CTM, and 35.2% in myelogram. At the L5/S1 disc level, the accuracy of hernia diagnosis by CTM and myelogram was decreased. MRI was useful for the diagnosis and cure of lumbar disc herniation. (author)

  20. Comparison of preoperative neuroradiographic findings and surgical findings in lumbar disc herniation

    International Nuclear Information System (INIS)

    Takahara, Kazuhiro; Sera, Keisuke; Nakamura, Masakazu; Uchida, Takeshi; Ito, Nobuyuki.

    1997-01-01

    Surgical findings in lumbar disc hernia were compared to pre-operative MRI, CTM and myelogram findings. Ninety-one cases were studied using Love's method. The accuracy of hernia diagnosis in MRI was 59.3%, 41.2% in CTM, and 35.2% in myelogram. At the L5/S1 disc level, the accuracy of hernia diagnosis by CTM and myelogram was decreased. MRI was useful for the diagnosis and cure of lumbar disc herniation. (author)

  1. Exacerbation of Symptoms of Lumbar Disc Herniation Complicated by a Schwannoma: A Case Report

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    Sen-Yung Liu

    2007-09-01

    Full Text Available Herniation of the lumbar disc is a common cause of low back pain. Conservative management with physiotherapy, such as lumbar spine traction, is usually effective. Although a schwannoma of the lumbar spine is relatively uncommon, the clinical manifestations are similar to those of lumbar disc herniation, making the diagnosis difficult. This case report describes a 51-year-old male who had suffered from low back pain for 3 years and who was diagnosed with L2/L3 lumbar disc herniation. The low back pain was well-controlled by conservative treatment and the symptoms improved progressively. Two months prior to our evaluation, however, the symptoms worsened acutely, and were accompanied by the onset of symptoms of cauda equina syndrome. A small tumor at the site of the L2/L3 disc herniation, observed incidentally during magnetic resonance imaging, was responsible for the symptoms of spinal stenosis at the lumbar region. The patient underwent laminectomy, tumor resection, and discectomy with near-complete resolution of symptoms. In patients with lumbar disc herniation that improves with conservative treatment, the recurrence of symptoms should prompt a thorough review of the medical history, physical examination, and imaging studies to establish the diagnosis and prevent delay in treatment.

  2. Interference of detection rate of lumbar disc herniation by socioeconomic status.

    Science.gov (United States)

    Ji, Gyu Yeul; Oh, Chang Hyun; Jung, Nak-Yong; An, Seong Dae; Choi, Won-Seok; Kim, Jung Hoon

    2013-03-01

    Retrospective study. The objective of the study is to evaluate the relationship between the detection rate of lumbar disc herniation and socioeconomic status. Income is one important determinant of public health. Yet, there are no reports about the relationship between socioeconomic status and the detective rate of disc herniation. In this study, 443 cases were checked for lumbar computed tomography for lumbar disc herniation, and they reviewed questionnaires about their socioeconomic status, the presence of back pain or radiating pain and the presence of a medical certificate (to check the medical or surgical treatment for the pain) during the Korean conscription. Without the consideration for the presence of a medical certificate, there was no difference in spinal physical grade according to socioeconomic status (p=0.290). But, with the consideration of the presence of a medical certificate, the significant statistical differences were observed according to socioeconomic status in 249 cases in the presence of a medical certificate (p=0.028). There was a lower detection rate in low economic status individuals than those in the high economic class. The common reason for not submitting a medical certificate is that it is neither necessary for the people of lower socioeconomic status nor is it financially affordable. The prevalence of lumbar disc herniation is not different according to socioeconomic status, but the detective rate was affected by socioeconomic status. Socioeconomic status is an important factor for detecting lumbar disc herniation.

  3. Therapeutic effect of percutaneous endoscopic lumbar discectomy on lumbar disc herniation and its effect on oxidative stress in patients with lumbar disc herniation.

    Science.gov (United States)

    Chang, Feng; Zhang, Ting; Gao, Gang; Yu, Chen; Liu, Ping; Zuo, Genle; Huang, Xinhu

    2018-01-01

    This study investigated the therapeutic effect of percutaneous endoscopic lumbar discectomy on lumbar disc herniation, and explored its effect on oxidative stress in patients with lumbar disc herniation. One hundred and ten patients with lumbar disc herniation were selected in The Affiliated People's Hospital of Shanxi Medical University from May 2015 to May 2016. Patients were divided into control group (n=50) and observation group (n=60) according to different surgical methods. Patients in control group were subjected to traditional open discectomy, while patients in observation group were treated with percutaneous endoscopic lumbar discectomy. Surgical-related indicators, ODI and VAS scores before and 3 months after surgery, serum inflammatory factors and oxidative stress indicators were compared between 2 groups. There was no significant difference in operation time between the groups. Blood loss, incision size and time of bed rest in observation group were better than those in control group (P0.05). Levels of serum inflammatory factors TNF-α and CRP and oxidative stress indicators MDA and MPO were significantly lower and levels of oxidative stress indicators SOD and TAC were significantly higher in observation group than in control group (Pdisc herniation with percutaneous endoscopic lumbar discectomy has the advantages of small trauma, less blood loss and fast recovery, and can effectively improve the dysfunction, reduce pain and serum levels of inflammatory factors, and improve the levels of oxidative stress indicators, thereby improving the surgical results. Thus, this method should be considered for wide-use.

  4. Percutaneous endoscopic lumbar discectomy for a huge herniated disc causing acute cauda equina syndrome: a case report.

    Science.gov (United States)

    Jha, Subash C; Tonogai, Ichiro; Takata, Yoichiro; Sakai, Toshinori; Higashino, Kosaku; Matsuura, Tetsuya; Suzue, Naoto; Hamada, Daisuke; Goto, Tomohiro; Nishisho, Toshihiko; Tsutsui, Takahiko; Goda, Yuichiro; Abe, Mitsunobu; Mineta, Kazuaki; Kimura, Tetsuya; Nitta, Akihiro; Hama, Shingo; Higuchi, Tadahiro; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.

  5. Clinical Features of Herniated Disc at Cervicothoracic Junction Level Treated by Anterior Approach.

    Science.gov (United States)

    Lee, Jun Gue; Kim, Hyeun Sung; Ju, Chang Il; Kim, Seok Won

    2016-06-01

    The anterior approach for C7-T1 disc herniation may be challenging because of obstruction by the manubrium and the narrow operative field. This study aimed to investigate the clinical and neurological outcomes of anterior approach for C7-T1 disc herniation. We retrospectively evaluated 13 patients who underwent the anterior approach for C7-T1 disc herniation by a single surgeon within a period of 11 years (2003-2014). The minimum follow-up duration was 6 months. We describe the clinical presentation, radiographic findings, neurological outcome, and related complications. Of 372 patients with single-level anterior discectomy and fusion or artificial disc replacement for cervical disc herniation, 13 (3.5%) had C7-T1 disc herniation. The main clinical presentation was unilateral motor weakness in intrinsic hand muscles (11 patients), along with numbness, pain, and tingling sensation that radiate down the arm to the little finger. Most of the patients improved after surgery via the anterior approach. Ten patients underwent successful anterior discectomy and fusion by the standard supramanubrial Smith-Robinson approach, but 2 needed additional manubriotomy and sternotomy. In 1 patient, we performed surgery at a wrong level because the correct level was difficult to identify intraoperatively. Two patients had transient vocal dysfunction, but none had major complications related to injuries of the great vessels such as the thoracic duct or esophagus. For patients who require direct anterior decompression for C7-T1 disc herniation, the anterior approach is relatively feasible. However, care should be taken to overcome physical constraints by the manubrium and slope.

  6. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

    Directory of Open Access Journals (Sweden)

    Manchikanti L

    2012-10-01

    Full Text Available Laxmaiah Manchikanti,1,2 Kimberly A Cash,1 Carla D McManus,1 Vidyasagar Pampati11Pain Management Center of Paducah, Paducah, 2Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USABackground: Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections.Methods: A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1 and the other group did (group 2. There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment.Results: Significant pain relief and functional status improvement (primary outcome defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months.Conclusion: Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and

  7. Outcomes After Lumbar Disc Herniation in the National Basketball Association.

    Science.gov (United States)

    Minhas, Shobhit V; Kester, Benjamin S; Hsu, Wellington K

    2016-01-01

    Professional basketball players are at risk for lumbar disc herniation (LDH), yet the evidence guiding treatment after operative or nonoperative management of this condition in the National Basketball Association (NBA) is limited. NBA players with LDH will have different performance outcomes based on treatment type. Case-control study. Level 4. Athletes in the NBA with an LDH were identified through team injury reports, transaction records, and public sports archives. A 1:2 case-control study was performed in which LDH players and players without LDH were matched for player variables. Statistical analysis was employed to compare pre- and postindex season performance (games played and player efficiency rating [PER]) and career longevity between test subjects and controls in the operatively treated (OT) and nonoperatively treated (NOT) cohorts. A total of 61 NBA players with LDH were included, of whom 34 underwent discectomy and 27 were managed nonoperatively. Return-to-play (RTP) rates did not differ between NOT and OT players (77.8% vs. 79.4%). When compared with controls, OT players played significantly fewer games and had a lower PER than controls during the first postoperative season, but no difference was seen 2 and 3 years after surgery, with no difference in postoperative career length. In contrast, no difference in games played or PER was seen between NOT players and controls, although NOT players played significantly fewer postindex seasons. NBA players have a high RTP rate regardless of type of treatment for LDH; however, postindex performance differs between surgically and nonoperatively managed patients when compared with players without an LDH. However, further studies with a larger sample size are required for more definitive recommendations. There is a high RTP rate after LDH in the NBA, although postindex performance may differ based on operative versus nonoperative treatment. © 2015 The Author(s).

  8. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation.

    Science.gov (United States)

    Fortin, Maryse; Lazáry, Àron; Varga, Peter Paul; McCall, Iain; Battié, Michele C

    2016-05-01

    To investigate asymmetry in size and composition of the multifidus and erector spinae in patients with posterolateral disc herniation and concordant radicular symptoms, and determine whether symptom duration is associated with degree of asymmetry. Thirty-three patients diagnosed with posterolateral disc herniation at L4-L5 verified on imaging and concordant leg pain were included. Multifidus and erector spinae cross-sectional area (CSA), functional cross-sectional area (FCSA, fat-free area), signal intensity and ratio of FCSA to total CSA were measured bilaterally from T 2-weighted axial magnetic resonance imaging (MRI) at L3-L4, L4-L5, L5-S1 and S1 levels. No side-to-side differences in multifidus CSA, FCSA, and ratio of FCSA/CSA reached statistical significance at any spinal level. The multifidus signal intensity at L5-S1 was significantly greater (more fatty infiltration) on the side of the disc herniation. The erector spinae FCSA (lean muscle mass) at L5-S1 was found to be significantly smaller on the side of the herniation and the ratio of FCSA/CSA was smaller (more fatty infiltration) on the side of the herniation at L4-L5 and L5-S1. The degree of muscle asymmetry was not associated with symptoms duration. There was no significant asymmetry of the multifidus at spinal level above, same or level below the disc herniation. Instead, variations in muscle composition were observed, with greater fat infiltration on the side and at spinal levels adjacent to the disc herniation. Muscle asymmetry was not correlated with symptom duration.

  9. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach.

    Science.gov (United States)

    Choi, Kyung Chul; Kim, Jin-Sung; Ryu, Kyeong-Sik; Kang, Byung Uk; Ahn, Yong; Lee, Sang-Ho

    2013-01-01

    Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive spinal technique. The unique anatomic features of the L5-S1 space include a large facet joint, narrow foramen, small disc space, and a wide interlaminar space. PELD can be performed via 2 routes, transforaminal (TF-PELD) or interlaminar (IL-PELD). However, it is questionable that the decision of the endoscopic route for L5-S1 discs only depends on the surgeon's preference and anatomic relation between iliac bone and disc space. Thus far, no study has compared TF-PELD with IL-PELD for L5-S1 disc herniation. The goal of this study was to compare the radiologic features and results of TF-PELD and IL-PELD. We have clarified the patient selection for the PELD route for L5-S1 disc herniation. Retrospective evaluation. Thirty consecutive patients each were treated with TF-PELD and IL-PELD for L5-S1 disc herniation in 2 institutes, respectively. Radiological assessments were performed pre- and postoperatively. The disc type, disc size, location, migration, disc height, foraminal height, iliolumbar angle, iliac height, and interlaminar space were analyzed. Clinical data were compared with a 2-year follow-up period. Pre- and postoperative pain was measured using a visual analog scale (VAS; 0 - 10) and functional status was assessed using the Oswestry Disability Index (ODI; 0 - 100%) and the time to return to work. In the 2 groups, the mean VAS scores for back and leg pain, as well as the ODI, were significantly improved. The mean time to return to work was 4.9 weeks with TF-PELD and 4.4 weeks with IL-PELD. Incomplete removal, resulting in the need for subsequent open surgery, occurred in one case (3.3%) of TF-PELD and in 2 cases (6.6%) of IL-PELD. Postoperative dysesthesia developed in 2 patients (6.7%) after IL-PELD; however, there was no dysesthesia after TF-PELD. Recurrence occurred in 3.3% with TF-PELD and in 6.7% with IL-PELD during the 2-year follow-up. A significant difference between groups was

  10. The value of ultrasonic evaluation for diagnosis of lumbar disc herniation

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    Oh, Jae Cheon [Sarang Hospitl, Seoul (Korea, Republic of); Rhim, Hyun Chul; Jeong, Woo Koeng; Lee, Seung Ro [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2001-12-15

    The aim of the investigation was to evaluate the diagnostic effectiveness of sonography in the evaluation of the lower lumbar intervertebral disc herniations. Prospective ultrasonographic examinations by transabdominal approach were performed on 65 consecutive patients (32 males and 33 females) with clinically suspected lumbar disc herniation, and the findings were compared with MR findings. The transabdominal representation of lumbar disc herniations was successful in 64 cases at L3-4 level,59 cases at L4-5 level and 55 cases at L5-S1 level. The sonographic examination wa inconclusive in the some patients because of degenerative disc with vacuum phenomenon, osteophytosis and diminution of the intervertebal disc space. Both sensitivity and specificity of sonography were 100% at L3-4 level. At the same time, the sensitivity and specificity of sonography were 60% and 97% at L4-5 level and 36% and 100% at L5-S1 level. Although ultrasound is not currently used as a screening modality because of the low sensitivity, ultrasound shows a high specificity with non-invasiveness but without radiation hazard. Therefore, ultrasound can be used as an aid for diagnosing lumbar disc herniation, especially in young men without spondylosis.

  11. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Altinkaya, Naime [Baskent University Medical School, Department of Radiology, Adana (Turkey); Cekinmez, Melih [Baskent University Medical School Adana, Department of Neurosurgery, Adana (Turkey)

    2016-01-15

    To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

  12. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

    International Nuclear Information System (INIS)

    Altinkaya, Naime; Cekinmez, Melih

    2016-01-01

    To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

  13. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging.

    Science.gov (United States)

    Altinkaya, Naime; Cekinmez, Melih

    2016-01-01

    To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P  0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation.

  14. Detection of residual disc hernia material and confirmation of nerve root decompression at lumbar disc herniation surgery by intraoperative ultrasound.

    Science.gov (United States)

    Aoyama, Takeshi; Hida, Kazutoshi; Akino, Minoru; Yano, Shunsuke; Iwasaki, Yoshinobu

    2009-06-01

    The aim of lumbar disc herniation surgery is the removal of herniated disc material (HDM) and complete decompression of the nerve root. As some patients present with residual HDM, we examined the ability of intraoperative ultrasound (IOUS) to detect this material. Between February 2006 and June 2007, we used IOUS in 30 patients undergoing surgery for lumbar disc herniation. They were 17 men and 13 women; their ages ranged from 22 to 63 y (mean 44.0 y). The level surgically addressed was L3/4 in 1, L4/5 in 14 and L5/S1 in 15 patients; they were operated in the prone position. After placing a 3-4 cm midline skin incision, partial hemi-semilaminotomy was performed. HDM was removed through a bone window; a surgical microscope was used during the operation. After removal was judged as adequate, IOUS was performed; 17 patients also underwent IOUS before removal of the herniated disc. For the acquisition of IOUS images, we used LOGIQ 9 and 8c microconvex probes (GE Healthcare, Wauwatosa, WI, USA). The normal anatomical structures were well visualized. HDM was iso- to hyperechoic compared with normal nerve tissue. In three of 17 patients, the dural sac and nerve root could not be distinguished from HDM before removal, although in all 30, the decompressed dural sac, intradural cauda equina and nerve root were well visualized. We posit that the echogenicity of nerve tissue was raised due to compression, rendering it similar to that of the herniated disc. In two patients, IOUS detected residual disc material; the surgical procedure was resumed and sufficient removal was accomplished. IOUS monitoring is safe, convenient and inexpensive. It is also highly useful for the detection of residual HDM and the confirmation of adequate nerve root decompression.

  15. A Rare Case of Near Complete Regression of a Large Cervical Disc Herniation without Any Intervention Demonstrated on MRI

    Directory of Open Access Journals (Sweden)

    Parag Suresh Mahajan

    2014-01-01

    Full Text Available There are very few reported cases of regression of large cervical disc herniation without any intervention—the so-called spontaneous regression, demonstrated using MRI. We report a rare and interesting case of MRI that demonstrated near complete regression of a large herniated cervical intervertebral disc, without any surgical treatment.

  16. Is Leg Length Discrepancy Associated With the Side of Radiating Pain in Patients With a Lumbar Herniated Disc?

    NARCIS (Netherlands)

    ten Brinke, Albert P.T.; van der Aa, Hans E.; van der Palen, Jacobus Adrianus Maria; Oosterveld, Frits P.T.

    1999-01-01

    Study Design. The association between leg length discrepancy and the side of the radiating pain in lumbar disc herniation was investigated in a case series. Objectives. To investigate whether pain tends to radiate into the longer or shorter leg in patients with a lumbar herniated disc. Summary of

  17. Cervical spine disc herniation at C2-C3 level: Study of a Clinical Observation and Literature Review

    Directory of Open Access Journals (Sweden)

    Oka Dominique N'Dri

    2015-12-01

    Full Text Available Cervical C2-C3 herniated disc is rare. It is characterized by its clinical polymorphism. Several surgical approaches have been described for the discectomy of a herniated disc. This work aims at discussing through personal observations and literature review clinical semiology and surgical treatment.

  18. Increase of nerve growth factor levels in the human herniated intervertebral disc: can annular rupture trigger discogenic back pain?

    Science.gov (United States)

    Aoki, Yasuchika; Nakajima, Arata; Ohtori, Seiji; Takahashi, Hiroshi; Watanabe, Fusako; Sonobe, Masato; Terajima, Fumiaki; Saito, Masahiko; Takahashi, Kazuhisa; Toyone, Tomoaki; Watanabe, Atsuya; Nakajima, Takayuki; Takazawa, Makoto; Nakagawa, Koichi

    2014-07-28

    Nerve growth factor (NGF) has an important role in the generation of discogenic pain. We hypothesized that annular rupture is a trigger for discogenic pain through the action of NGF. In this study, the protein levels of NGF in discs from patients with disc herniation were examined and compared with those from discs of patients with other lumbar degenerative disc diseases. Patients (n = 55) with lumbar degenerative disc disease treated by surgery were included. Nucleus pulposus tissue (or herniated disc tissue) was surgically removed and homogenized; protein levels were quantified using an enzyme-linked immunosorbent assay (ELISA) for NGF. Levels of NGF in the discs were compared between 1) patients with herniated discs (herniated group) and those with other lumbar degenerative disc diseases (non-herniated group), and 2) low-grade and high-grade degenerated discs. Patient's symptoms were assessed using a visual analog scale (VAS) and the Oswestry disability index (ODI); the influence of NGF levels on pre- and post-operative symptoms was examined. Mean levels of NGF in discs of patients were significantly higher in herniated discs (83.4 pg/mg total protein) than those in non-herniated discs (68.4 pg/mg). This study reports that NGF increased in herniated discs, and may play an important role in the generation of discogenic pain. Analysis of patient symptoms revealed that pre-operative NGF levels were related to post-operative residual lower extremity pain and LBP in motion. The results suggest that NGF in the disc is related to pain generation, however, the impact of NGF on generation of LBP varies in individual patients.

  19. Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly

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    Yılmaz, Tevfik; Turan, Yahya; Gülşen, İsmail; Dalbayrak, Sedat

    2014-01-01

    Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury. PMID:25210343

  20. Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly

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    Tevfik Yilmaz

    2014-01-01

    Full Text Available Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.

  1. Surgical results of myelopathy secondary to the cervical disc herniation and the availability of CTD

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    Sho, Tomoya; Kataoka, Osamu; Washimi, Masatoshi; Fujita, Masayuki; Bessho, Yasuo (National Kobe Hospital, Hyogo (Japan))

    1990-08-01

    This study evaluated the contribution of computed tomographic discography (CTD) to the surgical indications and selection of surgical techniques in cervical disc herniation. The study population consisted of 73 patients who were diagnosed as having cervical disc herniation by CTD: Of them, hernia mass was confirmed by surgery in 64 patients (a concordance rate of 88% between CTD and surgical findings). In evaluable 40 patients receiving computed tomographic myelography (CTM), the rate of flattened spinal cord on CTM was significantly correlatd with postoperative prognosis. Flattened spinal cord was favorably improved. Higher preoperative flat rate was associated with severer cervical disc herniation. CTD provided the information concerning the positional relation in the posterior longitudinal ligament of hernia mass. Preoperative severity, preoperative rate of flattened spinal cord, and the site of protrusion of hernia mass were independent of surgical outcome. (N.K.).

  2. CT- and fluoroscopy-guided percutaneous discectomy for lumbar radiculopathy related to disc herniation: a comparative prospective study comparing lateral to medial herniated discs.

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    Amoretti, Nicolas; Huwart, Laurent; Marcy, Pierre-Yves; Foti, Pauline; Hauger, Olivier; Boileau, Pascal

    2013-01-01

    To evaluate and compare two groups of patients with sciatica due to intervertebral disc herniation with no neurologic deficit. The groups consisted of patients with intervertebral disc herniation in a medial location (group 1) and those in a lateral location (group 2). A total of 200 patients were included in the study and were followed for a minimum of 6 months. In our series, we treated 80 postero-lateral herniated discs (40% of cases), 46 postero-medial herniated discs (23%), and 74 foraminal herniated discs (37%). Level L3-L4 was treated in 30 cases (15%), L4-L5 in 98 cases (49%), and L5-S1 in 72 cases (36%). The procedure was performed under dual guidance: fluoroscopic and CT. A helical probe was activated. It penetrates the herniated disc and causes the pulpous material to be mechanically evacuated through the probe. All 200 patients were followed for a minimum of 6 months. In group 1, the patients had a mean pain score of 7.9 ± 2.5 VAS units (range 6-10 units) prior to intervention. This was reduced to 3.2 ± 2.1 VAS units (range 0-10 units) at 48 h follow-up and increased to 3.9 ± 1.2 VAS units (range 0-10 VAS units) at 1 month follow-up and further reduced to 2.7 ± 1.2 units (range 0-10 VAS units) at 6 month follow-up. In group 2, the patients had a mean pain score of 8.2 ± 3.2 VAS units (range 6-10 units) prior to intervention. This was reduced to 2.8 ± 1.5 VAS units (range 0-10 units) at 48 h follow-up and decreased to 1.5 ± 0.9 VAS units (range 0-10 units) at 1 month and further reduced to 1.1 ± 0.5 VAS units (range 0-10 units) at 6 months. Our study showed that results were more satisfactory for the hernia located laterally (postero-lateral, foraminal, and extra-foraminal) as compared to the hernia located posteromedially.

  3. CT- and fluoroscopy-guided percutaneous discectomy for lumbar radiculopathy related to disc herniation: a comparative prospective study comparing lateral to medial herniated discs

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    Amoretti, Nicolas; Huwart, Laurent; Marcy, Pierre-Yves; Foti, Pauline; Hauger, Olivier; Boileau, Pascal

    2013-01-01

    To evaluate and compare two groups of patients with sciatica due to intervertebral disc herniation with no neurologic deficit. The groups consisted of patients with intervertebral disc herniation in a medial location (group 1) and those in a lateral location (group 2). A total of 200 patients were included in the study and were followed for a minimum of 6 months. In our series, we treated 80 postero-lateral herniated discs (40% of cases), 46 postero-medial herniated discs (23%), and 74 foraminal herniated discs (37%). Level L3-L4 was treated in 30 cases (15%), L4-L5 in 98 cases (49%), and L5-S1 in 72 cases (36%). The procedure was performed under dual guidance: fluoroscopic and CT. A helical probe was activated. It penetrates the herniated disc and causes the pulpous material to be mechanically evacuated through the probe. All 200 patients were followed for a minimum of 6 months. In group 1, the patients had a mean pain score of 7.9 ± 2.5 VAS units (range 6-10 units) prior to intervention. This was reduced to 3.2 ± 2.1 VAS units (range 0-10 units) at 48 h follow-up and increased to 3.9 ± 1.2 VAS units (range 0-10 VAS units) at 1 month follow-up and further reduced to 2.7 ± 1.2 units (range 0-10 VAS units) at 6 month follow-up. In group 2, the patients had a mean pain score of 8.2 ± 3.2 VAS units (range 6-10 units) prior to intervention. This was reduced to 2.8 ± 1.5 VAS units (range 0-10 units) at 48 h follow-up and decreased to 1.5 ± 0.9 VAS units (range 0-10 units) at 1 month and further reduced to 1.1 ± 0.5 VAS units (range 0-10 units) at 6 months. Our study showed that results were more satisfactory for the hernia located laterally (postero-lateral, foraminal, and extra-foraminal) as compared to the hernia located posteromedially. (orig.)

  4. CT- and fluoroscopy-guided percutaneous discectomy for lumbar radiculopathy related to disc herniation: a comparative prospective study comparing lateral to medial herniated discs

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    Amoretti, Nicolas; Huwart, Laurent; Marcy, Pierre-Yves [Centre Hospital-Universitaire de Nice, Department of Radiology, Hopital archet 2, Nice (France); Foti, Pauline [Centre Hospital-Universitaire de Nice, Department of Medical Statistics, Hopital archet 2, Nice (France); Hauger, Olivier [Centre Hospitalo-Universitaire de Bordeaux, Department of Radiology, Hopital Pellegrin, Bordeaux (France); Boileau, Pascal [Centre Hospital-Universitaire de Nice, Department of Orthopedic Surgery, Hopital archet 2, Nice (France)

    2013-01-15

    To evaluate and compare two groups of patients with sciatica due to intervertebral disc herniation with no neurologic deficit. The groups consisted of patients with intervertebral disc herniation in a medial location (group 1) and those in a lateral location (group 2). A total of 200 patients were included in the study and were followed for a minimum of 6 months. In our series, we treated 80 postero-lateral herniated discs (40% of cases), 46 postero-medial herniated discs (23%), and 74 foraminal herniated discs (37%). Level L3-L4 was treated in 30 cases (15%), L4-L5 in 98 cases (49%), and L5-S1 in 72 cases (36%). The procedure was performed under dual guidance: fluoroscopic and CT. A helical probe was activated. It penetrates the herniated disc and causes the pulpous material to be mechanically evacuated through the probe. All 200 patients were followed for a minimum of 6 months. In group 1, the patients had a mean pain score of 7.9 {+-} 2.5 VAS units (range 6-10 units) prior to intervention. This was reduced to 3.2 {+-} 2.1 VAS units (range 0-10 units) at 48 h follow-up and increased to 3.9 {+-} 1.2 VAS units (range 0-10 VAS units) at 1 month follow-up and further reduced to 2.7 {+-} 1.2 units (range 0-10 VAS units) at 6 month follow-up. In group 2, the patients had a mean pain score of 8.2 {+-} 3.2 VAS units (range 6-10 units) prior to intervention. This was reduced to 2.8 {+-} 1.5 VAS units (range 0-10 units) at 48 h follow-up and decreased to 1.5 {+-} 0.9 VAS units (range 0-10 units) at 1 month and further reduced to 1.1 {+-} 0.5 VAS units (range 0-10 units) at 6 months. Our study showed that results were more satisfactory for the hernia located laterally (postero-lateral, foraminal, and extra-foraminal) as compared to the hernia located posteromedially. (orig.)

  5. Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation.

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    Ahn, Yong; Jang, Il-Tae; Kim, Woo-Kyung

    2016-08-01

    Transforaminal percutaneous endoscopic lumbar discectomy (PELD) for high-grade migrated disc herniation has been regarded as a challenging task, but because of the remarkable improvement in navigable instruments and advanced epiduroscopic technique, it can be used for the treatment of high- or very high-grade migrated disc herniation. The purpose of this study was to describe in detail the standardized technique of transforaminal PELD for very high-grade migrated disc herniation and demonstrate the clinical results. Very high-grade lumbar migrated disc herniation was defined as a disc migration beyond the inferior margin of the pedicle. Thirteen consecutive patients with very high-grade lumbar migrated disc herniation were treated with transforaminal PELD, which has three stages: (1) direction-oriented transforaminal approach, (2) release of periannular anchorage, and (3) epiduroscopic fragmentectomy with navigable instruments. The surgical outcomes were assessed using the visual analogue pain score (VAS), Oswestry disability index (ODI), and modified Macnab criteria. The operated levels were L3-4 in 2 (15.4%) patients, L4-5 in 10 (76.9%), and L5-S1 in 1 (7.7%). The directions of migration were cranial in 8 patients and caudal in 5. The mean VAS for leg pain improved from 7.86±1.28 preoperatively to 2.54±1.51 at 6 weeks postoperatively and 1.85±1.07 at 1year postoperatively (Pdisc herniation, and a standardized technique may provide a reliable and reproducible result. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  6. Prevalence and Severity of Preoperative Disabilities in Iranian Patients with Lumbar Disc Herniation

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    Farzad Omidi-Kashani

    2013-12-01

    Full Text Available   Background: Literature recommends that refractory cases with lumbar disc herniation and appropriate indications are better to be treated surgically, but do all the patients throughout the world consent to the surgery with a same disability and pain threshold? We aim to elucidate the prevalence and severity of disabilities and pain in Iranian patients with lumbar disc herniation who have consented to the surgery.   Methods: In this case series study, we clinically evaluated 194 (81 female and 113 male admitted patients with primary, simple, and stable L4-L5 or L5-S1 lumbar disc herniation who were undergoing surgical discectomy. The mean age of the patients was 38.3±11.2 (range: 18-76 years old. Disabilities were evaluated by the items of the Oswestry Disability Index (ODI questionnaire and severity of pain by the Visual Analogue Scale (VAS. Chi-square test was used to compare the qualitative variables. Results: Severe disability (39.2% and crippled (29.9% were the two most common types of disabilities. Mean ODI score was 56.7±21.1 (range: 16-92. Total mean VAS in all patients was 6.1±1.9 (range: 0-10. Sex and level of disc herniation had no statistical effect on preoperative ODI and VAS. The scale of six was the most frequent scale of preoperative VAS in our patients. Conclusion: Iranian patients with lumbar disc herniation who consented to surgery have relatively severe pain or disability. These severities in pain or disabilities have no correlation with sex or level of disc herniation and are not equal with developed countries.

  7. Clinical outcomes of percutaneous plasma disc coagulation therapy for lumbar herniated disc diseases.

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    Kim, Sang Hyun; Kim, Sung Chul; Cho, Ki Hong

    2012-01-01

    This is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy. Forty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. This study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4±1.4, while the final follow-up VAS score was 1.4±0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy. PDCT is a safe and efficient treatment modality in a selective patient with HLD.

  8. Radiofrequency-Induced Intradiscal Nucleoplasty Chronic Low Back Pain Secondary To Lumbar Disc Herniation

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    DW Lee

    2013-07-01

    Full Text Available We set out to assess the efficacy of radiofrequency-induced intradiscal nucleoplasty in reducing pain in symptomatic patients with MRI-defined lumbar disc herniation and their satisfaction with the procedure. We compared the patients’ pain intensity and severity of disability scores before and after undergoing the procedure in a retrospective questionnaire. These patients reported statistically significant reduction of pain intensity and disability level after the procedure. We conclude that radio frequency induced intradiscal nucleoplasty is an acceptable alternative minimally invasive procedure in relieving the symptoms of patients with lumbar disc herniation.

  9. [Spontaneous regression from intervertebral disc herniation. Propos of a series of 37 cases].

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    Martínez-Quiñones, J V; Aso-Escario, J; Consolini, F; Arregui-Calvo, R

    2010-04-01

    The intervertebral disc disease (IDD) is one of the most common muscle-skeletal disorders, causing both high work disability and elevated healthcare costs. There are two specific origins of disk disease that should be kept in mind: degenerative (DDD) and traumatic (TDD). Concerning the TDD, nowadays it has not been determined which patients could gradually improve and which ones will require surgery. Some studies indicate that about 85% of lumbar and 90% cervical acute disc herniation will get better in an average of 6 weeks. We conducted an observational, prospective study, over a group of 858 patients, with the following inclusion criteria: 1. MRI imaging indicating TDD, 2. No signs or symptoms requiring urgent surgical treatment (cauda equina syndrome, progressive or serious motor deficit or unbearable pain) and 3. Development of progressively spontaneous symptoms remission. All of the patients included in our study were treated in our Department of Neurosurgery from 2006 to 2007. Patients were tested for disc herniation regression with a second MRI study. A spontaneous regression of their hernia was appreciated as follow: 33 cases of lumbar hernia (29 male, 4 female), 3 cervical hernia (1 male, 2 female) and 1 dorsal hernia (male). Research about other reported series was done, and the different factors that could take place in disc spontaneous regression were analyzed: a) lodgement of the herniated disc back into the intervertebral space; b) disappearance of the herniated fragment due to dehydration and retraction mechanisms; c) gradual resorption of the herniated tissue by phagocytosis and enzymatic degradation induced by an inflammatory reaction that appeared as the disc (acting the extrusion itself as an foreign body) and, d) pulsion of cephaloarchidian liquid against the herniated portion. Disc herniation can regress, or even disappear, in a number of patients, rendering the radiological findings not to be taken as the only surgical indication criterium

  10. Feasibility of Percutaneous Lumbar Discectomy Combined with Percutaneous Cementoplasty for Symptomatic Lumbar Disc Herniation with Modic Type I Endplate Changes.

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    Tian, Qing-Hua; Lu, Ying-Ying; Sun, Xi-Qi; Wang, Tao; Wu, Chun-Gen; Li, Ming-Hua; Cheng-Ying, Sheng

    2017-05-01

    Treatment of symptomatic lumbar disc herniation with Modic type I endplate changes is complex and challenging, requiring systemic and local therapies which include conservative therapy, epidural infiltrations, percutaneous therapeutic techniques, and surgical options. The clinical management of symptomatic lumbar disc herniation involving Modic type I endplate changes is uniquely challenging because it requires alleviating pain caused by both the herniated disc and the endplate osteochondritis. Through different approaches, percutaneous lumbar discectomy (PLD) and percutaneous cementoplasty (PCP) have been introduced into clinical practice as alternatives to traditional surgical and radiotherapy treatments of symptomatic lumbar disc herniation and other spine diseases. To evaluate the feasibility of PLD and PCP for symptomatic lumbar disc herniation with Modic type I endplate changes. PLD and PCP in 7 patients with symptomatic lumbar disc herniation with Modic type I endplate changes and its clinical effects were retrospectively evaluated. This study was conducted by an interventional therapy group at a medical center in a major Chinese city. Seven consecutive patients (2 men, 5 women; median age, 74.14 ± 5.34 years; age range, 68 - 82 years) who underwent percutaneous lumbar discectomy and cementoplasty for the treatment of symptomatic lumbar disc herniation with Modic type I changes between May 2013 and August 2015 were retrospectively analyzed. The MacNab Criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain were assessed before and one week, 6 months, and one year after the procedure. Furthermore, the procedure duration, hospital stay length, and complications were assessed. The VAS of the back and leg decreased from 6.14 ± 0.69 (range, 5 - 7) and 7.29 ± 0.76 (range, 6 - 8) preoperatively to 2.29 ± 1.38 (range, 1 - 5) and 2.71 ± 0.60 (range, 1 - 6) one week, 1.86 ± 0.69 (range, 1 - 3) and 2.00 ± 0.58 (range, 1 - 3) 6 months

  11. Thoracolumbar intradural disc herniation in eight dogs: clinical, low-field magnetic resonance imaging, and computed tomographic myelography findings.

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    Tamura, Shinji; Doi, Shoko; Tamura, Yumiko; Takahashi, Kuniaki; Enomoto, Hirokazu; Ozawa, Tsuyoshi; Uchida, Kazuyuki

    2015-01-01

    Intradural disc herniation is a rarely reported cause of neurologic deficits in dogs and few published studies have described comparative imaging characteristics. The purpose of this retrospective cross sectional study was to describe clinical and imaging findings in a group of dogs with confirmed thoracolumbar intradural disc herniation. Included dogs were referred to one of four clinics, had acute mono/paraparesis or paraplegia, had low field magnetic resonance imaging (MRI) and/or computed tomographic myelography, and were diagnosed with thoracolumbar intradural disc herniation during surgery. Eight dogs met inclusion criteria. The prevalence of thoracolumbar intradural disc herniation amongst the total population of dogs that developed a thoracolumbar intervertebral disc herniation and that were treated with a surgical procedure was 0.5%. Five dogs were examined using low-field MRI. Lesions that were suspected to be intervertebral disc herniations were observed; however, there were no specific findings indicating that the nucleus pulposus had penetrated into the subarachnoid space or into the spinal cord parenchyma. Thus, the dogs were misdiagnosed as having a conventional intervertebral disc herniation. An intradural extramedullary disc herniation (three cases) or intramedullary disc herniation (two cases) was confirmed during surgery. By using computed tomographic myelography (CTM) for the remaining three dogs, an intradural extramedullary mass surrounded by an accumulation of contrast medium was observed and confirmed during surgery. Findings from this small sample of eight dogs indicated that CTM may be more sensitive for diagnosing canine thoracolumbar intradural disc herniation than low-field MRI. © 2014 American College of Veterinary Radiology.

  12. The vertebral signal change on MRI and histological examination of the operated cases for lumbar disc herniations

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    Kasama, Fumio; Kusakabe, Takashi; Sato, Katsumi; Komatsu, Tetsuro; Watanuki, Munenori; Hara, Seigo [Tohoku Rosai Hospital, Sendai (Japan)

    2002-03-01

    We examined the pre-operative MRI of 97 cases of lumbar disc herniation retrospectively. Ninety-two cases (95%) had vertebral signal changes, end plate erosions and/or vertebral posterior corner changes. Thirty-seven (47%) cases of 78 histological examinations had a cartilaginous end plate. Patients whose MRI showed high signal intensity on both T1 and T2 weighted images near the end plates, had a high incidence of having the end plates in the prolapsed disc herniations. We must recognize the lumbar disc herniation as the injured state of the disc and endplates. (author)

  13. Lumbar Disc Herniation in a Patient With Congenital Vertebral Body Anomaly: A Case Report

    Science.gov (United States)

    Atabey, Cem; Topuz, Ali Kivanc; Velioğlu, Murat; Demircan, Mehmet Nusret

    2014-01-01

    Lumbar disc herniation is characterized with low back and leg pain resulting from the degenerated lumbar disc compressing the spinal nerve root. The etiology of degenerative spine is related to age, smoking, microtrauma, obesity, disorders of familial collagen structure, occupational and sports-related physical activity. However, disc herniations induced by congenital lumbar vertebral anomalies are rarely seen. Vertebral fusion defect is one of the causes of congenital anomalies. The pathogenesis of embryological corpus vertebral fusion anomaly is not fully known. In this paper, a 30-year-old patient who had the complaints of low back and right leg pain after falling from a height is presented. She had right L5-S1 disc herniation that had developed on the basis of S1 vertebra corpus fusion anomaly in Lumbar computed tomography. This case has been discussed in the light of literature based on evaluations of Lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This case is unique in that it is the first case with development of lumbar disc herniation associated with S1 vertebral corpus fusion anomaly. Congenital malformations with unusual clinical presentation after trauma should be evaluated through advanced radiological imaging techniques. PMID:25620987

  14. Correlation of matrix metalloproteinases-1 and -3 with patient age and grade of lumbar disc herniation.

    Science.gov (United States)

    Zigouris, Andreas; Batistatou, Anna; Alexiou, George A; Pachatouridis, Dimitrios; Mihos, Evaggelos; Drosos, Dimitrios; Fotakopoulos, George; Doukas, Michail; Voulgaris, Spyridon; Kyritsis, Athanasios P

    2011-02-01

    The authors studied the histological alterations and the expression of matrix metalloproteinase (MMP)-1 and MMP-3 in disc specimens of patients who had undergone operations for lumbar disc herniation. Forty-three lumbar disc specimens were evaluated histopathologically for degenerative changes and immunohistochemical expression of MMP-1 and MMP-3. The observed degenerative changes provided a degenerative score that was applied in each patient. Sections of disc immunostained for MMP-1 and MMP-3 were evaluated semiquantitatively. Patients were categorized in 3 age groups: 60 years of age. The expression of MMP-1 and MMP-3 were correlated to patient's age, degenerative score, and grade of lumbar disc herniation. There was no statistically significant difference in the degenerative score between the age groups. Degenerative changes were more pronounced in greater grades of herniation (p correlation between MMP-1 and MMP-3 expression and both degenerative score and herniation grade. For the group of patients 30-60 years of age, there was no significant difference between MMP-1 expression and degenerative score, but the correlation between MMP-1 expression and grade of herniation was significant. There was a significant correlation between MMP-3 expression and both degenerative score and herniation grade. Regarding the patients > 60 years of age, there was a significant correlation between MMP-1 and MMP-3 expression and both degenerative score and herniation grade. There was a significantly lower expression of both MMP-1 and MMP-3 in the group correlation was found in MMP-1 and MMP-3 expression between the groups of patients who were 30-60 and > 60 years of age. Interestingly, in age groups > 30 years, there were no statistically significant differences between the expression of MMP-1 and MMP-3, whereas in patients correlated to the age of the patients and the grade of herniation. An important finding in this study is the differential expression of MMP-1 and MMP-3

  15. Intervertebral disc cells produce tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 immediately after herniation: an experimental study using a new hernia model.

    Science.gov (United States)

    Yoshida, Masakazu; Nakamura, Takafumi; Sei, Akira; Kikuchi, Taro; Takagi, Katsumasa; Matsukawa, Akihiro

    2005-01-01

    A new hernia model that simulates human disc herniations was developed in rabbits. The herniated discs were examined by gross appearance and histology and production of tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 was investigated. To clarify the early mechanism of spontaneous herniated disc resorption. Macrophage infiltration in herniated discs is essential for disc resorption. However, surgically removed human herniated disc tissues and existing animal hernia models are not suitable for analyzing the mechanism of macrophage infiltration. Recently, we have demonstrated that intervertebral disc cells are capable of producing monocyte chemoattractant protein-1, a potent macrophage chemoattractant, after stimulation with tumor necrosis factor alpha and interleukin-1beta. Intervertebral disc herniations were surgically developed in rabbits using a new technique. The herniated discs were excised at appropriate time intervals after the surgery, and the size and histologic findings were examined. Expressions of tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 in herniated discs were investigated immunohistochemically. A new rabbit model of disc herniation was established. The herniated discs spontaneously reduced in size by 12 weeks postsurgery. Infiltrating cells, mainly composed of macrophages, were observed from day 3. Immunohistochemically, intervertebral disc cells in the herniated discs produced tumor necrosis factor alpha and interleukin-1beta on day 1, followed by monocyte chemoattractant protein-1 on day 3. The new hernia model appears to be very useful for studying herniated disc resorption. Intervertebral disc cells may produce inflammatory cytokines/chemokine immediately after the onset of disc herniation, possibly triggering subsequent macrophage infiltration that leads to disc resorption.

  16. How should we grade lumbar disc herniation and nerve root compression? A systematic review.

    Science.gov (United States)

    Li, Yiping; Fredrickson, Vance; Resnick, Daniel K

    2015-06-01

    MRI is the gold standard for evaluating the relationship of disc material to soft tissue and neural structures. However, terminologies used to describe lumbar disc herniation and nerve root compression have always been a source of confusion. A clear understanding of lumbar disc terminology among clinicians, radiologists, and researchers is vital for patient care and future research. Through a systematic review of the literature, the purpose of this article is to describe lumbar disc terminology and comment on the reliability of various nomenclature systems and their application to clinical practice. PubMed was used for our literature search using the following MeSH headings: "Magnetic Resonance Imaging and Intervertebral Disc Displacement" and "Lumbar Vertebrae" and terms "nomenclature" or "grading" or "classification". Ten papers evaluating lumbar disc herniation/nerve root compression using different grading criteria and providing information regarding intraobserver and interobserver agreement were identified. To date, the Combined Task Force (CTF) and van Rijn classification systems are the most reliable methods for describing lumbar disc herniation and nerve root compression, respectively. van Rijn dichotomized nerve roots from "definitely no root compression, possibly no root compression, indeterminate root compression, possible root compression, and definite root compression" into no root compression (first three categories) and root compression (last two categories). The CTF classification defines lumbar discs as normal, focal protrusion, broad-based protrusion, or extrusion. The CTF classification system excludes "disc bulges," which is a source of confusion and disagreement among many practitioners. This potentially accounts for its improved reliability compared with other proposed nomenclature systems. The main issue in the management of patients with lumbar disc disease and nerve root compression is correlation of imaging findings with clinical

  17. Magnetic resonance imaging of lumbar disc herniation with special reference to the myelographic and anatomical correlation

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    Iwamura, Yuichi; Imamura, Kiyohiko; Uematsu, Hirokazu; Sakai, Naotaka; Yamashita, Hajime; Takemura, Kenji (Yokosuka Kyosai Hospital, Kanagawa (Japan))

    1992-08-01

    T1-weighted magnetic resonance (MR) images of 49 lumbar vertebrae from 44 patients were restrospectively reviewed, focusing on herniated material, low signal intensity zone and extradural fatty tissue in the posterior edge of intervertebral disc. Morphological MR appearance was correlated with myelograms and surgical findings to determine which morphology can be detected by MR imaging alone. The MR features of the posterior edge of intervertebral disc were morphologically divided into three main types: (I) massive, swollen herniation and clear low signal intensity zone, but little or no disruption of the extradual fatty tissue; (II) posterior protrusion of the segmental herniation, partial unclearness or lack of low signal intensity zone, and disrupted extradual fatty tissue; and (III) massive herniation, lack of low signal intensity zone, and widespread disruption of the extradual fatty tissue. Types I, II and, III were seen in 18, 19, and 12 vertebrae, respectively. Herniation was clearly visualized on T1-weighted images in 73% for Type II and 83% for Type III, compared to 28% for Type I. Herniated material was seen as isointensity in 18 vertebrae in Type II and as hyperintensity in 7 vertebrae in Type III. Fifteen vertebrae (79%) in Type II and 9 vertebrae (75%) in Type III were diagnosed by MR imaging alone, which is contrast with Type I in which 11 vertebrae required myelography for diagnosis. In evaluable 25 vertebrae, common surgical findings were bulging in Type I, prolaps in Type II, and extrusion or sequestration in Type III. (N.K.).

  18. Characteristics and Neurological Manifestations of Patients with Operated Lumbar Disc Herniation

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    Amir Mohammad Bazzazi

    2014-01-01

    Full Text Available Background and aim: Lumbar disk herniation is one of the most common causes of surgery in the spine with a variety of signs and symptoms. Sensory and motor deficits, as well as reflex and autonomic abnormalities may be seen. This study aimed to investigate characteristics and neurological manifestations in a series of operated cases with lumbar disc herniation. Methods: In a retrospective setting, profiles of 163 operated cases with lumbar disc herniation were reviewed. Demographics as well as preoperational sign and symptoms were extracted and evaluated. Results: There were 86 females and 77 males with a mean age of 44.85±0.91 (range: 23-78 years in the studied population. The most common involved levels were L4-L5 and L5-S1, respectively. Low back pain, radicular pain, and positive Lasegue test were documented in 98.2%, 96.9% and 77.3% of the patients, respectively. Sensory, motor and reflexive abnormalities were documented in 66.3%, 51.5% and 19.6% of the cases, respectively. Sphincter and sexual dysfunction was presented in 4.9% and 1.2%, respectively. Conclusion: Clinical and neurological signs of operated patients with lumbar disc herniation in the studied center are not far different from available reports in this regard. Keywords: Lumbar disk herniation; Signs and symptoms; Surgery

  19. Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis

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    Manchikanti L

    2012-07-01

    Full Text Available Laxmaiah Manchikanti, Kimberly A Cash, Vidyasagar Pampati, Yogesh MallaPain Management Center of Paducah, Paducah, KY, USABackground: While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%–50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain.Methods: A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain.Results: One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1 or local anesthetic mixed with nonparticulate betamethasone (group 2. The primary outcome of significant pain relief and improvement in functional status (≥50% was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 37–39 weeks in the successful group over a period of 52 weeks.Conclusion: Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain.Keywords: chronic neck pain, cervical disc herniation, cervical discogenic pain, cervical epidural injections, epidural steroids, local anesthetics

  20. Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation.

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    Sun, Dong; Liu, Peng; Cheng, Jie; Ma, Zikun; Liu, Jingpei; Qin, Tingzheng

    2017-04-20

    To assess the correlation between lumbar disc degeneration (LDD), multifidus muscle atrophy (LMA), and facet joints degeneration in patients with L4-L5 lumbar disc herniation (LDH). Sixty patients with L4-L5 LDH diagnosed by a 1.5 T MRI scanner were enrolled in the study group and another 60 patients with non-specific back pain were enrolled in the control group. LDD, LMA, and facet joints degeneration were examined and analyzed independently by two independent orthopedic surgeons using T2-weighted images. Wilcoxon test was used for analyzing the difference of LDD and facet joints degeneration between L3-L4 and L5-S1 and difference of LMA between the herniated and control groups. Correlation analysis of the three degeneration grades at the same level was determined by Spearman rank correlation test. In the herniated group, most LMA at L3-L4 level was grade 1 (42, 70.0%); grade 2 (33, 55.0%) at L4-L5 level; and grade 3 (27, 45.0%) at L5-S1 level. LMA and LDD grading were significantly different between L3-L4 and L5-S1 levels (P herniation group, the Spearman value for LDD and LMA grading were 0.352 (P  0.05) at the L5-S1 level. The differences in LMA between the herniated and control groups at the three levels were significant (P Disc degeneration and multifidus muscles atrophy were positively correlated at the L3-L4 disc level. A lumbar extension muscle strengthening program could be helpful in preventing muscle atrophy and lumbar spinal degeneration.

  1. Severe Intradural Lumbar Disc Herniation with Cranially Oriented Free Fragment Migration.

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    Tempel, Zachary; Zhu, Xiao; McDowell, Michael M; Agarwal, Nitin; Monaco, Edward A

    2016-08-01

    Intrathecal disc herniation is a rare but serious condition that has the potential to generate devastating neurologic deficits. We present a case of a 56-year-old man who developed cauda equina syndrome after several episodes of severe Valsalva maneuver. The patient was found to have developed subacute urinary retention and leg weakness. Magnetic resonance imaging findings were concerning for an unusual-appearing lesion extending cranially at L2-3. Urgent decompression via an L2 laminectomy, exploration, and subsequent discectomy was performed. The patient recovered exceptionally well, regaining bladder function and ultimately being able to ambulate without assistance. Cranially extending intrathecal disc herniations are a rare phenomenon and exceptionally uncommon above L3. The clinician should have a high level of suspicion for herniation when looking at the clinical and historical information consistent with such a diagnosis even in the presence of ambiguous imaging findings. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Higher preoperative Oswestry Disability Index is associated with better surgical outcome in upper lumbar disc herniations.

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    Saberi, Hooshang; Isfahani, Arash Vatankhahan

    2008-01-01

    To evaluate the surgical outcome in terms of functional and subjective recovery, patients who needed discectomies at L1-L2, L2-L3 and L3-L4 levels were compared with an age and sex-matched group of patients who required L4-L5 and L5-S1 discectomies. We prospectively enrolled 50 consecutive patients, referred to our center, who had L1-L2, L2-L3 and L3-L4 herniations and required surgical intervention. Likewise, a comparative group of 50 consecutive patients with herniations at L4-L5 and L5-S1 were selected. All 100 patients were treated and followed for a 1 year period. Physical examination findings as well as Oswestry Disability Questionnaire before surgery were recorded. After 1 year, patients were requested to fill the same questionnaire. Significant decline in the Oswestry Disability Index (ODI) scores was considered to be a measure of functional improvement and recovery. The mean age of patients with upper lumbar disc herniation (L1-L2, L2-L3, L3-L4) was 45.7 years and patients with lower lumbar disc herniation (L4-L5, L5-S1) had a mean age of 41.2 years. There was no statistically significant difference in age between the two groups. The preoperative Oswestry Disability (ODI) Index score had a statistically significant impact on ODI score improvement after surgery in both lower and upper lumbar disc groups. All 100 patients with either lower or upper lumbar disc herniation had statistically significant ODI change after surgical intervention (P disability (ODI of 21-40%) did not show significant improvement, while patients with ODI greater than 40% had significant reduction (P = 0.018). Surprisingly, as many as 25% of the former had even an increase in ODI scores after surgery. Gender was also a conspicuous factor in determining the surgical outcome of patients with upper lumbar disc herniation, and male patients had more reduction in ODI score than female patients (P = 0.007). Since the functional recovery in patients with herniated lumbar disc, especially

  3. Recurrent Lumbar Disc Herniation After Tubular Microdiscectomy: Analysis of Learning Curve Progression.

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    Staartjes, Victor E; de Wispelaere, Marlies P; Miedema, Johan; Schröder, Marc L

    2017-11-01

    Tubular microdiscectomy has become a staple technique among spine surgeons. Yet the associated learning curve, especially its later stages, has not been extensively studied. With studies reporting a higher rate of recurrent herniation using tubular microdiscectomy, surgeons' level of experience becomes of primary importance for the interpretation of such findings. We aimed to analyze possible improvements in the later stages of the learning curve and to identify factors independently associated with recurrent herniation. A retrospective study was conducted using prospectively collected data from a consecutive cohort of all 1241 patients operated for single-level lumbar disc herniation with tubular microdiscectomy by a single surgeon who already had extensive experience with this technique. We collected demographic and perioperative data and consequently tracked all complications, recurrent herniations, and other reoperations. In addition, 495 patients (40%) provided complete outcome scores on a numeric rating scale for back and leg pain and the Oswestry Disability Index at baseline, 6 weeks, and 12 months postoperatively. A decrease in surgical time (P herniations was observed (P = 0.012) over time. Increased leg pain at 6 weeks was independently associated with recurrent herniation (P = 0.01). Fifty-six patients (4.5%) experienced ipsilateral recurrent herniation. Relevant improvements in clinical results were seen even after the surgeon had already accumulated extensive experience. Any future studies should unambiguously report the level of experience of the participating surgeons, possibly including the number of cases previously treated using a particular technique. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Diagnostic accuracy of contemporary multidetector computed tomography (MDCT) for the detection of lumbar disc herniation

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    Notohamiprodjo, S.; Stahl, R.; Braunagel, M.; Kazmierczak, P.M.; Thierfelder, K.M.; Treitl, K.M.; Wirth, S. [University Hospital of Munich, LMU Munich, Institute for Clinical Radiology, Munich (Germany); Notohamiprodjo, M. [University Hospital Tuebingen, Eberhard Karls University Tuebingen, Diagnostic and Interventional Radiology, Tuebingen (Germany)

    2017-08-15

    To evaluate the diagnostic accuracy of multidetector CT (MDCT) for detection of lumbar disc herniation with MRI as standard of reference. Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNR) of cerebrospinal fluid (CSF), annulus fibrosus (AF) and the spinal cord (SC) were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence and accuracy in the diagnosis of lumbar disc herniation using MRI as standard of reference. Inter-reader correlation was assessed with weighted κ. Sensitivity, specificity, precision and accuracy of MDCT for disc protrusion were 98.8%, 96.5%, 97.1%, 97.8% (disc level), 97.7%, 92.9%, 98.6%, 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the discs. κ (>0.90) was excellent for both algorithms. MDCT of the lumbar spine yields high diagnostic accuracy for detection of lumbar disc herniation. IR improves image quality so that the provided diagnostic accuracy is principally equivalent to MRI. (orig.)

  5. The Relationship Between Morphology of Lumbar Disc Herniation and MRI Changes in Adjacent Vertebral Bodies

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    Hamed Reyhani Kermani

    2013-12-01

    Full Text Available Background: Intervertebral disc herniation has two common types, extrusion and protrusion, which may affect the adjacent vertebrae.In addition, it is associated with significant signal changes in T1 MRI (short TR/TE and T2 MRI (long TR/TE.   Methods: The present study is a cross-sectional analytic one, in which sampling was performed retrospectively. Cases were randomly selected from the patients undergoing discectomy in our department in a one-year period. Before surgery, MRI images, T1-weighted and T2-weighted sagittal cuts were interpreted by an expert radiologist. Signal intensity of the upper and the lower adjacent vertebra and the operated herniated disc were compared with the normal discs, both in T1-weighted and T2-weighted. Changes in signal intensity were recorded in qualitative variables. Statistical analysis was then performed between two groups. Results: In the present study, we have evaluated 170 patients undergoing lumbar disc herniation surgery, which included 97 protruded and 86 extruded discs. The patients’ age ranged from 21 to 78 years old, with an average of 43.03 ±11.4 years. Evaluating the type of discopathy with the presence of signal changes (hypo or hyper signal changes demonstrated more signal changes in upper adjacent vertebrae in T2-weighted MRI (45.3%. However, patients with protruded discs showed less changes (30.9%. It showed that the difference was statistically significant (P

  6. The Relationship Between Morphology of Lumbar Disc Herniation and MRI Changes in Adjacent Vertebral Bodies

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    Hamed Reyhani Kermani

    2013-12-01

    Full Text Available   Background: Intervertebral disc herniation has two common types, extrusion and protrusion, which may affect the adjacent vertebrae.In addition, it is associated with significant signal changes in T1 MRI (short TR/TE and T2 MRI (long TR/TE.   Methods: The present study is a cross-sectional analytic one, in which sampling was performed retrospectively. Cases were randomly selected from the patients undergoing discectomy in our department in a one-year period. Before surgery, MRI images, T1-weighted and T2-weighted sagittal cuts were interpreted by an expert radiologist. Signal intensity of the upper and the lower adjacent vertebra and the operated herniated disc were compared with the normal discs, both in T1-weighted and T2-weighted. Changes in signal intensity were recorded in qualitative variables. Statistical analysis was then performed between two groups. Results: In the present study, we have evaluated 170 patients undergoing lumbar disc herniation surgery, which included 97 protruded and 86 extruded discs. The patients’ age ranged from 21 to 78 years old, with an average of 43.03 ±11.4 years. Evaluating the type of discopathy with the presence of signal changes (hypo or hyper signal changes demonstrated more signal changes in upper adjacent vertebrae in T2-weighted MRI (45.3%. However, patients with protruded discs showed less changes (30.9%. It showed that the difference was statistically significant (P

  7. Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation

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    Sang Ho Moon

    2017-01-01

    Full Text Available Background. Lower back pain is a common reason for disability and the most common cause is lumbar disc herniation. Percutaneous epidural adhesiolysis has been applied to relieve pain and increase the functional capacity of patients who present this condition. Objectives. In this study, we retrospectively evaluated the factors which predict the outcome of percutaneous epidural adhesiolysis in patients who were diagnosed with lumbar disc herniation. Methods. Electronic medical records of patients diagnosed with lumbar disc herniation who have received percutaneous epidural adhesiolysis treatment were reviewed. The primary outcome was the factors that were associated with substantial response of ≥4 points or ≥50% of pain relief in the numerical rating scale pain score 12 months after the treatment. Results. Multivariate logistic regression analysis demonstrated that the presence of high-intensity zone (HIZ at magnetic resonance imaging was a predictor of substantial response to percutaneous epidural adhesiolysis for 12 months (P=0.007. The presence of a condition involving the vertebral foramen was a predictor for unsuccessful response after 12 months (P=0.02. Discussion and Conclusion. The presence of HIZ was a predictor of favorable long-term outcome after percutaneous epidural adhesiolysis for the treatment of lower back pain with radicular pain caused by lumbar disc herniation.

  8. Minimally invasive surgery for lumbar disc herniation: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Kamper, S.J.; Ostelo, R.W.J.G.; Rubinstein, S.M.; Nellensteijn, J.M.; Peul, W.C.; Arts, M.P.; van Tulder, M.W.

    2014-01-01

    Purpose: Assessing the benefits of surgical treatments for sciatica is critical for clinical and policy decision-making. To compare minimally invasive (MI) and conventional microdiscectomy (MD) for patients with sciatica due to lumbar disc herniation. Methods: A systematic review and meta-analysis

  9. Transforaminal Endoscopic Lumbar Discectomy for Lumbar Disc Herniation Causing Bilateral Symptoms.

    Science.gov (United States)

    Ren, Chunpeng; Li, Yin; Qin, Rujie; Sun, Penghao; Wang, Peng

    2017-10-01

    Transforaminal endoscopic lumbar discectomy (TELD), a minimally invasive spinal technique, has advantages over open discectomy. Unilateral TELD for disc herniation causing bilateral symptoms is challenging. In this study, we describe a percutaneous endoscopic herniotomy technique by using a unilateral approach for lumbar disc herniation with bilateral obvious symptoms. From June 2014 to October 2015, 26 patients who had back as well as bilateral leg pain and/or weakness due to lumbar disc herniation were treated by TELD with a unilateral approach. Clinical outcomes were evaluated via a visual analogue scale (VAS; 0-10), and functional status was assessed with the Oswestry Disability Index (0-100%) postoperatively and 3 and 12 months postoperatively. Surgical satisfaction rate was assessed during the final follow-up. The mean VAS for leg pain on the operative side improved from preoperative 8.39 ± 1.84 to 2.18 ± 1.26 postoperatively, 1.96 ± 0.83 at 3 months postoperatively, and 2.05 ± 1.42 at 1 year postoperatively (P disc herniation causing bilateral symptoms, through one working channel. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Does Duration of Preoperative Sciatica Impact Surgical Outcomes in Patients with Lumbar Disc Herniation?

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    Farzad Omidi-Kashani

    2014-01-01

    Full Text Available Background. In lumbar disc herniation, most authors recommend nonoperative treatment for the first few weeks of presentation, but what about the upper limit of this golden period? The aim of this study is to assess the effect of preoperative sciatica duration on surgical outcome of lumbar disc herniation. Methods. We retrospectively evaluated 240 patients (124 males and 116 females with a mean age of 36.4±5.9 years (range 16 to 63 surgically treated due to primary stable L4-L5 disc herniation. The patients were placed into two groups: with more and less than 12-month duration of preoperative sciatalgia. Disability and pain were measured by Oswestry Disability Index (ODI and Visual Analogue Scale (VAS. Wilcoxon test and Mann-Whitney U test were used for statistical analysis. Results. Total mean duration of preoperative sciatalgia and follow-up period were 13.3 months (range 2 to 65 and 33.7±5.1 months (range 24 to 72, respectively. Comparison between the groups showed that duration of preoperative sciatalgia either less or more than 12 months did not affect the surgical outcomes significantly. Conclusions. More or less than 12-month duration of preoperative sciatalgia may not affect the surgical outcomes of simple lumbar disc herniation in the patients undergoing discectomy.

  11. Posterior migration of lumbar disc herniation - imaging dilemma due to contrast contraindication: a case report

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    Fabrício Guimarães Gonçalves

    2012-06-01

    Full Text Available Disc herniation with posterior epidural migration is a rare and often symptomatic entity. Multiple are the natural barriers that prevent this pattern of migration. Enhanced magnetic resonance imaging is the diagnostic modality of choice in these cases. The diagnostic dilemma in this case was the contraindication to the use of contrast since the patient was known to have chronic renal failure.

  12. Spontaneous resorption of a herniated cervical disc in a dog detected by magnetic resonance imaging.

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    Raimondi, Francesca; Moreno-Aguado, Beatriz; Witte, Phil; Shihab, Nadia

    2017-08-01

    This report describes, for the first time in small animal literature, the spontaneous resorption of herniated Hansen type I intervertebral disc material in the cervical spine of a chondrodystrophic dog over a 4-month period, documented by magnetic resonance imaging. Clinical signs (cervical hyperpathia) responded to conservative treatment during the same period.

  13. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain.

    NARCIS (Netherlands)

    Windt, D.A.W.M. van der; Simons, E.; Riphagen, I.I.; Ammendolia, C.; Verhangen, A.P.; Laslett, M.; Devillé, W.; Deyo, R.A.; Bouter, L.M.; Vet, H.C.W. de; Aertgeerts, B.

    2010-01-01

    Background: Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care

  14. Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation : A prospective case series

    NARCIS (Netherlands)

    Gadjradj, Pravesh S.; van Tulder, Maurits W.; Dirven, Clemens M. F.; Peul, Wilco C.; Harhangi, B. Sanjay

    Objective Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies

  15. Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: A prospective case series

    NARCIS (Netherlands)

    P.S. Gadjradj (Pravesh S.); M.W. van Tulder (Maurits); C.M.F. Dirven (Clemens); W.C. Peul (Wilco); B.S. Harhangi (Biswadjiet)

    2016-01-01

    markdownabstract__Objective__ Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been

  16. Is the surgical outcome for lumbar disc herniation related to the duration of symptoms?

    DEFF Research Database (Denmark)

    Støttrup, Christian; Ernst, Carsten; Clemmensen, Dorte

    Background: Lumbar disc herniation (LDH) is associated with great morbidity and significant socio-economic impact in many parts of the world. Studies have shown that most LDH can be treated effectively with conservative management and the passage of time. However for the group of patients where...

  17. A Novel Combination of Percutaneous Endoscopic Lumbar Discectomy and Epiduroscopic Laser Neural Decompression for Down-migrated Disc Herniation.

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    Choi, Kyung-Chul; Lee, Dong Chan; Park, Choon-Keun

    2017-05-01

    Although percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment for herniated discs, its application in a disc with extensive migration is still challenging. As such, epiduroscopic laser neural decompression (ELND) provides a new view of the epidural space as well as an alternative treatment for a herniated disc and epidural fibrosis. In this paper the authors introduce the novel combination of PELD and ELND for high grade down-migrated disc herniation.An 87-year old woman presented with severe pain radiating down her leg due to high grade down-migrated disc herniation at L4-5. The therapeutic plan was organized into 3 steps. First, the patient underwent PELD to remove the paracentral extruded disc and open the epidural space between the traversing nerve root and disc space. Second, ELND was performed to remove the down-migrated disc and simultaneously push the free fragment to the L4-5 disc space. Lastly, repetitive free fragments were picked up and streamed upward using ELND. The patient reported significant reduction of pain after surgery. Postoperative magnetic resonance imaging (MRI) showed complete removal of the ruptured disc fragment. A combination of PELD and ELND may be an option of treatments for down-migrated disc herniation.

  18. Availability of Gd-DTPA enhanced MRI for lumbar disc herniation; Mechanism enhancing scar tissue around herniated disc and its meaning

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    Morita, Chisato; Yoshizawa, Hidezo; Nakai, Sadaaki; Kobayashi, Shigeru; Morita, Tomofumi; Kojima, Motohiro (Fujita Health Univ., Toyoake, Aichi (Japan))

    1994-05-01

    Extradural scar tissue arising between the herniated disk in the lumbar spine and its surrounding tissue was examined in 44 patients with lumbar disc herniation, using Gd-DTPA enhanced magnetic resonance imaging (MRI). Findings of enhanced MRI were divided into three types: that is, type 1 in which the surrounding of the herniated disk was not enhanced; type 2 in which it was partially enhanced; type 3 in which it was entirely enhanced. Of these 44 patients, 15 (34.1%) had type I, 22 (50.0%) had type 2 and 7 (15.9%) had type 3. Extradural scar tissue was seen as high signal intensity on T1-weighted images in 66%, revealing the extent of nerve root compression. Furthermore, 18 of the 44 patients underwent surgery and surgical findings were compared with types of MRI findings. According to MRI findings, these 18 patients consisted of 2 with type 1, 11 with type 2, and 5 with type 3. The two type 1 patients had subligamentous type; 9 type 2 patients had subligamentous type and the other 2 had transligamentous type; and the 5 type 3 patients had all sequestration type. Extradural scar tissue was microscopically shown to be composed of collagenic fibers containing many vessels and to be leakily neovascular structure associated with gap junction and fenestra. Enhanced MRI was capable of delineating the proliferation of extradural scar tissue surrounding the herniated disk easily, thus allowing the determination of pathological changes arising between the herniated disc and nerve root. (N.K.).

  19. Lumbosacral Transitional Vertebra: Possible Role in the Pathogenesis of Adolescent Lumbar Disc Herniation.

    Science.gov (United States)

    Zhang, Bangke; Wang, Liang; Wang, Haibin; Guo, Qunfeng; Lu, Xuhua; Chen, Deyu

    2017-11-01

    To investigate the role of lumbosacral transitional vertebra (LSTV) in the pathogenesis of adolescent lumbar disc herniation (ALDH) and the association between LSTV type and the herniation level of ALDH. This study was a retrospective case-control analysis of roentgenographic images. All adolescent patients who received surgical treatment for L4/5 or L5/S1 single level lumbar disc herniation in our department from 2010 to 2015 were eligible for the ALDH group. All adolescent patients admitted to our hospital during the same period and who had ever undergone a plain anteroposterior radiologic examination of the abdomen and met the inclusion criteria that ensured the absence of any spinal disorders were selected into the control group. The anteroposterior lumbar or abdomen roentgenograms were collected to identify the LSTV. The incidence of LSTV in the ALDH group and the control group were compared. Among the ALDH group, the association between LSTV type (sacralization or lumbarization) and the herniation level of ALDH were evaluated. A total of 80 adolescent patients were included in the ALDH group and 92 asymptomatic adolescents were included in the control group. LSTV was found in 24 patients (30%) in ALDH group compared with 7 patients (7.6%) in the control group (P adolescent patients with sacralization, the L4/5 disc herniation was significantly more common than L5/S1 (81.3% vs. 18.7%; P = 0.019). The LSTV is associated with LDH in adolescents and the sacralization of L5 may contribute to the L4/5 disc herniation in adolescent patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up

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    Kautiainen Hannu

    2007-01-01

    Full Text Available Abstract Background The overall rate of operations after recurrent lumbar disc herniation has been shown to be 3–11%. However, little is known about the rate of residives. Thus the aim of this study was to explore the cumulative rates of re-operations and especially residive disc herniations at the same side and level as the primary disc herniation after first lumbar disc herniation surgery and the factors that influence the risk of re-operations over a five year follow-up study. Methods 166 virgin lumbar disc herniation patients (mean age 42 years, 57% males were studied. Data on patients' initial disc operations and type and timing of re-operations during the follow-up were collected from patient files. Back and leg pain on visual analog scale and employment status were collected by questionnaires. Results The cumulative rate of re-operations for lumbar disc herniation was 10.2% (95% Cl 6.0 to 15.1. The rate of residives at initial site was 7.4% (95% Cl 3.7 to 11.3 and rate of lumbar disc herniations at other sites was 3.1% (95% Cl 0.6 to 6.2. The occurrence of residive lumbar disc herniations was evenly distributed across the 5 years. Neither age, gender, preoperative symptoms, physical activity nor employment had effect on the probability of re-operation. Conclusion Seven percent of the lumbar disc patients had a residive lumbar disc operation within five years of their first operation. No specific factors influencing the risk for re-operation were found.

  1. Diagnostic accuracy of contemporary multidetector computed tomography (MDCT) for the detection of lumbar disc herniation.

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    Notohamiprodjo, S; Stahl, R; Braunagel, M; Kazmierczak, P M; Thierfelder, K M; Treitl, K M; Wirth, S; Notohamiprodjo, M

    2017-08-01

    To evaluate the diagnostic accuracy of multidetector CT (MDCT) for detection of lumbar disc herniation with MRI as standard of reference. Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNR) of cerebrospinal fluid (CSF), annulus fibrosus (AF) and the spinal cord (SC) were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence and accuracy in the diagnosis of lumbar disc herniation using MRI as standard of reference. Inter-reader correlation was assessed with weighted κ. Sensitivity, specificity, precision and accuracy of MDCT for disc protrusion were 98.8%, 96.5%, 97.1%, 97.8% (disc level), 97.7%, 92.9%, 98.6%, 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the discs. κ (>0.90) was excellent for both algorithms. MDCT of the lumbar spine yields high diagnostic accuracy for detection of lumbar disc herniation. IR improves image quality so that the provided diagnostic accuracy is principally equivalent to MRI. • MDCT is an accurate alternative to MRI in disc herniation diagnosis. • By IR enhanced image quality improves MDCT diagnostic confidence similar to MRI. • Advances in CT technology contribute to improved diagnostic performance in lumbar spine imaging.

  2. The Relationship Between Morphology of Lumbar Disc Herniation and MRI Changes in Adjacent Vertebral Bodies

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    Kermani, Hamed Reyhani; Keykhosravi, Ehsan; Mirkazemi, Masoud; Ehsaei, Mohammad R

    2013-01-01

    Background: Intervertebral disc herniation has two common types, extrusion and protrusion, which may affect the adjacent vertebrae.In addition, it is associated with significant signal changes in T1 MRI (short TR/TE) and T2 MRI (long TR/TE). Methods: The present study is a cross-sectional analytic one, in which sampling was performed retrospectively. Cases were randomly selected from the patients undergoing discectomy in our department in a one-year period. Before surgery, MRI images, T1-weighted and T2-weighted sagittal cuts were interpreted by an expert radiologist. Signal intensity of the upper and the lower adjacent vertebra and the operated herniated disc were compared with the normal discs, both in T1-weighted and T2-weighted. Changes in signal intensity were recorded in qualitative variables. Statistical analysis was then performed between two groups. Results: In the present study, we have evaluated 170 patients undergoing lumbar disc herniation surgery, which included 97 protruded and 86 extruded discs. The patients’ age ranged from 21 to 78 years old, with an average of 43.03 ±11.4 years. Evaluating the type of discopathy with the presence of signal changes (hypo or hyper signal changes) demonstrated more signal changes in upper adjacent vertebrae in T2-weighted MRI (45.3%). However, patients with protruded discs showed less changes (30.9%). It showed that the difference was statistically significant (P<0.05). Conclusion: Extruded discs are associated with increased signal in T1-weighted MRI (short TR/TE) in the upper adjacent vertebrae. Signal changes in T2-weighted MRI (long TR/TE) in upper adjacent vertebrae are significantly more common in extruded discs, in comparison with protruded discs. PMID:25207294

  3. Structural brain alterations in patients with lumbar disc herniation: a preliminary study.

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    Michael Luchtmann

    Full Text Available Chronic pain is one of the most common health complaints in industrial nations. For example, chronic low back pain (cLBP disables millions of people across the world and generates a tremendous economic burden. While previous studies provided evidence of widespread functional as well as structural brain alterations in chronic pain, little is known about cortical changes in patients suffering from lumbar disc herniation. We investigated morphometric alterations of the gray and white matter of the brain in patients suffering from LDH. The volumes of the gray and white matter of 12 LDH patients were determined in a prospective study and compared to the volumes of healthy controls to distinguish local differences. High-resolution MRI brain images of all participants were performed using a 3 Tesla MRI scanner. Voxel-based morphometry was used to investigate local differences in gray and white matter volume between patients suffering from LDH and healthy controls. LDH patients showed significantly reduced gray matter volume in the right anterolateral prefrontal cortex, the right temporal lobe, the left premotor cortex, the right caudate nucleus, and the right cerebellum as compared to healthy controls. Increased gray matter volume, however, was found in the right dorsal anterior cingulate cortex, the left precuneal cortex, the left fusiform gyrus, and the right brainstem. Additionally, small subcortical decreases of the white matter were found adjacent to the left prefrontal cortex, the right premotor cortex and in the anterior limb of the left internal capsule. We conclude that the lumbar disk herniation can lead to specific local alterations of the gray and white matter in the human brain. The investigation of LDH-induced brain alterations could provide further insight into the underlying nature of the chronification processes and could possibly identify prognostic factors that may improve the conservative as well as the operative treatment of the

  4. The distribution of infection with Propionibacterium acnes is equal in patients with cervical and lumbar disc herniation.

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    Javanshir, Naghmeh; Salehpour, Firooz; Aghazadeh, Javad; Mirzaei, Farhad; Naseri Alavi, Seyed Ahmad

    2017-12-01

    Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation. A total of 145 patients with mean age of 45.21 ± 11.24 years who underwent micro-discectomy in cervical and lumbar regions were enrolled into the study. The samples were excited during the operation and then cultured in the anaerobic incubations. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction. In this study, 145 patients including 25 cases with cervical and 120 cases with lumbar disc herniation were enrolled to the study. There was no significant difference in the age of male and female patients (p = 0.123). P. acnes infection was detected in nine patients (36%) with cervical disc herniation and 46 patients (38.3%) with lumbar disc herniation and no significant differences were reported in P. acnes presence according to the disc regions (p = 0.508.). Moreover, there was a significant difference in the presence of P. acnes infection according to the level of lumbar disc herniation (p = 0.028). According to the results, the presence of P. acnes is equal in patients with cervical and lumbar disc herniation. There was a significant difference in the distribution of P. acnes infection according to level of lumbar disc herniation. II.

  5. The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

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    Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan))

    1991-05-01

    A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.).

  6. The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

    International Nuclear Information System (INIS)

    Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun

    1991-01-01

    A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.)

  7. Conus medullaris syndrome due to an intradural disc herniation: A case report

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    Chaudhary Kshitij

    2008-01-01

    Full Text Available A 70-year-old male patient developed acute paraplegia due to conus medullaris compression secondary to extrusion of D12-L1 disc. After negative epidural examination intraoperatively, a durotomy was performed and an intradural disc fragment was excised. Patient did not regain ambulatory status at two-year follow-up. Intraoperative finding of negative extradural compression, tense swollen dura and CSF leak from ventral dura should alert the surgeon for the possibility of intradural disc herniation. A routine preoperative MRI is misleading and a high index of suspicion helps to avoid a missed diagnosis.

  8. Circumferential dural resection technique and reconstruction for the removal of giant calcified transdural herniated thoracic discs.

    Science.gov (United States)

    Walker, Corey T; Kalani, M Yashar S; Oppenlander, Mark E; Godzik, Jakub; Martirosyan, Nikolay L; Standerfer, Robert J; Theodore, Nicholas

    2018-02-01

    OBJECTIVE The authors report a novel paradigm for resection of the disc or dural complex to treat giant calcified transdural herniated thoracic discs, and they describe a technique for the repair of dural defects. These herniated thoracic discs are uncommon, complicated lesions that often require a multidisciplinary team for effective treatment. The intradural component must be removed to effectively decompress the spinal cord. The opening of the friable dura mater, which frequently adheres to the extradural component of the disc, can result in large defects and difficult-to-manage CSF leaks. METHODS The authors performed a retrospective study of the technique and outcomes in patients with a transdural herniated disc treated at St. Joseph's Hospital and Medical Center within a 4-year period between 2012 and 2015. RESULTS During the study period, 7 patients (mean age 56.1 years) presented to the department of neurosurgery with clinical symptoms consistent with myeloradiculopathy. In all cases, 2-level corpectomies of the involved levels were combined with circumferential resection of the dura and complete decompression of the spinal cord. The dural defect was repaired with an onlay dural patch, and a large piece of AlloDerm (LifeCell Corp) graft was sewn to close the pleural defect. Every patient had a perioperative lumbar drain placed for CSF diversion. No patient suffered neurological decline related to the surgery, and 3 patients experienced clinically significant improvement in function. Two patients developed an early postoperative CSF leak that required operative revision to oversew the defects. CONCLUSIONS This novel technique for decompression of the spinal cord by dural resection for the removal of giant calcified transdural herniated thoracic discs is safe and results in excellent decompression of the spinal cord. The technique becomes necessary when primary repair of the dura is not possible, and it can be used in cases in which the resection of pathology

  9. Spontaneous Regression of Intervertebral Disc Herniation – Case Reports

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    Rapan, Saša; Gulan, Gordan; Lovrić, Ivan; Jovanović, Savo

    2011-01-01

    Lumbar disc hernia (LDH) is a common cause of low back pain and radicular leg pain. It is well known that the majority of LDH patients recover spontaneously. Since the advent of MRI, a spontaneous regression of fragment size of disc hernia occurs, as well as mitigation of subjective difficulties and neurological disorders. Therefore, surgical treatment is not always method of choice in this disease. Two cases of conservatively treated large disc extrusion which result in significant ...

  10. Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report

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    Yeung Jacky T

    2012-06-01

    Full Text Available Abstract Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

  11. Percutaneous bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation.

    Science.gov (United States)

    Zeng, Zhenhua; Yan, Min; Dai, Yi; Qiu, Weidong; Deng, Shuo; Gu, Xinzhu

    2016-08-01

    Lumbar disc herniation is usually managed with conservative treatment or surgery. However, conservative therapy seldom yields good results, and surgery is associated with multiple complications. This study aimed to assess bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation. A total of 168 patients with lumbar disc herniation suitable for radiofrequency thermocoagulation were enrolled and randomized to monopolar radiofrequency thermocoagulation (control group, n=84) or bipolar radiofrequency thermocoagulation (experimental group, n=84) treatment groups. Ablation sites were targeted under CT scan guidance, and consecutive radiofrequency therapy was used. One and two probes were used for monopolar and bipolar thermocoagulation, respectively. Thermocoagulation was achieved at 50°C, 60°C, and 70°C for 60s each, 80°C for 90s, and 92°C for 100s. Symptoms and complications were evaluated using the modified Macnab criteria and Visual Analog Scale at 7, 30, and 180days postoperatively. At 180days, a significantly higher efficacy rate was obtained in the experimental group compared with control patients (91.6% versus 79.7%, Pdisc herniation treatment, and should be further explored for broad clinical application. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Spontaneous Cervical Intradural Disc Herniation Associated with Ossification of Posterior Longitudinal Ligament

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    Dachuan Wang

    2014-01-01

    Full Text Available Intradural herniation of a cervical disc is rare; less than 35 cases have been reported to date. A 52-year-old man with preexisting ossification of posterior longitudinal ligament developed severe neck pain with Lt hemiparesis while asleep. Neurological exam was consistent with Brown-Séquard syndrome. Magnetic resonance images showed a C5-6 herniated disc that was adjacent to the ossified ligament and indenting the cord. The mass was surrounded by cerebrospinal fluid signal intensity margin, and caudally the ventral dura line appears divided into two, consistent with the “Y-sign” described by Sasaji et al. Cord edema were noted. Because of preexisting canal stenosis and spinal cord at risk, a laminoplasty was performed, followed by an anterior C6 corpectomy. Spot-weld type adhesions of the posterior longitudinal ligament to the dura was noted, along with a longitudinal tear in the dura. An intradural extra-arachnoid fragment of herniated disc was removed. Clinical exam at 6 months after surgery revealed normal muscle strength but persistent mild paresthesias. It is difficult to make a definite diagnosis of intradural herniation preoperatively; however, the clinical findings and radiographic signs mentioned above are suggestive and should alert the surgeon to look for an intradural fragment.

  13. The shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending.

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    Lan, Haw-Chang H; Chen, Han-Yu; Kuo, Li-Chieh; You, Jia-Yuan; Li, Wei-Chun; Wu, Shyi-Kuen

    2014-08-12

    Abnormal intervertebral movements of spine have been reported to be associated with trauma and pathological conditions. The importance of objective spinal motion imaging assessment in the frontal plane was frequently underestimated. The clinical evaluation of the segmental motion contribution could be useful for detecting the motion pattern of individual vertebrae. Therefore the purpose of this study was to investigate the shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending to provide additional insights to cervical biomechanics. A total of 92 subjects (46 healthy adult subjects and 46 disc-herniated patients) were enrolled in this case-control study. The motion images during cervical lateral bending movements were digitized using a precise image protocol to analyze the intervertebral motion and contribution. Our results showed that the intervertebral angulation during cervical lateral bending for the C2/3 to C6/7 segments were 7.66°±2.37°, 8.37°±2.11°, 8.91°±3.22°, 7.19°±2.29°, 6.31°±2.11°, respectively for the healthy subjects. For the patients with herniated disc, the intervertebral angulation for the C2/3 to C6/7 segments were 6.87°±1.67°, 7.83°±1.79°, 7.73°±2.71°, 5.13°±2.05°, 4.80°±1.93°, respectively. There were significant angulation and translational differences between healthy subjects and the patients with herniated disc in the C5/6 and C6/7 segments (P=0.001-0.029). The segmental contributions of the individual vertebral segments were further analyzed. There was a significant increase in segmental contribution ratio of C3/4 (P=0.048), while a significant decrease in contribution ratio of C5/6 (P=0.037) was observed in the patients with herniated disc. Our results indicated that the segmental contribution shifted toward the middle cervical spine in the patients with herniated disc. The segmental contributions of cervical spine during lateral bending movement were first

  14. [A Case of Central-Type Disc Herniation at the C7/T1 Level Presenting with Myelopathy].

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    Yunoki, Masatoshi; Kanda, Takahiro; Suzuki, Kenta; Uneda, Atsuhito; Hirashita, Koji; Yoshino, Kimihiro

    2017-03-01

    In contrast to other levels of upper disc spaces, the Luschka joints are usually absent at the C7/T1 disc space. Therefore, it has been reported that the C7/T1 disc herniation is prone to herniate laterally rather than centrally. In this manuscript, we describe an extremely rare central-type disc herniation at the C7/T1 level presented with myelopathy. A 76-year-old man presented with a 20-day history of progressive gait disturbance. Physical examination revealed bilateral lower extremity hyperreflexia and mild foot numbness with no upper extremity motor weakness or sensory disturbance. Cervical magnetic resonance imaging(MRI)revealed severe spinal cord compression at the C7/T1 level caused by a central-type disc herniation. We removed the herniated disc and performed anterior fusion with a titanium box cage. Lower extremity numbness and weakness diminished rapidly. Three weeks later, cervical MRI showed a well-decompressed spinal cord and almost normal gait. We reevaluated the preoperative computed tomography of this patient and confirmed the absence of Luschka joints at the C7/T1 level. Although the condition is rare, clinicians should consider the possibility of C7/T1 disc herniation in patients with leg weakness or numbness but no or few hand-related symptoms.

  15. Nucleus pulposus cells derived IGF-1 and MCP-1 enhance osteoclastogenesis and vertebrae disruption in lumbar disc herniation.

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    Zhu, Zhongjiao; Huang, Peng; Chong, Yanxue; George, Suraj K; Wen, Bingtao; Han, Na; Liu, Zhiqiang; Kang, Lixin; Lin, Nie

    2014-01-01

    Chronic strained lumbar disc herniation (LDH) cases were classified into bulging LDH, herniated LDH and prolapse LDH types according to imaging examination, and vertebrae disruptions were evaluated. Cytokines derived from the nucleus pulposus cells were detected, and their effects on osteoclastogenesis, as well as the mechanisms involved, were studied via an in vitro osteoclast differentiation system. To clarify the mechanisms of lumbar vertebrae resorption induced by lumbar herniation. Chronic strained lumbar disc herniation induced vertebrae erosion exacerbates quality of patients' life and clinical outcome. Although nucleus pulposus cells derived cytokines were reported to play an important role in this pathogenesis, the fundamental mechanisms underlying this process are still unclear. Chronic strained lumbar disc herniation patients were diagnosed with CT scan and T2-weighted magnetic resonance imaging. RNA was extracted from 192 surgical specimens of the herniated lumbar disc and 29 surgical excisions of the lumbar disc from spinal injury patients. The expressions of osteoclastogenesis related cytokines and chemokines were examined using real time PCR. Monocytes were induced into osteoclast with M-CSF and RANKL in vitro, while the IGF-1 and MCP-1 were added into the differentiation procedure in order to evaluate the effects and explore the molecular mechanisms. Vertebrae erosion had a positive relationship with lumbar disc herniation severity types. In all of the osteoclastogenesis related cytokines, the IGF-1 and MCP-1 were the most highly expressed in the nucleus pulposus cells. IGF-1 enhances activation of NF-kB signaling directly, but MCP-1 upregulated the expression of RANK, so that enhanced cellular sensitivity to RANKL resulted in increasing osteoclastogenesis and activity. Lumbar herniation induced overexpression of IGF-1 and MCP-1 in nucleus pulposus cells aggravated vertebral erosions. Hence, this study suggests that targeting osteoclastogenesis

  16. Nucleus pulposus cells derived IGF-1 and MCP-1 enhance osteoclastogenesis and vertebrae disruption in lumbar disc herniation

    Science.gov (United States)

    Zhu, Zhongjiao; Huang, Peng; Chong, Yanxue; George, Suraj K; Wen, Bingtao; Han, Na; Liu, Zhiqiang; Kang, Lixin; Lin, Nie

    2014-01-01

    Study design: Chronic strained lumbar disc herniation (LDH) cases were classified into bulging LDH, herniated LDH and prolapse LDH types according to imaging examination, and vertebrae disruptions were evaluated. Cytokines derived from the nucleus pulposus cells were detected, and their effects on osteoclastogenesis, as well as the mechanisms involved, were studied via an in vitro osteoclast differentiation system. Objective: To clarify the mechanisms of lumbar vertebrae resorption induced by lumbar herniation. Summary and background data: Chronic strained lumbar disc herniation induced vertebrae erosion exacerbates quality of patients’ life and clinical outcome. Although nucleus pulposus cells derived cytokines were reported to play an important role in this pathogenesis, the fundamental mechanisms underlying this process are still unclear. Methods: Chronic strained lumbar disc herniation patients were diagnosed with CT scan and T2-weighted magnetic resonance imaging. RNA was extracted from 192 surgical specimens of the herniated lumbar disc and 29 surgical excisions of the lumbar disc from spinal injury patients. The expressions of osteoclastogenesis related cytokines and chemokines were examined using real time PCR. Monocytes were induced into osteoclast with M-CSF and RANKL in vitro, while the IGF-1 and MCP-1 were added into the differentiation procedure in order to evaluate the effects and explore the molecular mechanisms. Results: Vertebrae erosion had a positive relationship with lumbar disc herniation severity types. In all of the osteoclastogenesis related cytokines, the IGF-1 and MCP-1 were the most highly expressed in the nucleus pulposus cells. IGF-1 enhances activation of NF-kB signaling directly, but MCP-1 upregulated the expression of RANK, so that enhanced cellular sensitivity to RANKL resulted in increasing osteoclastogenesis and activity. Conclusion: Lumbar herniation induced overexpression of IGF-1 and MCP-1 in nucleus pulposus cells aggravated

  17. Variants of ACAN are associated with severity of lumbar disc herniation in patients with chronic low back pain.

    Science.gov (United States)

    Perera, Romain Shanil; Dissanayake, Poruwalage Harsha; Senarath, Upul; Wijayaratne, Lalith Sirimevan; Karunanayake, Aranjan Lional; Dissanayake, Vajira Harshadeva Weerabaddana

    2017-01-01

    Disc herniation is a complex spinal disorder associated with disability and high healthcare cost. Lumbar disc herniation is strongly associated with disc degeneration. Candidate genes of the aggrecan metabolic pathway may associate with the severity of lumbar disc herniation. This study evaluated the association of single nucleotide variants (SNVs) of the candidate genes of the aggrecan metabolic pathway with the severity of lumbar disc herniation in patients with chronic mechanical low back pain. In addition, we assessed the in-silico functional analysis of the significant SNVs and association of their haplotypes with the severity of lumbar disc herniation. A descriptive cross sectional study was carried out on 106 patients. Severity of disc herniation and disc degeneration were assessed on T2-weighted mid sagittal lumbar MRI scan. Sixty two exonic SNVs of ten candidate genes of aggrecan metabolic pathway (ACAN, IL1A, IL1B, IL6, MMP3, ADAMTS4, ADAMTS5, TIMP1, TIMP2 and TIMP3) were genotyped on a Sequenom MassARRAY iPLEX platform. Multivariable linear regression analysis was carried out using PLINK 1.9 software adjusting for age, gender, body mass index and severity of disc degeneration. Four online bioinformatics tools (Provean, SIFT, PolyPhen and Mutation Taster) were used for in-silico functional analysis. Mean age was 52.42 ± 9.42 years and 69.8% were females. The mean severity of disc herniation was 2.81 ± 1.98. The rs2272023, rs35430524, rs2882676, rs2351491, rs938609, rs3825994, rs1042630, rs698621 and rs3817428 variants and their haplotypes of ACAN were associated with the severity of lumbar disc herniation. However, only the rs35430524, rs938609 and rs3817428 variants of ACAN were detected as pathogenic by in-silico functional analysis. SNVs of ACAN and their haplotypes are associated with the severity of lumbar disc herniation. Functional genetic studies are necessary to identify the role of these significant SNVs in the pathogenesis of disc herniation.

  18. Transforaminal Epidural Steroid Injections Followed by Mechanical Diagnosis and Therapy to Prevent Surgery for Lumbar Disc Herniation

    NARCIS (Netherlands)

    van Helvoirt, H.; Apeldoorn, A.T.; Ostelo, R.W.J.G.; Knol, D.L.; Arts, M.P.; Kamper, S.J.; van Tulder, M.W.

    2014-01-01

    Study Design: Prospective cohort study. Objective: To report the clinical course of patients with MRI-confirmed lumbar disc herniation-related radicular noncentralizing pain who received transforaminal epidural steroid injections (TESIs) and mechanical diagnosis and therapy (MDT). Summary of

  19. Surgical treatment of thoracic disc herniations using a modified transfacet approach

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    Xizhong Yang

    2014-01-01

    Full Text Available Background: Ideal surgical treatment for thoracic disc herniation (TDH is controversial due to variations in patient presentation, pathology, and possible surgical approach. Althougth discectomy may lead to improvements in neurologic function, it can be complicated by approach related morbidity. Various posterior surgical approaches have been developed to treate TDH, but the gold standard remains transthoracic decompression. Certain patients have comorbidities and herniation that are not optimally treated with an anterior approach. A transfacet pedicle approach was first described in 1995, but outcomes and complications have not been well described. The aim of this work was to evaluate the clinical effect and complications in a consecutive series of patients with symptomatic thoracic disc herniations undergoing thoracic discectomy using a modified transfacet approach. Materials and Methods: 33 patients with thoracic disc herniation were included in this study. Duration of the disease was from 12 days to 36 months, with less than 1 month in 13 patients. Of these, 15 patients were diagnosed with simple thoracic disc herniation, 6 were associated with ossified posterior longitudinal ligament, and 12 with ossified or hypertrophied yellow ligament. A total of 45 discs were involved. All the herniated discs and the ossified posterior longitudinal ligaments were excised using a modified transfacet approach. Laminectomy and replantation were performed for patients with ossified or hypertrophied yellow ligament. The screw-rod system was used on both sides in 14 patients and on one side in l9 patients. Results: 29 patients were followed up for an average of 37 months (range 12-63 months and 4 patients were lost to followup. Evaluation was based on Epstein and Schwall criteria.5 15 were classified as excellent and 10 as good, accounting for 86.21% (25/29; 2 patients were classified as improved and 2 as poor. All the patients recovered neurologically after

  20. Comparison of discectomy versus sequestrectomy in lumbar disc herniation: a meta-analysis of comparative studies.

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    Jisheng Ran

    Full Text Available Lumbar disc removal is currently the standard treatment for lumbar disc herniation. No consensus has been achieved whether aggressive disc resection with curettage (discectomy versus conservative removal of the offending disc fragment alone (sequestrectomy provides better outcomes. This study aims to compare the reherniation rate and clinical outcomes between discectomy and sequestrectomy by literature review and a meta-analysis.A systematic search of PubMed, Medline, Embase and the Cochrane Library was performed up to June 1, 2014. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, recurrent herniation rate and post-operative functional outcomes.Twelve eligible trials evaluating discectomy vs sequestrectomy were identified including one randomized controlled study, five prospective and six retrospective comparative studies. By contrast to discectomy, sequestrectomy was associated with significantly less operative time (p<0.001, lower visual analogue scale (VAS for low back pain (p<0.05, less post-operative analgesic usage (p<0.05 and better patients' satisfaction (p<0.05. Recurrent herniation rate, reoperation rate, intraoperative blood loss, hospitalization duration and VAS for sciatica were without significant difference.According to our pooled data, sequestrectomy entails equivalent reherniation rate and complications compared with discectomy but maintains a lower incidence of recurrent low back pain and higher satisfactory rate. High-quality prospective randomized controlled trials are needed to firmly assess these two procedures.

  1. Evaluation of epidural blockade as therapy for patients with sciatica secondary to lumbar disc herniation

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    Rogerio Carlos Sanfelice Nunes

    2016-08-01

    Full Text Available ABSTRACT OBJECTIVE: Sciatic pain secondary to lumbar disc herniation is a complex condition that is often highly limiting. The causes of pain in disc herniation are multifactorial. Two physiopathological mechanisms are involved in discogenic pain: mechanical deformation of nerve roots and a biochemical inflammatory component resulting from contact between the intervertebral disc and neural tissue, by way of the nucleus pulposus. The aim of this study was to evaluate the efficacy and safety of epidural blockade as therapy for bulging lumbar disc herniation. METHODS: A clinical study was conducted based on a retrospective and prospective survey. The blockade consisted of interlaminar puncture and bolus drug delivery. The number of procedures varied according to the clinical response, as determined through weekly evaluations and then 30, 90, and 180 days after the final session. A total of 124 patients who received one to five blockades were evaluated. RESULTS: The success rate (defining success as a reduction in sciatic pain of at least 80% was 75.8%. CONCLUSION: The results demonstrated the therapeutic action of epidural blockade over the short term, i.e. in cases of acute pain, thus showing that intense and excruciating sciatic pain can be relieved through this technique. Because of the multifactorial genesis of sciatica and the difficulties encountered by healthcare professionals in treating this condition, epidural blockade can become part of therapeutic arsenal available. This procedure is situated between conservative treatment with an eminently clinical focus and surgical approaches.

  2. [Percutaneous intradiscal oxygen-ozone injection for lumbar disc herniation: no need of perioperative antibiotic prophylaxis].

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    Wei, Chuan-jun; Li, Yan-hao; Chen, Yong; Wang, Jiang-yun; Zeng, Qing-le; Zhao, Jian-bo; Mei, Que-lin

    2007-03-01

    To evaluate the feasibility of no antibiotic administration to prevent infection during the perioperative period of percutaneous intradiscal ozone-injection for treatment of lumbar disc herniation. Seventy-two patients with lumbar disc herniation but normal body temperature as well as normal results of three routine tests (blood, urine, stool) and C-reactive protein (CRP) level were randomly divided into two groups. The patients in prophylaxis group were given cephalothin V(2.0 g) intravenous 30 min before the operation, and the control group did not use any antibiotics. All the patients were injected with 6-10 ml ozone (40 microg/ml) for medical use into the discs with 21G needles under fluoroscopic guidance, followed by 10 ml ozone into the paravertebral space. Three days later the general examinations and CRP measurement were repeated. No infection was found in these patients, nor were any significant differences noted in the results of the examinations between the two groups after controlling in patients with above-normal white blood cell count, neutrophil percentage and CRP level. Prophylaxis antibiotics is not necessary during the perioperative period of percutaneous intradiscal ozone injection for lumbar disc herniation.

  3. Ipsilateral atrophy of the psoas major muscle in patients with lumbar disc herniation

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    Makino, Takahiro; Hosono, Noboru; Mukai, Yoshihiro; Miwa, Toshitada; Fuji, Takeshi

    2009-01-01

    We measured the cross-sectional area (CSA) of the psoas major muscles of 48 male patients under 50 years of age with unilateral sciatica caused by a single-level lumbar disc herniation. Patients who had multi-level disc lesions, lumbar canal stenosis, spondylolisthesis, scoliosis>5deg, or a history of lumbar surgery or hip joint disease were excluded. Mean age at surgery was 33 years old. Two orthopedic surgeons measured the CSA independently and blindly on magnetic resonance images in which the spinal canal had been blacked out. The CSA ratio (pain-positive side/pain-negative side) was 0.99 at L3/4, 0.98 at L4/5, and 1.00 at L5/S. There was a statistically significant difference between the CSA of the psoas major muscle on the painful side and the unaffected side at L4/5 (p=0.02). There was no correlation between the CSA ratio and the angle in the straight leg raising test, the duration of symptoms, or the size of the disc herniation. The atrophy of the psoas major muscle observed on the pain-positive side in lumbar disc herniation patients may be attributable to disuse of the affected leg. (author)

  4. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

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    Koshi Ninomiya

    2014-01-01

    Full Text Available A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an “intact” disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted.

  5. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

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    Iwatsuki, Koichi; Ohnishi, Yu-ichiro; Yoshimine, Toshiki

    2014-01-01

    A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an “intact” disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted. PMID:25276453

  6. A rare case of concomitant cervical disc herniation and intradural meningioma treated with one-stage posterior surgery.

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    Hu, Xiaojian; Chen, Zhong; Wang, Yue

    2017-12-14

    Case report. To present a rare case of cervical disc herniation concomitant with intradural meningioma which was successfully treated using a single one-stage posterior surgery of tumor resection and transdural discectomy. Coexistence of symptomatic disc herniation and intra-spinal tumor in the same cervical segment is extremely rare. Usually, two-stage anterior and posterior surgeries are needed to treat two conditions, respectively. One-stage posterior surgery to treat two pathologies simultaneously has not been reported in the literature. A 76-year-old man presented with leg weakness and numbness for 6 months and left arm pain for 2 months. Contrast MR imaging revealed C3/4 intervertebral disc herniation and a hyperintense intradural lesion at the right portion of C3 canal. A one-stage posterior surgery, including C3/4 laminectomy, intradural tumor resection, transdural C3/4 discectomy, and C3/4 lateral mass instrumentation and fusion, was performed to treat two distinct pathologies together. The patient's arm pain and numbness disappeared right after the surgery and symptoms of myelopathy fully recovered at 6-month follow-up. Histological studies confirmed a herniated disc and a meningioma. In rare case, intradural tumor coexists with cervical disc herniation. When suspicious findings were noticed, or clinical symptoms cannot be fully explained, contrast MR imaging is helpful in differential diagnosis. Microscopic transdural discectomy is safe, and could be used as an optional procedure for cervical disc herniation in some cases.

  7. Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review.

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    Manchikanti, Laxmaiah; Benyamin, Ramsin M; Falco, Frank J E; Kaye, Alan D; Hirsch, Joshua A

    2015-06-01

    As part of a comprehensive nonsurgical approach, epidural injections often are used in the management of lumbar disc herniation. Recent guidelines and systematic reviews have reached different conclusions about the efficacy of epidural injections in managing lumbar disc herniation. In this systematic review, we determined the efficacy (pain relief and functional improvement) of the three anatomic approaches (caudal, lumbar interlaminar, and transforaminal) for epidural injections in the treatment of disc herniation. We performed a literature search from 1966 to June 2013 in PubMed, Cochrane library, US National Guideline Clearinghouse, previous systematic reviews, and cross-references for trials studying all types of epidural injections in managing chronic or chronic and subacute lumbar disc herniation. We wanted only randomized controlled trials (RCTs) (either placebo or active controlled) to be included in our analysis, and 66 studies found in our search fulfilled these criteria. We then assessed the methodologic quality of these 66 studies using the Cochrane review criteria for RCTs. Thirty-nine studies were excluded, leaving 23 RCTs of high and moderate methodologic quality for analysis. Evidence for the efficacy of all three approaches for epidural injection under fluoroscopy was strong for short-term (disc herniation in terms of pain relief and functional improvement. The available evidence suggests that epidural injections performed under fluoroscopy by trained physicians offer improvement in pain and function in well-selected patients with lumbar disc herniation.

  8. Value of CT in the evaluation of nerve root compression in the lumbar herniated disc disease: comparative study with myelography

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    Kim, Kun Il; Ku, Yong Woon; Sol, Chang Hyo; Kim, Byung Su [Pusan National University College of Medicine, Busan (Korea, Republic of)

    1988-04-15

    High resolution computed tomography is the most accurate diagnostic tool to define a lumbar herniated disc disease, because it provides a complete in vivo analysis of bony framework of lumbar spine as well as the supporting soft tissue structures and neural elements. The purpose of this study is to estimate the valve of CT in athe evaluation of nerve root compression caused by herniated disc disease. We analyzed 52 roots of 26 patients of single level herniated disc disease with definite evidence of bilateral or unilateral neurologic deficit who had both CT and myelography at Pusan National University Hospital from May 1983 to March, 1987. The results were as follows: 1. Sensitivity and specificity of CT is 77% and 81%, respectively in the diagnosis of nerve root compression caused by lumbar herniated disc disease. 2. Sensitivity and specificity of myelography is 77% and 81% respectively, in the diagnosis of nerve root compression caused by lumbar herniated disc disease. 3. The results of this study indicate that high resolution CT was equivalent to myelography in the diagnosis of nerve root compression caused by lumar herniated disc disease.

  9. Intraforaminal and Extraforaminal Far lateral Lumbar Disc Herniation ( A Review of 63 Cases

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    Hamed Kheradmand

    2008-08-01

    Full Text Available Background:Far lateral discal herniation is an uncommon disorder and is difficult to assess by physical examination alone. This study is designed to define clinical and epidemiological findings and to establish the indications of surgical and medical treatment for FLLDH. Methods:Between 2000 and 2005, a total of 2035 patients with lumbar disc herniation underwent surgical discectomy by the authors in several neurosurgical centers in Mashhad. Among these patients, 63 (3.1% had FLLDH (42 men and 21 women.Clinically these patients had unilateral radicular pain with or without paresis. SLR   was positive in 100% of cases. Conservative therapy consisting of bed rest,nonsteroidal anti-inflammatory drugs and physiotherapy had failed. We used a combination of classical interlaminar approach and the intertransverse route through a midline approach for the treatment of our patients.Results: From 63 cases in our series, 42 were men and 21 were women.19 patients had extraforaminal and 44 had foraminal disc herniation. The most common level for far lateral discal herniation was L4-L5. Our patients had LBP in 43.6% (27 cases and positive SLR and radicular leg pain in 100% (63 cases. In all patients leg pain was relieved immediately after surgery.   Conclusion: FLLDH should be considered in all cases with lower limb radiculopathy.These patients have more severe radicular pain than patients with paracentral lumbar disc herniation.FLLDH happens more frequently at L4-L5 and L3-L4 levels.It can often be difficult to diagnose or easily overlooked on radiographic studies.In almost all cases,conservative treatment is unsuccessful and surgical treatment is recommended.

  10. The clinical study of percutaneous disc decompression of treating herniation of cervical disc with Nd:YAG laser

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    Zhang, Dianxue; Cheng, Hefu; Wang, Jindong

    2005-07-01

    Objective: The possibility of PLDD (percutaneous laser disc decompression) and an ideal non-operative method which is long everlasting effect for PLDD was investigated. Methods: 159 patients of Cervical Disc Herniation with PLDD were studied. All the herniated discs were irradiated with 10­15J/S Nd:YAG laser quantum through optical-fiber under the supervision of C-arm X-ray. Results: All the patients were followed and reexamined CT or MRI after one to six months of PLDD. The result of cured (67.92%), excellent (24.53%), moderation (5.66%), non-effect (1.88%) was got. The excellent rate was 88.24%. The effective rate was 97.65%. Non-effective rate was 2.35%. Conclusion: When irradiated with Nd:YAG laser, the nucleus pulposus was vapouring, charring and coagulating. The volume and inner-pressure of the disc decreased. So the symptoms and signs improved. The main value of this methods were micro-damage, non-operation, no bleeding, no bone injury, good therapy effect, quick recovery, lesser pain, safety and excellent long everlasting effect. It is an ideal non-operative method of treating PLDD.

  11. Comprehensive comparison of therapeutic efficacy of radiofrequency target disc decompression and nucleoplasty for lumbar disc herniation: a five year follow-up.

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    Nie, Hui-Yong; Qi, Ya-Bin; Li, Na; Wang, Suo-Liang; Cao, Yong-Xiao

    2018-04-01

    To compare the therapeutic efficacy of radiofrequency target disc decompression(TDD) and nucleoplasty for lumbar disc herniation. Two hundred sixty patients with lumbar disc herniation were divided into two groups: target disc decompression group (group T, n = 147) and nucleoplasty group (group N, n = 113). Visual analogue scale (VAS) and functional rating index (FRI) were measured at one, three, six, 12, 24, and 60 months after the surgery. Hospitalization time, operation time, complications, and recurrence/invalid were compared between the two groups. Compared with the pre-operation, the VAS and FRI in both groups were significantly decreased in post-operation(P disc herniation and improve quality of life. Group N had shorter hospitalization and operation time than group T.

  12. Experimental chemonucleolysis with recombinant human matrix metalloproteinase 7 in human herniated discs and dogs.

    Science.gov (United States)

    Haro, Hirotaka; Nishiga, Miyuki; Ishii, Daisuke; Shimomoto, Takasumi; Kato, Tsuyoshi; Takenouchi, Osami; Koyanagi, Satoshi; Ohba, Tetsuro; Komori, Hiromichi

    2014-07-01

    Chemonucleolysis has been proposed as a less invasive technique than surgery for patients with lumbar disc herniation. Once chymopapain had been approved as a chemonucleolysis drug, it was withdrawn because of serious complications. A novel agent with fewer complications would be desirable. The purpose of this study was to investigate the effects of recombinant human matrix metalloproteinase 7 (rhMMP-7) in experimental chemonucleolysis in vitro and in vivo and examine its effects on tissue damage. The study design is the experimental study using human herniated discs and enzyme substrates in vitro and dogs in vivo. The effects of rhMMP-7 on the degradation of human herniated discs were examined by measuring the wet weight in vitro. The correlations between the decrease in wet weight by rhMMP-7 and the conditions associated with herniated discs were also analyzed. The effects of rhMMP-7 on the proteoglycan and water contents were respectively examined with alcian blue staining and T2-weighted magnetic resonance imaging at 7 days after intradiscal injection in dogs. The distribution of [125I]-labeled rhMMP-7 was investigated by autoradioluminography at 7 days after intradiscal injection in dogs. An epidural injection study with rhMMP-7 was performed to evaluate the effects on the tissue damage around the discs at 1 and 13 weeks after the treatment in dogs. The Type 1 and 2 collagen cleavage rates were measured and compared with those of aggrecan in vitro. Recombinant human matrix metalloproteinase 7 concentration dependently decreased the wet weight of herniated discs in vitro. The decrease in wet weight of the discs by rhMMP-7 did not significantly correlate with the conditions associated with herniated discs. Intradiscal injection of rhMMP-7 reduced the proteoglycan and water contents, with an increase in the serum keratan sulfate levels. Radioactivity of [125I]-labeled rhMMP-7 was detected in the nucleus pulposus and annulus fibrosus but not in the muscle

  13. A history of lumbar disc herniation from Hippocrates to the 1990s.

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    Truumees, Eeric

    2015-06-01

    In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with

  14. RESULTS OF TREATMENT OF ACUTE LUMBAR DISC HERNIATION WITH TRANSFORAMINAL NERVE ROOT BLOCK

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    EMILIANO NEVES VIALLE

    Full Text Available ABSTRACT Objective: To determine the efficacy of anesthetic transforaminal nerve root block in patients with sciatica secondary to lumbar disc herniation through a prospective observational study. Methods: The study included 176 patients from a private clinic undergoing transforaminal injection performed by a single spinal surgeon. The patients were assessed after two weeks, three months and six months regarding to the improvement of the pain radiating to the lower limbs. In case of persistent symptoms, patients could choose to perform a new nerve root block and maintenance of physical therapy or be submitted to conventional microdiscectomy. Results: By the end of six-month follow-up of the 176 patients, 116 had a favorable outcome (95 after one block and 21 after two blocks, and only 43 required surgery. Conclusion: The results of our study suggest a positive effect of transforaminal block for the treatment of sciatica in patients with lumbar disc herniation.

  15. Intervertebral disc and macrophage interaction induces mechanical hyperalgesia and cytokine production in a herniated disc model in rats.

    Science.gov (United States)

    Takada, Toru; Nishida, Kotaro; Maeno, Koichiro; Kakutani, Kenichiro; Yurube, Takashi; Doita, Minoru; Kurosaka, Masahiro

    2012-08-01

    The expression of proinflammatory factors such as tumor necrosis factor α (TNFα), interleukin-6 (IL-6), IL-8, and prostaglandin E(2) (PGE(2) ) is significantly correlated with the symptoms of herniated disc disease. Among the different types of immune cells, macrophages are frequently noted in the herniated disc tissue. We undertook this study to clarify the interaction of the intervertebral disc (IVD) and macrophages with regard to the production of TNFα, IL-6, IL-8, and PGE(2) . We developed 2 animal models to assess the interactions of IVDs with macrophages in terms of TNFα, IL-6, IL-8, and PGE(2) production and pain-related behavior. We also cocultured IVDs and macrophages to assess the role of TNFα in IL-6, IL-8, and PGE(2) production. IVD autografts induced TNFα, IL-6, IL-8, and cyclooxygenase 2 (COX-2) messenger RNA (mRNA) up-regulation; macrophage infiltration was seen shortly after the autograft was implanted. A significant decrease was noted in the mechanical threshold of the ipsilateral paw following the up-regulation of TNFα, IL-6, IL-8, and COX-2 mRNA. Only IVD and macrophage cocultures resulted in IL-8 and PGE(2) up-regulation. TNFα up-regulation was maximized before that of IL-6 and IL-8. TNFα neutralization attenuated production of IL-6 and PGE(2) , but not that of IL-8. Neutralization of TNFα and IL-8 significantly increased the paw withdrawal mechanical threshold in the IVD autograft and spinal nerve ligation model. IVD-macrophage interaction plays a major role in sciatica and in the production of TNFα, IL-6, IL-8, and PGE(2) . TNFα is required for IL-6 and PGE(2) production, but not for IL-8 production, during IVD-macrophage interaction. Neutralization of TNFα and IL-8 can be a valuable therapy for herniated disc disease. Copyright © 2012 by the American College of Rheumatology.

  16. Single level cervical disc herniation: A questionnaire based study on current surgical practices

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    Abrishamkar Saeid

    2009-01-01

    Full Text Available Background: Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons. Materials and Methods: About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed. Results: The mean age of enrolled surgeons was 51 yrs (range 45-73 with mean surgical experience of 16.9 yrs (range 12-40 yrs on single level cervical disc herniation. Out of 120 surgeons 10(8% had 15-25 years experience and always preferred fusion with or without instrumentation and six (five per cent with 17-27 yrs experience had never used fusion techniques. However, 104 (87% surgeons with 12-40 yrs experience had their own criteria based on their experiences for performing fusion with graft and instrumentation (FGI, while. 85 (75% preferred auto graft with cage. Conclusions: Most of surgeons performed FGI before the age of 40, but for others, patient criteria such as job (heavier job, physical examination (especially myelopathy and imaging findings (mild degenerative changes on X-ray and signal change in the spinal cord on MRI were considered significant for performing FGI.

  17. The effect of movement therapy on quality of life of patients after lumbar disc herniation surgery

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    Alimohammadi N

    2015-08-01

    Full Text Available Background and Objective: Patients after lumbar disc herniation surgery experience chronic pain and disability and can impact on their quality of life. This study aimed to determine the effect of movement therapy on quality of life of patients after lumbar disc herniation surgery. Materials and Method: The current clinical trial study with before and after design in three stages was done on patients with lumbar disc herniation surgery in one of the hospitals in Isfahan in 2013. Patients were selected through convenience sampling and then were randomly allocated into two intervention and control groups (32 patients in each group. The movement program was implemented 4 weeks after surgery for 2 weeks. Data were collected through demographic questionnaire and SF-36 quality of life questionnaire. Data were analyzed by SPSS-18 using independent t-test and repeated measures ANOVA. Results: There has been a significant increase in the mean of overall quality of life score in intervention group 6 weeks (65.2 ± 7.45 and 3 months after intervention (70.9 ± 8.2, in compare with before the intervention (31.5 ± 6.05 (p < 0.001. Also the mean of overall quality of life score showed the significant difference in two groups (p < 0.001. Physical and psychological aspects increased significantly in both groups in the period of 6 weeks and 3 months after intervention, the increase was greater in intervention group than control group. (p<0.001. Conclusion: Movement therapy promotes the quality of life of patients after lumbar disc herniation surgery. Thus, using this program by health care professionals in improving the quality of life of patients is recommended.

  18. Intradural lumbar disc herniation with intradural gas: report of three cases

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    Chung, Seung Eun; Lee, Sang Ho; Jo, Byung June [Wooridul Spine Hospital, Seoul (Korea, Republic of); Kim, Tae Hong [Inje University College of Medicine, Seoul (Korea, Republic of)

    2005-12-15

    This paper reports on three cases of an intradural lumbar disc herniation (IDLDH) that were diagnosed by a radiological examination. In all cases, an intradural vacuum (IDV) was detected on the CT scans, and the IDLDH showed iso- or lower signal intensity on the T2-weighted images. Enhanced MRI of one case revealed a small amount of air, but this was without enhancement. All the cases showed definite IDV on the CT scans, and this was an important clue for diagnosing IDLDH.

  19. Predictive outcome factors in the young patient treated with lumbar disc herniation surgery.

    Science.gov (United States)

    Strömqvist, Fredrik; Strömqvist, Björn; Jönsson, Bo; Gerdhem, Paul; Karlsson, Magnus K

    2016-10-01

    OBJECTIVE The aim of this study was to evaluate predictive factors for outcome after lumbar disc herniation surgery in young patients. METHODS In the national Swedish spine register, the authors identified 180 patients age 20 years or younger, in whom preoperative and 1-year postoperative data were available. The cohort was treated with primary open surgery due to lumbar disc herniation between 2000 and 2010. Before and 1 year after surgery, the patients graded their back and leg pain on a visual analog scale, quality of life by the 36-Item Short-Form Health Survey and EuroQol-5 Dimensions, and disability by the Oswestry Disability Index. Subjective satisfaction rate was registered on a Likert scale (satisfied, undecided, or dissatisfied). The authors evaluated if age, sex, preoperative level of leg and back pain, duration of leg pain, pain distribution, quality of life, mental status, and/or disability were associated with the outcome. The primary end point variable was the grade of patient satisfaction. RESULTS Lumbar disc herniation surgery in young patients normalizes quality of life according to the 36-Item Short-Form Health Survey, and only 4.5% of the patients were unsatisfied with the surgical outcome. Predictive factors for inferior postoperative patient-reported outcome measures (PROM) scores were severe preoperative leg or back pain, low preoperative mental health, and pronounced preoperative disability, but only low preoperative mental health was associated with inferiority in the subjective grade of satisfaction. No associations were found between preoperative duration of leg pain, distribution of pain, or health-related quality of life and the postoperative PROM scores or the subjective grade of satisfaction. CONCLUSIONS Lumbar disc herniation surgery in young patients generally yields a satisfactory outcome. Severe preoperative pain, low mental health, and severe disability increase the risk of reaching low postoperative PROM scores, but are only of

  20. How does surgery affect sexual desire and activities in patients with lumbar disc herniation?

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    Kanayama, Masahiro; Horio, Michiko; Umi, Yumi; Yamaguchi, Ai; Omata, Junichi; Togawa, Daisuke; Hashimoto, Tomoyuki

    2010-03-15

    A retrospective survey using privacy-conscious questionnaires. To determine the quality and frequency of sexual activities in patients with lumbar disc herniation before and after surgery. Patients and health care professionals often hesitate to talk about the effects of disease, illness, or surgery on sexuality, but it is imperative that sexuality issues be addressed. Of 90 consecutive patients, 64 who had surgically-treated lumbar disc herniation participated in this survey after informed consent. There were 43 males and 21 females with mean age of 36 years. Duration of symptom was averaged 42 weeks. The patients were asked to complete questionnaires concerning sexual desire, activity, adjustment, and satisfaction. About 83% of the patients had sexual desire, and 89% achieved satisfaction during sexual activities in presick period. Lumbar disc herniation decreased sexual desire in 50% and frequency of sexual activity in 59% of the patients. About 67% of males and 81% of females felt discomfort during sexual activity; satisfaction decreased in 28% of male and 41% of females. Adjustment in sexual position was required in 54% of males and 86% of females. Surgery improved sexual desire, frequency of sexual activity, and satisfaction in 85%, 88%, and 94%, respectively. However, 31% of females did not regain sexual desire and 46% still felt discomfort during sexual activity (the rates were 7% and 17% in males, respectively). Sexual activity was resumed within 2 postoperative weeks in 23% (27% in males and 14% in females), and 4 weeks in 53%. Males resumed sexual activity earlier than females. Lumbar disc herniation largely impacted sexual desire, activity, and satisfaction. Adjustment in sexual position was required in large number of patients to avoid discomfort during sexual activities. Surgical treatment improved quality of sexual activities, but more females did not regain sexual desire, felt sexual discomfort, and thereby resumed sexual activities later than males

  1. Proinflammatory cytokine expression profile in degenerated and herniated human intervertebral disc tissues.

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    Shamji, Mohammed F; Setton, Lori A; Jarvis, Wingrove; So, Stephen; Chen, Jun; Jing, Liufang; Bullock, Robert; Isaacs, Robert E; Brown, Christopher; Richardson, William J

    2010-07-01

    Prior reports document macrophage and lymphocyte infiltration with proinflammatory cytokine expression in pathologic intervertebral disc (IVD) tissues. Nevertheless, the role of the Th17 lymphocyte lineage in mediating disc disease remains uninvestigated. We undertook this study to evaluate the immunophenotype of pathologic IVD specimens, including interleukin-17 (IL-17) expression, from surgically obtained IVD tissue and from nondegenerated autopsy control tissue. Surgical IVD tissues were procured from patients with degenerative disc disease (n = 25) or herniated IVDs (n = 12); nondegenerated autopsy control tissue was also obtained (n = 8) from the anulus fibrosus and nucleus pulposus regions. Immunohistochemistry was performed for cell surface antigens (CD68 for macrophages, CD4 for lymphocytes) and various cytokines, with differences in cellularity and target immunoreactivity scores analyzed between surgical tissue groups and between autopsy control tissue regions. Immunoreactivity for IL-4, IL-6, IL-12, and interferon-gamma (IFNgamma) was modest in surgical IVD tissue, although expression was higher in herniated IVD samples and virtually nonexistent in control samples. The Th17 lymphocyte product IL-17 was present in >70% of surgical tissue fields, and among control samples was detected rarely in anulus fibrosus regions and modestly in nucleus pulposus regions. Macrophages were prevalent in surgical tissues, particularly herniated IVD samples, and lymphocytes were expectedly scarce. Control tissue revealed lesser infiltration by macrophages and a near absence of lymphocytes. Greater IFNgamma positivity, macrophage presence, and cellularity in herniated IVDs suggests a pattern of Th1 lymphocyte activation in this pathology. Remarkable pathologic IVD tissue expression of IL-17 is a novel finding that contrasts markedly with low levels of IL-17 in autopsy control tissue. These findings suggest involvement of Th17 lymphocytes in the pathomechanism of disc

  2. Effectiveness of epidural steroid injection for the management of symptomatic herniated lumbar disc.

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    Baral, B K; Shrestha, R R; Shrestha, A B; Shrestha, C K

    2011-12-01

    Low-back pain is a common clinical presentation of herniated lumbar disc. This is the most common presenting complain of the young adults. The incidence of low back pain is high in our part of the world. The reason may be hilly terrain, difficult working and living environment. The initial treatment of low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a simple, effective and minimally invasive treatment modality. The aim of this study is to assess the effectiveness of epidural steroid injection for low back and radicular pain. This is a Prospective observational study. It was carried out on the patients presenting with the complain of low back and radicular pain due to herniated lumbar disc not responding to conservative treatment. All the patients of herniated lumbar disc were proven by Magnetic Resonance Imaging (MRI). Injection Methyl prednisolone 80 mg and 2 ml of 0.5% bupivacaine was diluted in 8 ml of normal saline and injected into the affected lumbar epidural space. The functional status of the patient and the severity of pain were evaluated before injection and after injection during the follow-up period by using Ostrewy disability index and visual analogue score. Sixty two patients received the epidural steroid injections, but only fifty patients came for regular follow up till six months. Among the fifty patients, 26 were male and 24 were female. The functional status and pain response of the patients were improved significantly during all the follow-up periods (p herniated discs.

  3. No differences in post-operative rehabilitation across municipalities in patients with lumbar disc herniation

    DEFF Research Database (Denmark)

    Paulsen, Rune Tendal; Bergholdt, Erik; Carreon, Leah

    2015-01-01

    decompressive surgery for lumbar disc herniation were identified. Changes in Oswestry disability index (ODI), EuroQol-5D (EQ-5D) and duration of sick leave were compared among the municipalities. RESULTS: Patient-reported outcome measures showed no statistical difference in ODI, EQ-5D or sick leave at the one...... between hospital and rehabilitation unit to ensure the best possible patient treatment. Further studies should focus on the effect of rehabilitation. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

  4. Minimally invasive discectomy versus microdiscectomy/ discectomy for symptomatic lumbar disc herniation

    OpenAIRE

    Rahimi-Movaghar, Vafa; Rasouli, Mohammad; Shokraneh, Farhad; Moradi-lakeh, Maziyar; Vakaro, Alex; Sadeghi-Naini, Mohsen

    2012-01-01

    Abstract: Background: Lumbar discectomy is a surgery to remove all or part of a disc cushion that helps protect the spinal column. These cushions, called disks, separate the spinal vertebrae/bones. When one of the disks herniates (moves out of place) in patients with protruded disc, the soft gel inside pushes through the wall of the disk. The disk may then place pressure on the spinal cord and nerves that are coming out of the spinal column. The lumbar discectomy procedure remained basically ...

  5. Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations.

    Science.gov (United States)

    Alexandre, A; Corò, L; Azuelos, A; Buric, J; Salgado, H; Murga, M; Marin, F; Giocoli, H

    2005-01-01

    For disc herniations the use of open surgical approaches is reduced since new percutaneous methods allowing shrinkage of the disc and improvement of the radicular function are gaining interest. Studies on the spontaneous disappearance of disc fragments have demonstrated autoimmune responses with a chronic inflammatory reaction. Also radicular pain has been shown to be mostly due to biochemical mechanisms. Researchers in different fields surprisingly noticed that a brief, calculated, oxidative stress by ozone administration may correct a persistent imbalance due to excessive, chronic oxidative injury. Oxygen-ozone gas injection in painful patients has a dramatic effect on clinical symptoms. On these bases the intradiscal injection of oxygen-ozone gas has been conceived. We report the treatment on a series of patients affected by cervical disc pathology, treated by intradiscal injection of oxygen-ozone gas mixture. The effects both on pain and on radicular dysfunction are impressive. The morphological effect of the treatment was also evaluated by pathological examination.

  6. Psychometric evaluation of a decision quality instrument for treatment of lumbar herniated disc.

    Science.gov (United States)

    Sepucha, Karen R; Feibelmann, Sandra; Abdu, William A; Clay, Catharine F; Cosenza, Carol; Kearing, Stephen; Levin, Carrie A; Atlas, Steven J

    2012-08-15

    Retrospective and prospective patient surveys and a physician survey using a sample from American Medical Association master file. To evaluate the performance of a new instrument designed to measure the quality of decisions about treatment of herniated disc. There is growing consensus on the importance of engaging and informing patients to improve the quality of significant medical decisions, yet there are no instruments currently available to measure decision quality. The herniated disc-decision quality instrument (HD-DQI) was developed with input from clinical experts, survey research experts, and patients. The HD-DQI produces 2 scores each scaled to 0% to 100%, with higher scores indicating better quality: (1) a total knowledge score and (2) a concordance score (indicating the percentage of patients who received treatments that matched their goals). We examined hypotheses relating to the acceptability, feasibility, validity, and reliability of the instrument, using data from 3 samples. The HD-DQI survey was feasible to implement and acceptable to patients, with good response rates and low missing data. The knowledge score discriminated between patients who had seen a decision aid or no decision aid (55% vs. 38%, P herniated disc. More work is needed to examine acceptability for use as part of routine patient care.

  7. Relationship between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation.

    Science.gov (United States)

    Taspinar, Ferruh; Taspinar, Betul; Ozkan, Yasemin; Afsar, Emrah; Gul, Canan; Durmaz, Elif Dilara

    2016-06-17

    Lumbar disc herniation leads to disability by restricting of patients' lives and reducing their quality of life. This situation causes a decrease in motivation of patients by triggering depressive mood. Therefore, the aim of the study was investigation of correlation between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation. Totally forty-seven patients (24 male and 23 female patients) diagnosed lumbar disc herniation was included in this study. Maslach II Burnout Inventory (MBI) and Fear Avoidance Beliefs Questionnaire (FABQ) for determining of levels of burnout and fear avoidance level were used, respectively. It was observed that MBI and FABQ scores of the patients were 50.78 ± 10.07 and 36.61 ± 13.91, respectively. Moderate level correlation was found between FABQ and MBI total scores (r= 0.49, p= 0.00). Fear avoidance beliefs of patients with chronic back pain can affect level of burnout syndrome. Therefore, symptoms of burnout syndrome and fear avoidance beliefs of patients should be considered in evaluation and treatment process.

  8. Primary immune system responders to nucleus pulposus cells: evidence for immune response in disc herniation

    Directory of Open Access Journals (Sweden)

    K Murai

    2010-01-01

    Full Text Available Although intervertebral disc herniation and associated sciatica is a common disease, its molecular pathogenesis is not well understood. Immune responses are thought to be involved. This study provides direct evidence that even non-degenerated nucleus pulposus (NP cells elicit immune responses. An in vitro colony forming inhibition assay demonstrated the suppressive effects of autologous spleen cells on NP cells and an in vitro cytotoxicity assay showed the positive cytotoxic effects of natural killer (NK cells and macrophages on NP cells. Non-degenerated rat NP tissues transplanted into wild type rats and immune-deficient mice demonstrated a significantly higher NP cell survival rate in immune-deficient mice. Immunohistochemical staining showed the presence of macrophages and NK cells in the transplanted NP tissues. These results suggest that even non-degenerated autologous NP cells are recognized by macrophages and NK cells, which may have an immunological function in the early phase of disc herniation. These findings contribute to understanding resorption and the inflammatory reaction to disc herniation.

  9. The Relationship between Lifestyle and Pain in Patients with Spinal Disc Herniation

    Directory of Open Access Journals (Sweden)

    Monireh Dadashzadeh

    2016-12-01

    Full Text Available Due to the rapid growth of the industries and constantly involvement of the new technologies into the human lives, the lifestyles of the people are altering. Simultaneously few new disorders in their lifestyles and diseases in their lives are also emerging. The spinal cord abnormalities i.e., the spinal disc herniation and/or low back pain is one of them which have made the life of some people very miserable (Farahani et al., 2012. Indeed the overall lifestyle of a human being regulates the musculoskeletal symptoms. Differences in lifestyle and psychosocial factors associated with individuals' lifestyle are effective in experiencing the level of pressure in musculoskeletal systems. Studies related to the lifestyle and musculoskeletal system, including pain and inflammation, are largely correlate (Mikkonen et al., 2015. Proper knowledge regarding the relationship between lifestyle and spinal disc herniation is very important. Social habits such as diet, exercise, weight gain, anxiety, and depression can cause changes in the spinal cord and spinal disc herniation (Kadow et al., 2014. Further, some of the lifestyle parameters such as smoking, nutrition, BMI, level of activity, sleep status, stress, and anxiety are also seen to reduce the need for medication or avoid and reduce musculoskeletal pain (Dean et al., 2015. As per Bohman et al. (2014 people with a healthy lifestyle suffer 66% less from low back pain than those who have unhealthy lifestyles.

  10. [Manipulative reduction for lumbar intervertebral disc herniation: a controlled clinical trial].

    Science.gov (United States)

    Zhang, Wei-bin; Cao, Yu; Sun, Yong-an; Wang, Chun-sheng; Wang, Ying; Dong, Shi-long; Ren, Guo-zhong; Yang, Ying-xin; Zhang, Jing-zhong

    2008-04-01

    To investigate the effects of manipulative reduction on pain and clinical curative effect in patients with lumbar intervertebral disc herniation. Eleven thousands one hundred and twenty-eight patients with lumbar intervertebral disc herniation from our hospital were enrolled from November 1986 to June 2007. They were randomly divided into control group and treatment group. Patients of the control group received lumbar traction and various physiotherapies. Patients of the treatment group received manipulative reduction, besides the treatment in the control group. The treatment was performed once a day,ten times as a course. Curative effects were assessed three courses later. Pain was evaluated by visual analogue scale before and after the treatment. No significant difference in the score of visual analogue scale was found before the treatment in the two groups (P > 0.05). As compared with the score before treatment,it was decreased by 4.73 points after treatment in the control group, and decreased by 6.37 points in the treatment group. The decrease was more significant in the treatment group than the control group (P Manipulative reduction for lumbar intervertebral disc herniation can remarkably relieve lumbar pain and improve clinical curative effect.

  11. Impact of Obesity and Underweight on Surgical Outcome of Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Farzad Omidi-Kashani

    2014-01-01

    Full Text Available Background. The relationship between underweight and lumbar spine surgery is still unknown. Aim. To evaluate the effect of underweight versus obesity based on surgical outcome of lumbar disc herniation. Material and Method. In this retrospective study, we evaluated 206 patients (112 male and 94 female with a mean age of 37.5±3.1 years old (ranged 20–72 who have been surgically treated due to the refractory simple primary L4-L5 disc herniation. We followed them up for a mean period of 42.4±7.2 months (ranged 24–57. We used Body Mass Index (BMI, Oswestry Disability Index (ODI, and Visual Analogue Scale (VAS for categorization, disability, and pain assessment, respectively. We used Wilcoxon and Mann-Whitney U tests for statistics. Results. Surgical discectomy in all weight groups was associated with significant improvement in pain and disability, but intergroup comparison showed these improvements in both underweight and obese groups and they were significantly lower than in normal weight group. Excellent and good satisfaction rate was also somewhat lower in both these ends of weight spectrum, but statistically insignificant. Conclusion. Both obesity and underweight may have adverse prognostic influences on the surgical outcome of lumbar disc herniation, although their impact on subjective satisfaction rate seems to be insignificant.

  12. [The delayed OP--indications for surgery of lumbar disc herniations].

    Science.gov (United States)

    Mayer, H M

    2005-01-01

    In Germany, lumbar disc herniations require surgical treatment in about 50,000 patients/year. The clinical and socio-economical results are determined by the preoperative duration of symptoms and preoperative time out of work (highly predictive). Other parameters such as severity of neurological deficits, morphology of disc herniation, age, associated diseases, type of surgery, working conditions or litigation processes are only weak predictors of outcome. Postoperative improvement of clinical symptoms as well as professional reintegration is strongly determined by the time period between onset of symptoms and surgery. Surgery performed "too early" diminishes the chance for improvement by conservative therapy. If surgery is performed "too late" the risk of a bad result is high, and the reintegration of the patient into his preoperative social and professional activities may be prevented. The duration of conservative therapy including so-called semi-invasive procedures is critical in this sense. If a therapeutic success (= professional and social reintegration) cannot be achieved by conservative measures and if there is a clear morphological correlate (= disc herniations with corresponding clinical symptoms) of the clinical symptoms an early change of the strategy towards surgical therapy is recommended.

  13. Combination of Magnetic Resonance Imaging and Electrophysiological Studies in Lumbar Disc Herniation.

    Science.gov (United States)

    Zhong, Wenxiang; Wang, Jichao; Zhang, Wenchuan; Liu, Pengfei; Visocchi, Massimiliano; Li, Shi-Ting

    2017-01-01

    Objective We aimed to study the clinical value of magnetic resonance imaging (MRI) and electrophysiological studies in the diagnosis of lumbar disc herniation and in the evaluation of the therapeutic effect of discectomy. Methods In this study, 265 patients with LDH were treated with discectomy after assessment by the Japanese Orthopedic Association (JOA) score, MRI, and electrophysiological studies. All the patients were followed-up for 6 years. The effects of the operation were assessed by determining the angle between the nerve root canal and disc protrusion (AN value), the stenotic ratio of the spinal canal, the width of the lateral recess, motor conduction velocity (MCV), sensory conduction velocity (SCV), and nerve action potential (NAP) before and after operation. Results The AN value, stenotic ratio of the spinal canal, and the width of the lateral recess of protruding intervertebral discs showed significant differences from these values for the patients' unaffected intervertebral discs (P disc herniation, and in the evaluation of the effect of surgery.

  14. A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation

    Directory of Open Access Journals (Sweden)

    Masatoshi Morimoto

    2016-01-01

    Full Text Available A lesion of the lumbar posterior endplate is sometimes identified in the spinal canal of children and adolescents; it causes symptoms similar to those of a herniated disc. However, the pathology of the endplate lesion and the pathology of the herniated disc are different. We present a rare case of a 23-year-old woman who developed progressive palsy of the lower leg caused by huge lumbar posterior endplate lesion after recurrent disc herniation.

  15. A potential role of thymic stromal lymphopoietin in the recruitment of macrophages to mouse intervertebral disc cells via monocyte chemotactic protein 1 induction: implications for herniated discs.

    Science.gov (United States)

    Ohba, Tetsuro; Haro, Hirotaka; Ando, Takashi; Koyama, Kensuke; Hatsushika, Kyosuke; Suenaga, Fumiko; Ohnuma, Yuko; Nakamura, Yuki; Katoh, Ryohei; Ogawa, Hideoki; Hamada, Yoshiki; Nakao, Atsuhito

    2008-11-01

    To determine whether thymic stromal lymphopoietin (TSLP) plays a role in the resorption of herniated disc tissue. The expression of TSLP messenger RNA (mRNA) and protein in mouse intervertebral disc cells was assessed by quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assay (ELISA), and immunohistochemical analysis. The ability of mouse intervertebral disc cells to respond to TSLP stimulation was examined by Western blot analysis, ELISA, and protein array analysis. Intracellular signaling pathways involved in TSLP signaling in mouse intervertebral disc cells were investigated using several chemical inhibitors. The role of TSLP in macrophage migration into the intervertebral disc was assessed by in vitro migration assay. Finally, TSLP expression in clinical specimens derived from patients with a herniated disc was examined by immunohistochemistry. Mouse intervertebral disc cells expressed TSLP mRNA and protein upon stimulation with NF-kappaB-activating ligands such as tumor necrosis factor alpha. In addition, the mouse intervertebral disc cells expressed the TSLP receptor and produced monocyte chemotactic protein 1 (MCP-1; CCL2) and macrophage colony-stimulating factor in response to TSLP stimulation. Both anulus fibrosus and nucleus pulposus intervertebral disc cells expressed MCP-1 upon TSLP stimulation, which was mediated via the phosphatidylinositol 3-kinase/Akt pathway. Consistently, the supernatants of TSLP-activated intervertebral disc cultures had the capacity to induce macrophage migration in an MCP-1-dependent manner. Finally, TSLP and MCP-1 were coexpressed in human herniated disc specimens in which macrophage infiltration into the tissue was observed. TSLP induced by NF-kappaB-activating ligands in intervertebral discs may contribute to the recruitment of macrophages to the intervertebral disc by stimulating MCP-1 production and may be involved in the resorption of herniated disc tissue.

  16. Mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation.

    Science.gov (United States)

    Kayhan, Fatih; Albayrak Gezer, İlknur; Kayhan, Ayşegül; Kitiş, Serkan; Gölen, Mustafa

    2016-01-01

    We investigated the prevalence of mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation and the relationships between pain and mood, and anxiety disorders. In total, 149 patients with disc herniation and 60 healthy subjects were included. Disc herniation was diagnosed based on a physical examination and magnetic resonance imaging. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. The mean age of the study subjects (n = 209) was 45.96 ± 11.45 years. Seventy (46.6%) patients with disc herniation met the criteria for at least one mood or anxiety disorder. The prevalence rates of mood and anxiety disorders were 16.6% and 35.8%, respectively. The most common specific diagnoses were major depression (n = 25, 16.9%) and generalised anxiety disorder (n = 19, 12.8%). Mood and anxiety disorders were more commonly seen in patients with lumbar or cervical disc herniation than in those without herniation. No relationship was detected between pain severity and mood or anxiety disorders. However, mood and anxiety disorders were associated with neurological deficits.

  17. Molecular profile of major growth factors in lumbar intervertebral disc herniation: Correlation with patient clinical and epidemiological characteristics

    Science.gov (United States)

    Tsarouhas, Alexandros; Soufla, Giannoula; Tsarouhas, Konstantinos; Katonis, Pavlos; Pasku, Dritan; Vakis, Antonis; Tsatsakis, Aristides M.; Spandidos, Demetrios A.

    2017-01-01

    The involvement of growth factors (GFs) in the pathogenesis of lumbar intervertebral disc (ID) herniation and the spontaneous resorption of herniated ID fragments remains only partially elucidated. A simultaneous assessment of the transcript levels of numerous GFs and their association with clinical and epidemiological profiles of human ID herniation would provide valuable insight into the biology and clinical course of the disease. In the present study, we examined simultaneously the transcript levels of vascular endothelial growth factor (VEGF), transforming growth factor β1 (TGF-β1), basic fibroblast growth factor 2 (bFGF2), platelet derived growth factor (PDGF) isoforms and receptors, epidermal growth factor (EGF) and insulin growth factor-1 (IGF-1) in herniated and control ID specimens and investigated their correlation with the clinicopathological profiles of patients suffering from symptomatic lumbar ID herniation. GF mRNA expression levels were determined by RT-qPCR in 63 surgical specimens from lumbar herniated discs and 10 control ID specimens. Multiple positive correlations were observed between the transcript levels of the GFs examined in the ID herniation group. VEGF mRNA expression was significantly increased in the protruding compared with the extruded discs. Intense and acute pain significantly upregulated the PDGF transcript levels. Significant negative correlations were observed between the patient body mass index and the transcript levels of VEGF and PDGF receptors. Our findings support the hypothesis of the involvement of GFs in the natural history of ID herniation. GFs synergistically act in herniated IDs. Increased VEGF expression possibly induces the neovascularization process in the earliest stages of ID herniation. PDGF-C and -D play a role in the acute phase of radiculopathy in a metabolic response for tissue healing. A molecular effect, in addition to the biomechanical effect of obesity in the pathogenesis of ID herniation is also

  18. Degenerative disc disease of herniated intervertebral discs is associated with extracellular matrix remodeling, vimentin-positive cells and cell death.

    Science.gov (United States)

    Loreto, Carla; Musumeci, Giuseppe; Castorina, Alessandro; Loreto, Corrado; Martinez, Giuseppa

    2011-03-01

    We studied patients with degenerative disc disease (DDD) to demonstrate that i) remodeling of the extracellular matrix (ECM) in the intervertebral disc (IVD), particularly the elastic fiber system, of subjects with herniated discs is dysregulated and that ii) it is accompanied by accelerated elastin degradation due to increased expression of matrix metalloprotease-9 (MMP-9). Moreover we wanted to obtain a deeper insight into the pathogenesis of DDD through the study of ECM calcification, DNA fragmentation using TUNEL analysis, BAX, bcl-2 and vimentin immunopositive cells. We studied herniated discs from patients of three age groups (group 1=30-40 years; group 2=40-50 years; and group 3=50-65 years) to evaluate the oxytalan fiber systemMMP-9, apoptosis and vimentin immunopositive cells. The results demonstrated the presence of oxytalan fibers in the annulus fibrosus (AF) and the nucleus pulposus (NP) of herniated discs. In the AF oxytalan fibers replaced disrupted mature elastic fibers in calcified areas, while in the NP they were mostly found in nests at the periphery of chondrocytes. MMP-9 was prevalently observed in NP nests above all in group 1 and group 3 discs while group 2 exhibited a lower MMP-9 immunostaining. Activation of the apoptotic process was demonstrated by upregulated BAX expression in group 3. BAX immunopositivity was inversely mirrored by a significant decrease in bcl-2 expression. Intermediate filament protein vimentin was strongly expressed only in group 1 samples. A large number of apoptotic TUNEL+ cells was observed in group 3 specimens. The presence of oxytalan fibers may be the result of a process of incomplete elastogenesis, or a response to mechanical stress trying to functionally replace the lack of elastic fibers. MMP-9 expression seems to relate to disc damage, while chondrocyte BAX upregulation and TUNEL+ cell staining revealed apoptosis activation regardless of patient age. Vimentin immunopositivity was clearly detected in group 1

  19. A REVIEW OF 3200 CASES 0F HERNIATED LUMBAR DISC

    OpenAIRE

    A. ALIMOHAMMADI

    1987-01-01

    I t 1S a t t emted t o reV1ew 3200 c a s e s of herniat ed lumbar d isc t o point out the i ndic a tions for ope ra t i o n , the value o f myelog raphy . t he r esult o f ope rat ion and the caus e s o f comp l i cat i ons . We believe tha t myelography s houl d be performed i n a l most a ll patients. I n ne a rl y"n96 .8 pe rcent of cases my e l o grams co r r e s pond to clinical f i ndings. In general when there is clear s igns and s ympt oms of dis c disease , con fi rmed r adiolo ...

  20. Driving reaction time before and after surgery for disc herniation in patients with preoperative paresis.

    Science.gov (United States)

    Thaler, Martin; Lechner, Ricarda; Foedinger, Bernhard; Haid, Christian; Kavakebi, Pujan; Galiano, Klaus; Obwegeser, Alois

    2015-05-01

    The effect of many types of surgeries on driving reaction time (DRT) has been reported. Although lumbar disc herniation is one of the most common spinal diseases, the effect on DRT has not been investigated. To assess the effect of left- and right-sided pareses caused by lumbar disc herniation on DRT before and after surgery. Controlled prospective clinical trial. Patients undergoing disc surgery. Impact of paresis caused by lumbar disc herniation and disc surgery on DRT. Forty-two consecutive patients (mean age, 50.3 years) were tested for DRT 1 day before surgery, postoperatively before hospital discharge, and 5 weeks after surgery. Visual analogue scale (VAS) for back and leg pain as well as pain medication and patients' driving frequency were recorded. Significant improvement of DRT after surgery was seen in patients with left- and right-sided pareses (p<.005). For the right-sided paresis group, the preoperative DRT was 761 ms (median, interquartile range [IQR]: 490), 711 ms (median, IQR: 210) immediately postoperatively, and 645 ms (median, IQR: 150) at follow-up (FU). For the left-sided paresis group, DRT was 651 ms (median, IQR: 270) preoperatively, 592 ms (median, IQR: 260) postoperatively, and 569 ms (median, IQR: 140) at FU. Significant differences between right- and left-sided pareses were identified preoperatively and at FU testing (p<.005). No correlation was found between VAS for leg or back pain and DRT. Historical control subjects had a DRT of 487 (median, IQR: 116), which differed significantly at all three test times (p<.001). A significant reduction in DRT in patients with right- and left-sided pareses was found after surgery, indicating a positive effect of surgery. The improvement in DRT seen immediately postoperatively and the lack of a generally accepted threshold for DRT would suggest that for both patient samples, it is safe to continue driving after hospital discharge. However, patients should be informed accordingly. Copyright © 2015

  1. Percutaneous treatment of herniated lumbar disc by intradiscal oxygen-ozone injection.

    Science.gov (United States)

    Muto, M; Avella, F

    1998-12-20

    We report our experience of treating lumbar herniated disc by intradiscal injection of an oxygen-ozone mixture. Ozone (03, MW = 48) is a triatomic molecule, having antiviral, disinfectant and antiseptic properties. Several mechanisms of action have been proposed to explain the efficacy of the treatment: 1) analgesic action; 2) anti-inflammatory action; 3) oxidant action on the proteoglycan in the nucleus pulposus. We treated 93 patients (50 women, 43 men) aged from 24 to 45 yrs (average age 38 yrs) from June 1996 to April 1998. All patients presented sciatica and/or low back pain, lasting two or more months; patients had in the mean time received both medical and physical therapy with mild or no benefit. Diagnostic tests in all patients included plain film x-ray, CT and/or MR at the level of the lumbar spine disclasing a herniated or protruded disc with nerve root or thecal sac compression. We divided patients to be treated in to two groups: the first one group included 35 patients already selected for surgery who presented herniated or protruded disc with radicular pain with associated neurological deficit (hypoesthesia and partial loss of reflex). Those patients had already had medical and physical therapy for two or more months and agreed to try the percutaneous treatment before surgery. CT or MR in this group demonstrated the presence of intraforaminal, extra or sub-ligamentary and sequestrated herniated disc. The second group included 58 patients with radicular pain but without neurological deficit; patients in this group had received medical and/or physical therapy for two or more months and CT showed the presence of a small subligamentary herniated or protruded disc. We considered the results according to the modified MacNab method. In the first group we had "failure" in all patients; in seven cases the symptoms improved for one month, but recurred later on. In the second group 45 patients had "success" showing complete clinical recovery within five to six

  2. Surgery versus Nerve Blocks for Lumbar Disc Herniation : Quantitative Analysis of Radiological Factors as a Predictor for Successful Outcomes.

    Science.gov (United States)

    Kim, Joohyun; Hur, Junseok W; Lee, Jang-Bo; Park, Jung Yul

    2016-09-01

    To assess the clinical and radiological factors as predictors for successful outcomes in lumbar disc herniation (LDH) treatment. Two groups of patients with single level LDH (L4-5) requiring treatment were retrospectively studied. The surgery group (SG) included 34 patients, and 30 patients who initially refused the surgery were included in the nerve blocks group (NG). A visual analogue scale (VAS) for leg and back pain and motor deficit were initially evaluated before procedures, and repeated at 1, 6, and 12 months. Radiological factors including the disc herniation length, disc herniation area, canal length-occupying ratio, and canal area-occupying ratio were measured and compared. Predicting factors of successful outcomes were determined with multivariate logistic regression analysis after the optimal cut off values were established with a receiver operating characteristic curve. There was no significant demographic difference between two groups. A multivariate logistic regression analysis with radiological and clinical (12 months follow-up) data revealed that the high disc herniation length with cutoff value 6.31 mm [odds ratio (OR) 2.35; confidence interval (CI) 1.21-3.98] was a predictor of successful outcomes of leg pain relief in the SG. The low disc herniation length with cutoff value 6.23 mm (OR 0.05; CI 0.003-0.89) and high baseline VAS leg (OR 12.63; CI 1.64-97.45) were identified as predictors of successful outcomes of leg pain relief in the NG. The patients with the disc herniation length larger than 6.31 mm showed successful outcomes with surgery whereas the patients with the disc herniation length less than 6.23 mm showed successful outcomes with nerve block. These results could be considered as a radiological criteria in choosing optimal treatment options for LDH.

  3. Molecular effects of chondroguard in osteoarthritis and herniated discs

    Directory of Open Access Journals (Sweden)

    A. M. Lila

    2017-01-01

    Full Text Available Chondroitin sulfates (CS are a building material for the cartilage and have anti-inflammatory and antioxidant effects. The paper gives the results of analyzing the pharmaceutical composition of chondroguard and its pharmaceutical substance CS-BIOACTIVE (CS-BIOACTIVE©Bioiberika S.A.U., Spain. It discusses the molecular-physiological mechanisms of action of CS in intervertebral disc extrusions and protrusions.

  4. A REVIEW OF 3200 CASES 0F HERNIATED LUMBAR DISC

    Directory of Open Access Journals (Sweden)

    A. ALIMOHAMMADI

    1987-05-01

    Full Text Available I t 1S a t t emted t o reV1ew 3200 c a s e s of herniat ed lumbar d isc t o point out the i ndic a tions for ope ra t i o n , the value o f myelog raphy . t he r esult o f ope rat ion and the caus e s o f comp l i cat i ons . We believe tha t myelography s houl d be performed i n a l most a ll patients. I n ne a rl y"n96 .8 pe rcent of cases my e l o grams co r r e s pond to clinical f i ndings. In general when there is clear s igns and s ympt oms of dis c disease , con fi rmed r adiolo gically, i n the hand of an e xpo r t surgeon. in 93 percent the result will be excel e nt .

  5. Akt/PKB isoforms expression in the human lumbar herniated disc: correlation with clinical and MRI findings.

    Science.gov (United States)

    Pasku, Dritan; Soufla, Giannoula; Katonis, Pavlos; Tsarouhas, Alexandros; Vakis, Antonis; Spandidos, Demetrios A

    2011-10-01

    Intervertebral disc (IVD) degeneration suggests a complex process influenced by genetics, lifestyle and biomechanics, which accounts for the development of low back pain (LBP) and lumbar radiculopathy, a major cause of musculoskeletal disability in humans. The family of Akt/PKB kinases is a principal mediator in the signal transduction pathways, which contribute to transcriptional regulation, cell growth, proliferation, apoptosis, and survival ability. The purpose of this study was to evaluate the transcriptional profile of the AKT family genes in human herniated discs and the involvement of the PI3K-Akt signaling pathway in human IVD degeneration. Real-time PCR analysis was used to assess the mRNA expression pattern of the three Akt/PKB isoforms in 63 herniated and 10 control disc specimens. Our results showed a significant positive correlation between AKT1 and AKT3 mRNA in herniated discs suggesting a synergistic action between these isoforms in disc herniation. Interestingly, AKT2 mRNA was up-regulated in patients with acute pain during the first 12 months, indicating that AKT2 transcriptional activation may be associated with acute rather than chronic inflammation and phagocytosis. Finally, Akt1/PKB transcription presented a stepwise activation as disc herniation deteriorated. Our findings provide evidence on the transcriptional activation of the Akt/PKB pathway indicating that it is involved in lumbar disc degeneration. There is need for further studies to elucidate the exact role and down-stream signaling action of Akt/PKB isoforms in the pathogenesis of lumbar disc herniation.

  6. Diagnostics and therapy of spinal disc herniation; Diagnostik und Therapie des Bandscheibenvorfalls

    Energy Technology Data Exchange (ETDEWEB)

    Zimmer, A.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2014-11-15

    Degenerative processes in a movement segment of the vertebral column, which can potentially give rise to herniation of elements of the nucleus pulposus, are complex and of variable clinical and radiological dimensions; however the mere assumption that degenerative changes precede disc herniation remains a matter of debate. By definition, spinal disc herniation (SDH) refers to components of the gelatinous nucleus pulposus protruding beyond the dorsal level of the vertebral body margin through tears in the annulus fibrosus. Clinical presentation may include pain, paresis and sensory disturbances. Magnetic resonance imaging (MRI) is considered the gold standard in the diagnosis of SDH. In the majority of patients a conservative approach with physical therapy exercises and adequate analgesic and antiphlogistic medical treatment results in a substantial improvement of symptoms. (orig.) [German] Degenerative Prozesse eines Bewegungssegments, die in einem Prolaps des Nucleus pulposus resultieren koennen, sind vielschichtig und von unterschiedlicher klinischer und radiologischer Auspraegung. Selbst die Annahme, dass Bandscheibenvorfaellen eine Degeneration vorangeht, ist keineswegs unumstritten. Definitionsgemaess spricht man von einem Bandscheibenvorfall (BSV), wenn das Gewebe des gelatinoesen Nucleus pulposus durch eine Dehiszenz im Anulus fibrosus ueber das Niveau der normalen dorsalen Begrenzung des Bandscheibenfachs hinaus prolabiert. Klinisch kann dies mit Schmerzen, Paresen und Sensibilitaetsstoerungen einhergehen. Die Magnetresonanztomographie gilt als Goldstandard in der Diagnostik eines BSV. In der Mehrzahl der Faelle fuehrt ein konservatives Vorgehen zu einer deutlichen Besserung der Symptomatik im Verlauf. (orig.)

  7. Serum lipid levels are positively correlated with lumbar disc herniation--a retrospective study of 790 Chinese patients.

    Science.gov (United States)

    Zhang, Yuedong; Zhao, Yunpeng; Wang, Mei; Si, Meng; Li, Jingkun; Hou, Yong; Jia, Jialin; Nie, Lin

    2016-04-18

    Abnormal serum lipid levels have been shown to be associated with the occurrence of atherosclerosis, but little is known about the relationships of them with the risk of developing intervertebral disc degeneration (IVDD) in Chinese population. We performed a case-control study to assess the relationship between serum lipid levels and lumbar disc degeneration. A total of 790 Chinese patients were recruited for this study at the time of hospitalization. We examined fasting serum lipid levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). 396 patients (235 men and 161 women; mean age: 41.07 years) underwent surgery for single-level lumbar disc herniation. A control group of 394 patients (225 men and 169 women; mean age: 42.1 years) underwent surgery for wounded lower limbs during the same period. Patients in the control group were collected randomly from among patients who were age- and sex-matched patients with the case group. Patients with lumbar disc herniation had significantly higher TC and LDL-C serum concentrations (P disc herniation group (P = 0.017, P = 0.002, P = 0.039, P =0.002 and P disc herniation (P disc herniation, in which odds ratio (OR) was 1.462 and confidence interval (CI) was 1.179 ~ 1.813. Moreover, patients with High-TG and borderline High-LDL-C had a higher probability of disc herniation (OR: 2.974, CI: 1.488 ~ 5.945, statistical power: 100%; OR: 1.626, CI: 1.012 ~ 2.612, statistical power: 61.4%, respectively). However, hyperlipidaemia did not seem to be associated with the herniated segment of the lumbar intervertebral disc (p = 0.374). The present study suggests that dyslipidaemia may be associated with a higher risk of developing lumbar disc herniation. Serum lipid levels could be a useful predictor for intervertebral disc degeneration in Chinese population.

  8. The impact of psychiatric comorbidity on the return to work in patients undergoing herniated disc surgery.

    Science.gov (United States)

    Zieger, Margrit; Luppa, Melanie; Meisel, Hans Jörg; Günther, Lutz; Winkler, Dirk; Toussaint, René; Stengler, Katarina; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G

    2011-03-01

    This study examines (1) return to work (RTW) and ability to work (ATW) rates, and the association with (2) psychiatric comorbidity and (3) socio-demographic, illness-related, vocational and rehabilitation-related characteristics in herniated disc surgery patients. In this longitudinal observational study 305 consecutive patients took part in face-to-face interviews during hospital stay. 277 patients also participated in a 3-month follow-up survey via telephone (drop-out rate 9%). Psychiatric comorbidity was assessed with the Composite International Diagnostic Interview (CIDI-DIA-X). Calculations were conducted via Chi-Square tests, independent T-tests and binary logistic regression analyses. 40.1% of the herniated disc patients in this study were able to RTW, 44.4% had regained their ATW 3 months after surgery. Psychiatric comorbidity appeared to be an important risk factor for RTW and ATW. Other risk factors were lower educational qualification, unemployment status, a lower subjective prognosis of gainful employment, a higher number of herniated discs in medical history, cervical disc surgery, and the existence of other chronic diseases, a longer hospital stay and higher pain intensity. Patients who did not RTW, or did not regain their ATW participated more often in inpatient rehabilitation. Identifying a high risk group for RTW and ATW at an early age is of utmost importance for the purpose of improving rehabilitation effects and to make a return to the work place easier. Specific interventions, such as social-medical counselling, pain therapy and management, as well as the assistance of mental health professionals during hospital and rehabilitation treatment are recommended for this risk group.

  9. MR findings of the transligamentous type of the herniated lumbar disc

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Byung Chul; Kim, Dong Ik; Yoon, Choon Sik; Suh, Jung Ho [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    1994-03-15

    The purpose of this study is to describe the findings of the transligamnetous type of the herniated lumbar disc (HLD) with magnetic resonance MR imaging. We retrospectively analyzed the MR images of surgically proven 20 cases of transligamentous type of HLD from January 1, 1992 to August 20, 1992. The MR imaging was performed with 1.0T MR unit, using sagittal spin echo (SE) and axial gradient echo (GE) techniques. The results were as follows; 1) the interruption of black line of the posterior longitudinal ligament (PLL) was identified in 19 levels and 17 levels in sagittal SE and axial GE images, retrospectively; 2) the widening of adjacent epidural fat space was demonstrated in 16 cases of central or posterolateral HLD. The herniated disc material, as compared with the parent intervertebral disc, showed intermediate signal intensity (SI) in 19 and low SI in 1 level on T1WI, high SI in 10, intermediate SI in 7, low SI in levels on T2WI, and high SI in 10, intermediate SI in 9, low SI in 1 level on GE images. The most important sign of the transligamentous type HLD on MRI was the interruption of the black line with additional finding of the widening of adjacent epidural fat space. The MR signal intensity of the herniated disc was variable. Axial GE image was valuable for the evaluation of the direction of HLD and it relationship with neural structure, but had no addiational information for the degree and biochemical change of HLD over SE image.

  10. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion

    OpenAIRE

    Ninomiya, Koshi; Iwatsuki, Koichi; Ohnishi, Yu-ichiro; Ohkawa, Toshika; Yoshimine, Toshiki

    2014-01-01

    A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to...

  11. Application of percutaneous cervical nucleoplasty using the navigable disc decompression device in patient of cervical herniated intervertebral disc: a case report.

    Science.gov (United States)

    Lim, Ji-Hoon; Lee, Hye-Jin; Lee, Sang-Heon

    2013-10-01

    Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.

  12. Cervical disc herniation. Follow-up studies on morphological changes seen by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Nagata, Kensei; Ohashi, Teruaki; Ishibashi, Kazumasa; Abe, Jun; Morita, Masakazu; Hirohashi, Akiyuki; Satou, Kimiaki; Ishida, Hyota; Inoue, Akio [Kurume Univ., Fukuoka (Japan). School of Medicine

    1996-03-01

    In recent years, many authors have reported that an extruded lumbar intervertebral disc was absorbed through phagocytosis and dehydration. However, absorption of an extruded cervical intervertebral disc has rarely been reported. We have investigated the follow-up MRI of all 24 patients with cervical disc herniation seen between 1991 and 1995. Of these, 8 patients with radiculopathy and 7 with myelopathy had been treated nonoperatively, and a further 9 patients with severe myelopathy had undergone expansive laminoplasty. In follow-up MRI, a reduction in the size of the extruded disc was seen in 5 of the 15 nonoperative patients and in 8 of the 9 operative patients. The 9 operative patients showed a mean recovery rate of 68.4{+-}15.2% (range from 44 to 90%) according to their JOA score. In the nonoperative group, recovery of symptoms was seen in all 5 patients with reduction, and in only 4 of 10 patients with nonreduction. The initial MRI of the 5 patients with reduction was taken between 2 and 7 weeks (mean 4 weeks) after onset, and between 1 month and 14 years (mean 13 months, not including the one at 14 years) after onset in the 10 patients with nonreduction. The initial MRI of the 9 operative patients was taken between 1 month and 6 years (mean 14 months after onset). The pathomechanism for disc reduction was concluded to have been the same as for lumbar disc herniation in the nonoperative patients. However, the pathomechanism in the operative patients was inconclusive and was likely to be different from that in the nonoperative patients. (author).

  13. Cervical disc herniation. Follow-up studies on morphological changes seen by MRI

    International Nuclear Information System (INIS)

    Nagata, Kensei; Ohashi, Teruaki; Ishibashi, Kazumasa; Abe, Jun; Morita, Masakazu; Hirohashi, Akiyuki; Satou, Kimiaki; Ishida, Hyota; Inoue, Akio

    1996-01-01

    In recent years, many authors have reported that an extruded lumbar intervertebral disc was absorbed through phagocytosis and dehydration. However, absorption of an extruded cervical intervertebral disc has rarely been reported. We have investigated the follow-up MRI of all 24 patients with cervical disc herniation seen between 1991 and 1995. Of these, 8 patients with radiculopathy and 7 with myelopathy had been treated nonoperatively, and a further 9 patients with severe myelopathy had undergone expansive laminoplasty. In follow-up MRI, a reduction in the size of the extruded disc was seen in 5 of the 15 nonoperative patients and in 8 of the 9 operative patients. The 9 operative patients showed a mean recovery rate of 68.4±15.2% (range from 44 to 90%) according to their JOA score. In the nonoperative group, recovery of symptoms was seen in all 5 patients with reduction, and in only 4 of 10 patients with nonreduction. The initial MRI of the 5 patients with reduction was taken between 2 and 7 weeks (mean 4 weeks) after onset, and between 1 month and 14 years (mean 13 months, not including the one at 14 years) after onset in the 10 patients with nonreduction. The initial MRI of the 9 operative patients was taken between 1 month and 6 years (mean 14 months after onset). The pathomechanism for disc reduction was concluded to have been the same as for lumbar disc herniation in the nonoperative patients. However, the pathomechanism in the operative patients was inconclusive and was likely to be different from that in the nonoperative patients. (author)

  14. Mini-open Anterior Lumbar Interbody Fusion for Recurrent Lumbar Disc Herniation Following Posterior Instrumentation.

    Science.gov (United States)

    Mamuti, Maiwulanjiang; Fan, Shunwu; Liu, Junhui; Shan, Zhi; Wang, Chongyan; Li, Shengyun; Zhao, Fengdong

    2016-09-15

    A retrospective study. The aim of this study is to evaluate, clinically and radiographically, the efficacy of mini-open retroperitoneal anterior lumbar discectomy followed by anterior lumbar interbody fusion (ALIF) for recurrent lumbar disc herniation following primary posterior instrumentation. Recurrent disc herniation following previous disc surgery occurs in 5 to 15% of cases. This is often treated by further surgical intervention where posterior approach is generally preferred. However, posterior surgery may be problematic if the initial surgery involved posterior instrumentation. An anterior approach may be indicated in these patients, and recent findings suggest that a "mini-open" procedure may have some benefits when compared with traditional open techniques and their associated morbidities. A total of 35 recurrent lumbar disc herniation patients (10 male, 25 female) following primary posterior instrumentation with an average age of 52.8 years (range: 34-70 yrs) who underwent the mini-open ALIF procedures between August 2001 and February 2012 were evaluated retrospectively. The ALIF was performed at the levels L4-L5 (n = 14), L5-S1 (n = 15), or both L4-L5 and L5-S1 (n = 6). Visual Analog pain Scale (VAS) and Oswestry Disability Index (ODI) together with radiological results were assessed. The mean operating time, intraoperative estimated blood loss, and hospital stay were 115 minutes, 70 mL, and 6 days, respectively. No blood transfusion was needed. Transient complication was recorded in two patients. Postoperative follow-up was a minimum 24.3 months. VAS score and ODI percentage decreased significantly from 7.9 ± 0.8 and 78.8% ± 12.4% pre-operatively to 1.4 ± 0.6 and 21.7 ± 4.2% at final follow-up, respectively. There was no neurological worsening and radicular pain improved significantly compared with pre-operation in all the patients. Computed tomographic reconstruction 12 and 24 months after surgery showed bony fusion

  15. Significance of Gd-DTPA enhanced MRI in lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Hijikuro, Taiji; Nakai, Osamu; Shindo, Shigeo; Mizuno, Kouichi; Otani, Kazuyuki; Yamaura, Isakichi [Kudanzaka Hospital, Tokyo (Japan)

    2001-04-01

    To know the significance of enhanced MRI images for prediction of prognosis of lumbar disc herniation, the images of 202 patients were retrospectively compared in relation with their findings at surgery, histo-pathological ones, clinical process and morphology. After intravenous injection of soluble Gd, T1 and T2-weighted imaging had been done with Yokogawa SignaConta (0.5T). Surgery was conducted on 99 patients and conservative therapy, on 103. Patients were classified into 3 groups: those giving enhanced effect in and behind the herniation, and without the effect. The enhancement was observed in 62%. Bad prognosis was seen in 37% of patients without the enhancing effect and the enhanced MRI was concluded to be useful for prediction of prognosis. (K.H.)

  16. No differences in post-operative rehabilitation across municipalities in patients with lumbar disc herniation

    DEFF Research Database (Denmark)

    Paulsen, Rune Tendal; Bergholdt, Erik; Carreon, Leah

    2015-01-01

    decompressive surgery for lumbar disc herniation were identified. Changes in Oswestry disability index (ODI), EuroQol-5D (EQ-5D) and duration of sick leave were compared among the municipalities. RESULTS: Patient-reported outcome measures showed no statistical difference in ODI, EQ-5D or sick leave at the one...... between hospital and rehabilitation unit to ensure the best possible patient treatment. Further studies should focus on the effect of rehabilitation. FUNDING: not relevant. TRIAL REGISTRATION: not relevant........ This study examined rehabilitation in the 22 municipalities of the Region of Southern Denmark for patients with lumbar disk herniation. METHODS: A total of 22 physiotherapists answered a questionnaire regarding their rehabilitation programmes. The municipalities of 789 patients who had undergone...

  17. Gadolinium-DTPA enhanced MRI with CHESS method for lumbar disc herniation

    International Nuclear Information System (INIS)

    Aota, Yoichi; Kumano, Kiyoshi; Hirabayashi, Shigeru; Ogawa, Yutaka; Yoshikawa, Koki

    1993-01-01

    A total of 34 DTPA-enhanced magnetic resonance imaging (MRI) studies were made pre- and/or post-operatively by using chemical shift selective method in 31 patients with lumbar disc herniation. DTPA enhancement was seen in affected nerve roots in 7 of 15 preoperative cases and 6 of 12 postoperative cases with unfavorable course. When straight leg raising test revealed severe stimulation to the lower extremity nerve roots (less than 45degree), affected nerve roots were significantly enhanced with DTPA. All enhanced sites, except for one of arachnoid inflammation, was most remarkably compressed by herniation. Edema within the affected nerve root would be detected by DTPA-enhanced MRI. (N.K.)

  18. PTED study : design of a non-inferiority, randomised controlled trial to compare the effectiveness and cost-effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) versus open microdiscectomy for patients with a symptomatic lumbar disc herniation

    NARCIS (Netherlands)

    Seiger, Ankie; Gadjradj, Pravesh S; Harhangi, Biswadjiet S; van Susante, Job Lc; Peul, Wilco C; van Tulder, Maurits W; de Boer, Michiel R; Rubinstein, Sidney M

    2017-01-01

    INTRODUCTION: Lumbosacral radicular syndrome is often caused by a disc herniation. The standard surgical technique to remove a disc herniation is open microdiscectomy. An alternative technique is percutaneous transforaminal endoscopic discectomy (PTED), which is less invasive. In the Netherlands,

  19. Minimally Invasive Anterior Cervical Discectomy Without Fusion to Treat Cervical Disc Herniations in Patients with Previous Cervical Fusions

    Science.gov (United States)

    Granville, Michelle; Berti, Aldo

    2017-01-01

    Adjacent level cervical disc disease and secondarily progressive disc space degeneration that develops years after previously successful anterior cervical fusion at one or more levels is a common, but potentially complex problem to manage. The patient is faced with the option of further open surgery which involves adding another level of disc removal with fusion, posterior decompression, and stabilization, or possibly replacing the degenerated disc with an artificial disc construct. These three cases demonstrate that some patients, especially after minor trauma, may have small herniated discs as the cause for their new symptoms rather than progressive segmental degeneration. Each patient became symptomatic after minor trauma three to six years after the original fusion and had no or minimal radiologic changes of narrowing of the disc or spur formation commonly seen in adjacent level disease, but rather had magnetic resonance imaging (MRI) findings typical of small herniated discs. After failing multiple months of conservative treatment they were offered surgery as an option. Subsequently, all three were successfully treated with minimal anterior discectomy without fusion. There are no reports in the literature of using minimal anterior cervical discectomy without fusion in previous fused patients. This report reviews the background of adjacent level cervical disease, the various biomechanical explanations for developing a new disc herniation rather than progressive segmental degeneration, and how anterior cervical discectomy without fusion can be an option in these patients. PMID:28473949

  20. Usefulness of dynamic contrast enhanced lumbar spine MR imaging postoperative herniated lumbar disc

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Ji Eun; Chung, Tae Sub; Kim, Young Soo; Cho, Yong Eun; Park, Mi Suk [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To compare the usefulness of dynamic contrast enhanced lumbar spine MR imaging with that of conventional delayed contrast enhanced MR imaging in the assessment of postoperative herniated lumbar disc. Forty-one postoperative herniated lumbar disc (HLD) lesions of 32 patients with back pain were examined with MR imaging (1.5T, Vision, Siemens, Germany). Five-phase dynamic 2D FLASH sagittal images (TR/TE = 118.1msec/4.1msec) were obtained every 19 seconds with a 4 minutes delayed image after contrast injection. As seen on delayed images, the discs were assessed as recurred, fibrosis, or no change. On dynamic images, the pattern of enhancement was evaluated as follows : Type 1 (no change in peripheral disc enhancement between the early and late phases) ; or Type 2 (minimal internal extension of marginal smooth enhancement during the late phase) ; or Type 3 (marked internal extension of peripheral irregular enhancement). Dynamic and delayed imaging were compared, and early epidural space enhancement with rapid wash-out was also evaluated. Of 41 postoperative HLDs, 39 lesions showed peripheral contrast enhancement. Evaluation depended on delayed imaging, and was as follows : recurred HLD (n=27) ; fibrosis (n=5) ; no change in postoperative disc (n=7). On dynamic contrast-enhanced imaging, enhancement patterns were Type 1 (n=29), Type 2 (n=7), and Type 3 (n=3). In 29 Type 1 lesions, there were no significant differences in image findings between dynamic and delayed images. However, in ten lesions (type 2 : n=7, type 3 : n=3), findings additional to those revealed by delayed images were demonstrated by dynamic contrast-enhanced MR imaging. Nine of the ten Type 2 and 3 lesions were diagnosed as recurred HLD. On dynamic images, five lesions showed early epidural space enhancement. Dynamic contrast-enhanced lumbar spine MR imaging provided additional findings such as increased peripheral disc enhancement, and epidural space enhancement, which cannot be detected on

  1. Postoperative changes of herniated intervertebral disc: Normal and discitis MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seung Jae; Ryu, Kyung Nam; Choi, Woo Suk; Yoon, Yup; Kim, Ki Tack [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-08-15

    To describe normal postoperative MR findings and MR findings of postoperative discitis in patients who underwent operation due to herniated intervertebral disc. We retrospectively reviewed normal postoperative MR findings and MR findings of discitis in 30 patients(21-61 yrs) (13 cases diagnosed as discitis and 17 cases as normal) who previously underwent laminectomy and discectomy, or bony fusion. We analyzed signal intensity of end plate and disc, end plate destruction,and enhancement of end plate and disc on T1- and T2-weighted images(WI) of 1.5 T MRI. Among 14 out 17 patients with no evidence of discitis, 7 patients showed high signal of the posterior portion of disc on T1- and T2-WI and 11 patients revealed enhancement at the same sites. In all 13 patients suspected of having discitis, end plate and disc showed low signal on T1-WI, high signal on T2-WI, heterogeneous enhancement,and irregular destruction of end plate. Meanwhile, 3 cases with no evidence of postoperative discitis clinically who underwent bony fusion showed similar findings to those of the above 13 patients, except for homogeneous enhancement of end plate and vertebral body. The MR findings of postoperative discitis were low signal on T1-WI, high signal on T2-WI, and heterogeneous enhancement of and plate and disc, and destruction of end plate.

  2. Clinical Outcomes of Percutaneous Transforaminal Endoscopic Discectomy Versus Fenestration Discectomy in Patients with Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Zheng-mei DING

    2017-03-01

    Full Text Available Background: Fenestration discectomy (FD is a common treatment method for lumber disc herniation (LDH, with good effects obtained. Nevertheless, it also causes many complications, such as lumbar instability, lumbago and back pain. Percutaneous endoscopic lumbar discectomy (PTED is a new minimally invasive treatment available for LDH with conservative therapy failure. At present, this technique has been carried out in China. The purpose of this study was to conduct a randomized prospective trial to compare the surgical outcomes of PTED and FD, explore the clinical application value of PTED, and discuss the operative manipulated skills of PTED.Methods: Totally 100 patients with LDH were enrolled from March 2014 to December 2015 and randomly divided into PTED group and FD group, 50 cases in each group. FD group received FD including epidural anesthesia, unilateral fenestration decompression, removal of nucleus pulposus, and nerve root decompression and release, while FTED group received PTED including local anesthesia, endoscopic removal of herniated nucleus pulposus and nerve root decompression and release. Both groups were followed up postoperatively. The duration of operation, incision length, postoperative bed-rest and hospital stay were compared between two groups, and the visual analogue scale (VAS, Oswestry disability index (ODI, and therapeutic effects at the final follow-up time were recorded and compared between 2 groups.Results: All patients completed the operation successfully. The surgical duration was similar between two groups (P>0.05. PTED group showed a less incision length and shorter postoperative bed-rest time and hospital stay than FD group (P<0.01. The VAS and ODI scores showed a significant decrease in both groups postoperatively when compared with operation before (P<0.05, but with no significant difference between two groups (P>0.05. Moreover, the excellent and good rate was higher in PTED group thanin FD group, with no

  3. Safe physiotherapy interventions in large cervical disc herniations.

    LENUS (Irish Health Repository)

    Keramat, Keramat Ullah

    2012-01-01

    A 34-year-old woman was seen in a physiotherapy department with signs and symptoms of cervical radiculopathy. Loss of cervical lordosis and a large paracentral to intraforaminal disc prolapse (8 mm) at C5-C6 level was reported on MRI. She was taking diclofenac sodium, tramadol HCl, diazepam and pregabalin for the preceding 2 months and no significant improvement, except temporary relief, was reported. She was referred to physiotherapy while awaiting a surgical opinion from a neurosurgeon. In physiotherapy she was treated with mobilisation of the upper thoracic spine from C7 to T6 level. A cervical extension exercise was performed with prior voluntary extension of the thoracic spine and elevated shoulders. She was advised to continue the same at home. General posture advice was given. Signs and symptoms resolved within the following four sessions of treatment over 3 weeks. Surgical intervention was subsequently deemed unnecessary.

  4. [THE CHOICE OF PERIOPERATIVE MULTIMODAL ANALGESIA IN PATIENTS WITH LUMBAR HERNIATED DISC: THE PRELIMINARY RESULTS.

    Science.gov (United States)

    Genov, P G; Timerbaev, V H; Grin, A A; Rebrova, O Yu

    2017-09-01

    129 patients scheduled for elective lumbar discectomy in 2010-2013 were enrolled in prospective study. Group K (n=20) underwent general anaesthesia and postoperative analgesia on-demand. Group PMA+SA (n=23) got subarachnoid block and preventive multimodal analgesia (PMA) including ketoprofen, paracetamol and nalbuphine. At PMA group (n=21) general anaesthesia and PMA were used; at PMA+I (n=21) also bupivacaine wound infiltration was administrated; at PlvL4+S (n=20) - depo-corticosteroid was applied locally on affected spinal nerve root; at PMA+IS (n=24) wound infiltration and local corticosteroids were combined. Patients could use i.v. nalbuphine on-demand by PCA device in addition to PMA post-operatively. 7 days post-operatively, the pain scores using 10 cm VAS at rest and during movement were also recorded. Group K patients had not adequate pain relief during 4 postoperative days. At PMA group the postoperative analgesia was adequate during the whole assessment time, PMA group patients had significant less pain scores than at K group during 4 postoperative days. Patients at PM +SA had better than PMA group pain relief only during 2 hours postoperatively. Groups PMA+I and PMA+IS did not demand nalbuphine at al. Their pain scores were signifcant less than at PMA group during 2 postoperative days. Postoperative analgesia on-demand is not adequate but the PMA is. Subarachnoid block results in decreasing severity of pain only during first hours postoperatively. The additional bupivacaine wound infiltration in pa- tients with lumbar herniated disc follows avoiding of opioids and significant pain relief during 2 postoperative days.

  5. Prevalence of Concomitant Sacroiliac joint Dysfunction in Patients With Image Proven Herniated Lumbar Discs

    Directory of Open Access Journals (Sweden)

    Salah Alalawi

    2009-05-01

    Full Text Available Background:Sacroiliac joint (SIJ dysfunction is a widely known but poorly defined cause of low back pain. To our knowledge, few published studies have been conducted to evaluate systematically the prevalence and significance of concomitant sacroiliac joint dysfunction in patients with herniated lumbar discs. As concomitant SIJ dysfunction in low back pain patients is likely to respond to particular noninvasive interventions such as manipulation,improved understanding of the relationship between these two diagnoses would improve clinical decision making and research.Methods:This study was designated to estimate the prevalence of concomitant sacroiliac joint dysfunction in sub acute low back pain patients with image proven discopathy and evaluate the theory that sacroiliac joint dysfunction can be a source of pain and functional disability in discopathy. A total of 202 patients with sub acute radicular back pain and MRI proven herniated lumbar discs underwent standardized   physiatrist history and physical examination, specified for detection of concomitant sacroiliac joint dysfunction.Results: Sacroiliac joint dysfunction is a concomitant finding in 72.3% of evaluated patients.There was significantly higher SIJ dysfunction prevalence in female patients (p <0.0001. Conclusion: SIJ dysfunction is a significant pathogenic factor with high possibility of occurrence in low back pain. Thus, in the presence of radicular and sacroiliac joint symptoms, SIJ dysfunction, regardless of intervertebral disc pathology, must be considered in clinical decisiomaking.

  6. Analysis of the Characteristics and Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for Upper Lumbar Disc Herniation.

    Science.gov (United States)

    Wu, Junlong; Zhang, Chao; Zheng, Wenjie; Hong, Christopher S; Li, Changqing; Zhou, Yue

    2016-08-01

    Lumbar disc herniations at the L1-L2 and L2-L3 levels have unique characteristics that result in worse surgical outcomes after traditional microdiscectomy compared with herniation at L3-L4. The purpose of this study was to evaluate the characteristics, clinical presentation, and outcomes of patients who underwent percutaneous endoscopic lumbar discectomy (PELD) at L1-L2 and L2-L3, compared with those who underwent PELD at L3-L4. We retrospectively evaluated the clinical data from 55 patients who underwent PELD for single-level lumbar disc herniation between 2008 and 2014, at a mean follow-up of 29.9 ± 16.4 months (12-month minimum; effective rate, 89.1%). Surgical duration; length of postoperative hospital stay; hospitalization cost; recurrence rate; Macnab criteria assessment; visual analog scale (VAS) of back pain, leg pain, and numbness; Japanese Orthopedic Association (JOA) low back pain score; and Oswestry Disability Index (ODI) before and after surgery were evaluated. In the L1-L3 group, 76.9% of the patients had a positive femoral stretch test, compared with only 42.8% of those in the L3-L4 group (P disc herniation and may compare favorably with the same procedure for lower lumbar disc herniation. In addition, the positive femoral stretch test was a relatively good diagnostic method for disc herniation at L1-L2 and L2-L3, compared with herniation at L3-L4. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Spontaneous and complete regression of a thoracic disc herniation; Regression spontanee et complete en IRM d`une hernie discale dorsale

    Energy Technology Data Exchange (ETDEWEB)

    Coevoet, V.; Benoudiba, F.; Doyon, D.; Lignieres, C.; Said, G. [Centre Hospitalier Universitaire de Bicetre, 94 - Le Kremlin-Bicetre (France)

    1997-09-01

    Spontaneous regression of disc herniation is well known but the mechanism is not clear. Some hypotheses have been made. We present here a large thoracic disc herniation diagnosed by MRI which completely regressed one year after a medical treatment with complete amendment of symptoms. (authors). 11 refs.

  8. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.

    Science.gov (United States)

    Gugliotta, Marinella; da Costa, Bruno R; Dabis, Essam; Theiler, Robert; Jüni, Peter; Reichenbach, Stephan; Landolt, Hans; Hasler, Paul

    2016-12-21

    Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (-0.97; 95% CI -1.89 to -0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (-3.7; 95% CI -7.4 to -0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. An updated review of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J E; Calodney, Aaron K; Onyewu, Obi; Helm, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

    2013-04-01

    Lumbar disc prolapse, protrusion, and extrusion are the most common causes of nerve root pain and surgical interventions, and yet they account for less than 5% of all low back problems. The typical rationale for traditional surgery is that it is an effort to provide more rapid relief of pain and disability. It should be noted that the majority of patients do recover with conservative management. The primary rationale for any form of surgery for disc prolapse associated with radicular pain is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, although several alternative techniques, including automated percutaneous mechanical lumbar discectomy, have been described. There is, however, a paucity of evidence for all decompression techniques, specifically alternative techniques including automated and laser discectomy. A systematic review of the literature of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc. To evaluate and update the effectiveness of automated percutaneous mechanical lumbar discectomy. The available literature on automated percutaneous mechanical lumbar discectomy in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria, as utilized for interventional techniques for randomized trials, and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies.The level of evidence was classified as good, fair, and limited or poor, based on the quality of evidence scale developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Pain relief was the primary

  10. [Surgical treatment for incisions fat colliquation or infections at early stage after operation of lumbar disc herniation].

    Science.gov (United States)

    Guan, Ting-Jin; Zheng, Liang-Guo; Sun, Peng; Li, Xing-Xue

    2014-05-01

    To explore the reason, key diagnosic point and therapeutic method of the incisions fat colliquation or infections at early stage after operation of lumbar disc herniation. From July 2007 to May 2012, clinical data of 11 patients with incision fat liquefaction or early infection after lumbar discectomy were retrospectively analyzed. There were 5 males and 6 females with an average age of 43.1 years, and the mean time of incisions fat colliquation or infection was 5 days and a half after operation. The main clinical features included local wound pain aggravating, fervescence, fresh seepage in the wound, and blood inflammatory index increased, etc. The wound could heal at the first treatment stage or not was an evaluation standard of curative effect. All patients were followed up with an average period of 21 months. The wounds of 10 cases healed at the first stage without recurrence and complications. In 1 case infected by staphylococcus aureus, distal part of the wound present local red, swelling and with wave motion at 2 months after operation, staphylococcus aureus infection was confirmed after puncture and bacterial culture, and 1 thrum was found after local incision. The wound healed after change dressings for 1 week, without recurrence after followed up for 13 months. Preventing the risk factors before operation, minimizing invasive technique during operation reasonable antibiotics application for the lumbar operation reguiring placement objects, and correctly handling with wound after operation could prevent and reduce the incidence of incisions fat liquefaction or infection after operation of lumbar disc herniation. For incision fat liquefaction or infection, early diagnosis, debridement, VSD negative pressure irrigation and drainage, to choosing sensitive antibiotics according to the results of drug sensitivity, may contribute to wound early healing and decrease complication.

  11. Effects of six-week exercise training protocol on pain relief in patients with lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Amir Hossein Yazdani

    2016-02-01

    Full Text Available Introduction: Paraspinal, abdominal, and core muscles are playing the main role in lumbar disc herniation. The aim of the present study was to investigate the efficacy of a 6 weeks exercise training protocol on pain relief in males and females with lumbar disc herniation. Methods: In this before-after trial study, 64 patients with lumbar disc herniation were assigned to a 6 weeks exercise training program. Training protocol included leg press, trunk lateral flexion, trunk rotation, trunk flexion/extension, and stretching exercises in two sessions a week with 25-30 minutes each. Pain was measured with visual analog scale (VAS at 1st, 6th, and 12th sessions. Results: A total of 64 patients (13 males with mean age 47.53 ± 11.71 years and 51 females with mean age 46.50 ± 11.76 years completed the protocol. The pain was significantly reduced in both males and females during sessions 6 and 12 in comparison with the first session (P = 0.001. The amount of pain relief in males was higher than females (P = 0.047. Conclusion: About 6 weeks exercise training program could reduce more pain in males with lumbar disc herniation compared to females. This core stabilizing exercise protocol could be a good recommendation for patients with disk herniated low back pain (LBP.

  12. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature.

    Science.gov (United States)

    Wong, Jessica J; Côté, Pierre; Quesnele, Jairus J; Stern, Paula J; Mior, Silvano A

    2014-08-01

    Cervical spine disc herniation is a disabling source of cervical radiculopathy. However, little is known about its course and prognosis. Understanding the course and prognosis of symptomatic cervical disc herniation is necessary to guide patients' expectations and assist clinicians in managing patients. To describe the natural history, clinical course, and prognostic factors of symptomatic cervical disc herniations with radiculopathy. Systematic review of the literature and best evidence synthesis. A systematic search of MEDLINE, EMBASE, CINAHL, SportsDiscus, and the Cochrane Central Register of Controlled Trials from inception to 2013 was conducted to retrieve eligible articles. Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results from articles with low risk of bias were analyzed using best evidence synthesis principles. We identified 1,221 articles. Of those, eight articles were eligible and three were accepted as having a low risk of bias. Two studies pertained to course and one study pertained to prognosis. Most patients with symptomatic cervical disc herniations with radiculopathy initially present with intense pain and moderate levels of disability. However, substantial improvements tend to occur within the first 4 to 6 months post-onset. Time to complete recovery ranged from 24 to 36 months in, approximately, 83% of patients. Patients with a workers' compensation claim appeared to have a poorer prognosis. Our best evidence synthesis describes the best available evidence on the course and prognosis of cervical disc herniations with radiculopathy. Most patients with symptomatic cervical spine disc herniation with radiculopathy recover. Possible recurrences and time to complete recovery need to be further studied. More studies are also needed to understand the prognostic factors for this condition. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation.

    Science.gov (United States)

    Abrishamkar, Saeid; Kouchakzadeh, Masih; Mirhosseini, Ahmad; Tabesh, Homayoun; Rezvani, Majid; Moayednia, Amir; Ganjeifar, Babak; Mahabadi, Amir; Yousefi, Elham; Kooshki, Ali Mehrabi

    2015-12-01

    Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into

  14. Comparison of radiation delivered by current diagnostic procedures for herniated disc

    International Nuclear Information System (INIS)

    Gasquet, C.; Drouineau, J.; Goubault, F.; Hurmic, A.; Lavigne, B.; Vandermarcq, P.

    1983-01-01

    Three methods are currently employed for the diagnosis of sciatica due to disc lesions: radiculography, spinal phlebography, and computed tomography. Though their indications vary according to the author, it seemed worthwhile to compare radiation delivered by each of them, because of the often young age of the patients. Dosimetric studies using a Rando Phantom enabled calculation of doses to the skin, spinal cord, and gonads. Results indicated that low doses were delivered by the scanner, relatively high doses by spinal phlebography, and intermediate doses by radiculography. These findings suggest that the initial examination preoperatively in cases of simple sciatica due to herniated disc should be a CT scan whenever possible. Phlebography, on the contrary, and particularly in young women, should be used only exceptionally, as a result of the high doses delivered to the ovaries even during technically simple explorations [fr

  15. Changes of signal intensity on precontrast magnetic resonance imaging in spontaneously regressed lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Okushima, Yuichiro; Chiba, Kazuhiro; Matsumoto, Morio; Maruiwa, Hirofumi; Nishizawa, Takashi; Toyama, Yoshiaki [Keio Univ., Tokyo (Japan). School of Medicine

    2001-04-01

    To see whether the MRI images can give a criterion for conservative therapy of the lumbar disc herniation, time changes of the images were retrospectively studied on 41 cases of spontaneous regression. They had the imaging diagnosis 3 times in average until regression with GE Signa equipment (1.5T). Images were evaluated by 2 experts. Certain cases accompanying the brightness change were seen during the process of regression. The period leading to the disappearance of melosalgia and to the regression tended to be short in cases with the brighter pulp center than disc and/or with less bright pulp verge than center. Further studies were thought necessary for clear conclusion. (K.H.)

  16. Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy

    Science.gov (United States)

    Oh, In-Soo; Seo, Jun-Yeong; Kim, Yoon-Chung

    2010-01-01

    We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a posterolateral mass compressing the spinal cord at the T9-T10 level. The patient was treated with a discectomy through the posterior approach combined with posterior instrumentation. The patient's symptoms and myelopathy resolved completely after the discectomy and instrumented fusion. The thoracic disc herniation might have been caused by the increased motion and stress concentration at the adjacent segment. PMID:20622956

  17. Static axial overloading primes lumbar caprine intervertebral discs for posterior herniation

    Science.gov (United States)

    Paul, Cornelis P. L.; de Graaf, Magda; Bisschop, Arno; Holewijn, Roderick M.; van de Ven, Peter M.; van Royen, Barend J.; Mullender, Margriet G.; Smit, Theodoor H.; Helder, Marco N.

    2017-01-01

    Introduction Lumbar hernias occur mostly in the posterolateral region of IVDs and mechanical loading is an important risk factor. Studies show that dynamic and static overloading affect the nucleus and annulus of the IVD differently. We hypothesize there is also variance in the effect of overloading on the IVD’s anterior, lateral and posterior annulus, which could explain the predilection of herniations in the posterolateral region. We assessed the regional mechanical and cellular responses of lumbar caprine discs to dynamic and static overloading. Material and methods IVDs (n = 125) were cultured in a bioreactor and subjected to simulated-physiological loading (SPL), high dynamic (HD), or high static (HS) overloading. The effect of loading was determined in five disc regions: nucleus, inner-annulus and anterior, lateral and posterior outer-annulus. IVD height loss and external pressure transfer during loading were measured, cell viability was mapped and quantified, and matrix integrity was assessed. Results During culture, overloaded IVDs lost a significant amount of height, yet the distribution of axial pressure remained unchanged. HD loading caused cell death and disruption of matrix in all IVD regions, whereas HS loading particularly affected cell viability and matrix integrity in the posterior region of the outer annulus. Conclusion Axial overloading is detrimental to the lumbar IVD. Static overloading affects the posterior annulus more strongly, while the nucleus is relatively spared. Hence, static overloading predisposes the disc for posterior herniation. These findings could have implications for working conditions, in particular of sedentary occupations, and the design of interventions aimed at prevention and treatment of early intervertebral disc degeneration. PMID:28384266

  18. Static axial overloading primes lumbar caprine intervertebral discs for posterior herniation.

    Directory of Open Access Journals (Sweden)

    Cornelis P L Paul

    Full Text Available Lumbar hernias occur mostly in the posterolateral region of IVDs and mechanical loading is an important risk factor. Studies show that dynamic and static overloading affect the nucleus and annulus of the IVD differently. We hypothesize there is also variance in the effect of overloading on the IVD's anterior, lateral and posterior annulus, which could explain the predilection of herniations in the posterolateral region. We assessed the regional mechanical and cellular responses of lumbar caprine discs to dynamic and static overloading.IVDs (n = 125 were cultured in a bioreactor and subjected to simulated-physiological loading (SPL, high dynamic (HD, or high static (HS overloading. The effect of loading was determined in five disc regions: nucleus, inner-annulus and anterior, lateral and posterior outer-annulus. IVD height loss and external pressure transfer during loading were measured, cell viability was mapped and quantified, and matrix integrity was assessed.During culture, overloaded IVDs lost a significant amount of height, yet the distribution of axial pressure remained unchanged. HD loading caused cell death and disruption of matrix in all IVD regions, whereas HS loading particularly affected cell viability and matrix integrity in the posterior region of the outer annulus.Axial overloading is detrimental to the lumbar IVD. Static overloading affects the posterior annulus more strongly, while the nucleus is relatively spared. Hence, static overloading predisposes the disc for posterior herniation. These findings could have implications for working conditions, in particular of sedentary occupations, and the design of interventions aimed at prevention and treatment of early intervertebral disc degeneration.

  19. Suprapedicular Circumferential Opening Technique of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for High Grade Inferiorly Migrated Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Hyeun Sung Kim

    2018-01-01

    Full Text Available Purpose. To evaluate the efficacy of suprapedicular circumferential opening technique (SCOT of percutaneous endoscopic transforaminal lumbar discectomy (PETLD for high grade inferiorly migrated lumbar disc herniation. Material and Methods. Eighteen consecutive patients who presented with back and leg pain with a single-level high grade inferiorly migrated lumbar disc herniation were included. High grade inferiorly migrated disc was removed by the SCOT through PETLD approach. Outcome evaluation was done with visual analog scale (VAS and Mac Nab’s criteria. Result. There were 14 males and 4 females. The mean age of patients was 53.3±14.12 years. One, 4, and 13 patients had disc herniation at L1-2, L3-4, and L4-5 levels, respectively, on MRI, which correlated with clinical findings. The mean follow-up duration was 8.4±4.31 months. According to Mac Nab’s criteria, 9 patients (50% reported excellent and the remaining 9 patients (50% reported good outcomes. The mean preoperative and postoperative VAS for leg pain were 7.36±0.73 and 1.45±0.60, respectively (p<0.001. Improvement in outcomes was maintained even at final follow-up. There was no complication. Conclusion. In this preliminary study we achieved good to excellent clinical results using the SCOT of PETLD for high grade inferiorly migrated lumbar disc herniation.

  20. Thin-section CT in the examination of cervical disc herniation. A prospective study with 1-mm axial and helical images

    Energy Technology Data Exchange (ETDEWEB)

    Ilkko, E. [Dept. of Diagnostic Radiology, Oulu Univ. Central Hospital (Finland); Laehde, S. [Dept. of Diagnostic Radiology, Oulu Univ. Central Hospital (Finland); Heiskari, M. [Dept. of Neurosurgery, Oulu Univ. Central Hospital (Finland)

    1996-03-01

    The aim of the investigation was to determine whether thin-section high-resolution CT imaging could replace MR imaging and/or myelography in preoperative evaluation of radiculopathy and/or myelopathy. A total of 120 patients, referred for cervical myelography (n=107) or MR imaging (n=13), were further examined with 1-mm non-contrast CT of the suspected disc space, including at least the next cephalic and caudal interspaces. Thirty-seven patients underwent Cloward`s operation, at which 32 were found to have disc herniation. The sensitivities of CT (n=37), myelography (n=29), and MR imaging (n=8) were 66%, 84%, and 86%, respectively. The corresponding figures for false-positives were 8%, 10%, and 13%. Artefacts caused by wide shoulders in the 1-mm CT images were estimated to have contributed to a false-negative finding in 8 cases. The remaining 3 false-negatives were retrospectively considered evaluation errors. The true-positive CT findings usually presented with a local disc bulge measuring over 80 HU in density. Local ligamentous hypertropy presented an indistinguishable finding in 3 cases, yielding false-positive CT findings. Conventional thin-section CT is considered a usable alternative for the evaluation of suspected cervical disc herniations in selected patients. Stocky patients with wide shoulders and a short neck are not suitable candidates, even when new generation equipment is available. (orig.).

  1. Thin-section CT in the examination of cervical disc herniation. A prospective study with 1-mm axial and helical images

    International Nuclear Information System (INIS)

    Ilkko, E.; Laehde, S.; Heiskari, M.

    1996-01-01

    The aim of the investigation was to determine whether thin-section high-resolution CT imaging could replace MR imaging and/or myelography in preoperative evaluation of radiculopathy and/or myelopathy. A total of 120 patients, referred for cervical myelography (n=107) or MR imaging (n=13), were further examined with 1-mm non-contrast CT of the suspected disc space, including at least the next cephalic and caudal interspaces. Thirty-seven patients underwent Cloward's operation, at which 32 were found to have disc herniation. The sensitivities of CT (n=37), myelography (n=29), and MR imaging (n=8) were 66%, 84%, and 86%, respectively. The corresponding figures for false-positives were 8%, 10%, and 13%. Artefacts caused by wide shoulders in the 1-mm CT images were estimated to have contributed to a false-negative finding in 8 cases. The remaining 3 false-negatives were retrospectively considered evaluation errors. The true-positive CT findings usually presented with a local disc bulge measuring over 80 HU in density. Local ligamentous hypertropy presented an indistinguishable finding in 3 cases, yielding false-positive CT findings. Conventional thin-section CT is considered a usable alternative for the evaluation of suspected cervical disc herniations in selected patients. Stocky patients with wide shoulders and a short neck are not suitable candidates, even when new generation equipment is available. (orig.)

  2. MR imaging of the lumbar disk herniation : relationship between the direction of herniated disc and pressure effect on nerve root and dural sac

    Energy Technology Data Exchange (ETDEWEB)

    Cha, B. H.; Shon, M. Y.; Kim, K. W.; Lim, M. A.; Kwon, K. R; Kim, S. S. [Sunlin Presbyterian Hospital, Pohang (Korea, Republic of)

    1996-04-01

    To evaluate the relationship between the direction of herniated disc and pressure effect on nerve root and dural sac, as seen on MRI. We retrospectively reviewed lumbar spine MR images of 122 cases of lumbar disk herniation 75 patients MRI findings were analyzed with regard to the relationship between the direction of the herniated disc and pressure effect on nerve root and dural sac. Pressure effect on nerve root and dural sac was arbitrarily divided into three types. Type I was defined as zero or minimal compression of nerve roots or thecal sac by the herniated disc ; type II was defined as mild to moderate compression, while III was defined as severe compression or displacement of nerve roots and/or thecal sac. Of the 122 cases seen in these 75 patients, 97(80%) were observed at L4-5 and L5-S1. The central type(71cases ; 58%) was more frequently observed than the posterolateral type(48cases ; 40%) or lateral type(3cases ; 2%). The totals of types I, II, and III were 44(36%), 43(35%) and 35 cases(29%), respectively. Seventy-seven %(34/44) of type I and 65%(28/43) of type II were of the central type but for type III, the corresponding figure was only 26%(9/35). On MR imaging, most of lumbar disk herniations were observed at L4-5 and L5-S1, with a predominance of the central type rather than the posterolateral one. Most of the central types were either type I or type II.

  3. MR imaging of the lumbar disk herniation : relationship between the direction of herniated disc and pressure effect on nerve root and dural sac

    International Nuclear Information System (INIS)

    Cha, B. H.; Shon, M. Y.; Kim, K. W.; Lim, M. A.; Kwon, K. R; Kim, S. S.

    1996-01-01

    To evaluate the relationship between the direction of herniated disc and pressure effect on nerve root and dural sac, as seen on MRI. We retrospectively reviewed lumbar spine MR images of 122 cases of lumbar disk herniation 75 patients MRI findings were analyzed with regard to the relationship between the direction of the herniated disc and pressure effect on nerve root and dural sac. Pressure effect on nerve root and dural sac was arbitrarily divided into three types. Type I was defined as zero or minimal compression of nerve roots or thecal sac by the herniated disc ; type II was defined as mild to moderate compression, while III was defined as severe compression or displacement of nerve roots and/or thecal sac. Of the 122 cases seen in these 75 patients, 97(80%) were observed at L4-5 and L5-S1. The central type(71cases ; 58%) was more frequently observed than the posterolateral type(48cases ; 40%) or lateral type(3cases ; 2%). The totals of types I, II, and III were 44(36%), 43(35%) and 35 cases(29%), respectively. Seventy-seven %(34/44) of type I and 65%(28/43) of type II were of the central type but for type III, the corresponding figure was only 26%(9/35). On MR imaging, most of lumbar disk herniations were observed at L4-5 and L5-S1, with a predominance of the central type rather than the posterolateral one. Most of the central types were either type I or type II

  4. Herniated lumbar disc treated with Global Postural Reeducation. A middle-term evaluation.

    Science.gov (United States)

    Di Ciaccio, E; Polastri, M; Bianchini, E; Gasbarrini, A

    2012-08-01

    Herniated lumbar intervertebral disc (HLID) is a pathological condition frequently seen in rehabilitation medicine that is characterized by the compression of one or more nerve roots. The aim of this study was to describe the effects of Global Postural Reeducation on function and pain in patients with herniated disc at levels L4-L5 and/or L5-S1. Twenty-four consecutive subjects were treated with Global Postural Reeducation. Before treatment, patients reported median average pain duration of 180 days. At the beginning of treatment and on days 15, 45, 120, and 180, all completed the Quebec Back Pain Disability Scale and the Numeric Pain Rating Scale. The median value of the Quebec Back Pain Disability Scale score decreased from 49 points at baseline to 22 points at 45 days. Moreover, the median Numeric Pain Rating Scale score decreased from 6 points at baseline to 2 points at 45 days. The present study indicates that Global Postural Reeducation is suitable for the conservative management of HLID. Moreover, patients gained a therapeutic benefit from being active participants in their recovery.

  5. Intradural disc herniation: radiographic findings and surgical results with a literature review.

    Science.gov (United States)

    Kobayashi, Kazuyoshi; Imagama, Shiro; Matsubara, Yuji; Yoshihara, Hisatake; Hirano, Kenichi; Ito, Zenya; Ando, Kei; Ukai, Junichi; Muramoto, Akio; Shinjo, Ryuichi; Matsumoto, Tomohiro; Nakashima, Hiroaki; Ishiguro, Naoki

    2014-10-01

    To report a series of four cases of intradural disc herniation (IDH) with a review of the literature. IDH is a rare type of disc herniation. Preoperative diagnosis is difficult and IDH is only confirmed during surgery in most cases. Here, we describe four cases of IDH, including three with lumbar hernia and one with thoracic hernia. A retrospective chart review, surgical database query, and review of radiology reports are presented for each case, along with a literature review of IDH. Two of the four patients had a history of surgery at the same spinal level. Ring enhancement in gadolinium-enhanced MRI, an air image in computed tomography, and complete block in myelography were observed in the series. Surgery was performed with a transdural approach in all patients. One patient underwent transforaminal lumbar interbody fusion after postoperative recurrence. Three patients with lumbar involvement had nerve root symptoms preoperatively, but showed symptomatic improvement in the early postoperative period. In contrast, the patient with thoracic involvement had preoperative muscle weakness due to myelopathy symptoms, and had residual symptoms after surgery. IDH is a rare disease and characteristic imaging findings can be useful for diagnosis. Intraoperative findings lead to a definitive diagnosis in many cases and recognition of the pathological characteristics of IDH is important. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Middle-long term clinical study of osteoplastic hemilaminectomy for extraforaminal lumbar disc herniation

    International Nuclear Information System (INIS)

    Tominaga, Hiroyuki; Wada, Shoichi; Hirotsu, Masataka; Shimono, Tetsuro; Yoshinaga, Kazuharu; Maehara, Toyo; Komiya, Setsuro

    2009-01-01

    We examined 11 patients with extraforaminal lumbar disc herniation who underwent osteoplastic hemilaminectomy. The follow-up period was more than six years (to ten years). The subjects included seven male and four female patients, with an average age of 58 years (28 to 77 years). The level of extraforaminal lumbar disc herniation was L2/3 in two, L4/5 in two, and L5/S1 in seven cases. Clinical results were evaluated by Japanese Orthopedic Association (JOA) score. Bone union of spinous processes and vertebral arch was assessed by computed tomographs (CT). The results were as follows. The mean JOA score was 13/15 in the last follow-up, compared to 8.4/15 pre-operatively. Clinical evaluation improved with statistically significant differences. The bone union rate of spinous processes and vertebral arch was 91% and 73%, respectively. No case achieved bone union of neither spinous processes nor vertebral arch. These results suggest that osteoplastic hemilaminectomy is effective for middle to long term treatment. (author)

  7. Posterior laminoforaminotomy in the treatment of lateralcervical herniated disc and foraminal stenosis.

    Science.gov (United States)

    Yilmaz, Hakan; Ertürk, Ali Rıza; Karataş, Ayşe; Atci, İbrahim Burak; Yurt, Alaettin

    2016-02-17

    Posterior cervical laminoforaminotomy is an effective surgical treatment in selected cases of cervical radiculopathy caused by posterolateral herniated discs or foraminal stenosis. The aim of the present study was to evaluate the surgical techniques, rates of complications, long-term outcomes, advantages, and disadvantages of keyhole foraminotomy retrospectively. Keyhole foraminotomy was performed in 83 patients. In 51 patients (61.5%) soft disc herniation was removed, and in 32 of them (38.5%) osteophytes were evident. The clinical data were evaluated according to Odom's criteria, and the mean follow-up time was 6 months. Postoperative results were classed as excellent in 66 patients (79.5%), good in 13 patients (15.7%), fair in 3 patients (3.6%), and poor in only 1 patient (1.2%). Radiculopathy symptoms regressed in 79 patients (95%). Among the 83 patients, surgical complications (dural injury and level error) were noted in 2 patients (2.4%). Posterior laminoforaminotomy is applied to selected patients with a low complication rate. The advantages of this surgery are suitable visualization of the nerve root, preserved motion of the operated segment, avoidance of cervical instability, and a decrease in the length of hospital stay.

  8. Bilateral post-injection fibrosis of the gluteal region mimicking lumbar disc herniation: a case report

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    Kamil Cagri Kose

    2009-11-01

    Full Text Available Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in children due to vaccinations and injections. Herein we report a case of post injection gluteal fibrosis that had undergone two unsuccessful lumbar discectomies to treat the symptoms of this disease. A 45 years old male patient was consulted to our clinic from the department of neurochirurgy with complaints of bilateral hip pain. The patient was operated on for lumbar disc herniation in L4-5 level twice but his complaints had not resolved. A third operation including L4-5 instrumentation and fusion was planned. His examination revealed nodules in his both hips. His x-rays, MRI and blood tests were normal. He underwent bilateral gluteal fascia excision and his complaints resolved totally. The clinical diagnosis of post-injection fibrosis is problematic, due to the difficulty of determining the etiology. In many patients the diagnosis comes from a history of injection. Pain in the gluteal region is not a frequently described clinical feature of this condition. Many reports in the literature emphasize a contracture rather than pain. Post-injection fibrosis in the gluteal region may mimic lumbar disc herniation and a detailed physical examination is the key for correct differential diagnosis. In refractory cases not responding to conservative treatment, surgical excision of the nodules may lead to a complete clinical recovery of the patient.

  9. Comparison of growth factor and cytokine expression in patients with degenerated disc disease and herniated nucleus pulposus.

    Science.gov (United States)

    Lee, Seungcheol; Moon, Chan Sam; Sul, Donggeun; Lee, Jiyoung; Bae, Minyoung; Hong, Youngki; Lee, Min; Choi, Seonyoung; Derby, Richard; Kim, Byung-Jo; Kim, Juhan; Yoon, Joon-Sik; Wolfer, Lee; Kim, Jaemin; Wang, Joonho; Hwang, Sun-Wook; Lee, Sang-Heon

    2009-10-01

    This study was conducted to investigate the expression of cytokines and growth factors in disc specimens obtained from patients with herniated nucleus pulposus (HNP) and degenerated disc disease (DDD). MRI and Western blot analyses were performed to evaluate the levels of disc degeneration and the expression levels of cytokines and growth factors. The levels of TNF-alpha and IL-8 were significantly greater in the DDD group than in the HNP group, but no statistical differences were observed in the expression of IL-1beta, IL-6 and IL-12 between the HNP and DDD groups. In addition, the expression of TGF beta, VEGF and NGF was significantly higher in the DDD group than in the HNP group. The greater levels of cytokine and growth factor expression in the DDD group than in the HNP explain why discogenic patients usually have more severe back pain than patients with herniated discs.

  10. Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness

    Directory of Open Access Journals (Sweden)

    Nezih Akca

    2014-01-01

    Full Text Available Context: Little seems to be known about the sexual dysfunction (SD in lumbar intervertebral disc herniation. Aims: Investigation of sexual and sphincter dysfunction in patient with lumbar disc hernitions. Settings and Design: A retrospective analysis. Materials and Methods: Sexual and sphincter dysfunction in patients admitted with lumbar disc herniations between September 2012-March 2014. Statistical Analysis Used: Statistical analysis was performed using the Predictive Analytics SoftWare (PASW Statistics 18.0 for Windows (Statistical Package for the Social Sciences, SPSS Inc., Chicago, Illinois. The statistical significance was set at P < 0.05. The Wilcoxon signed ranks test was used to evaluate the difference between patients. Results: Four patients with sexual and sphincter dysfunction were found, including two women and two men, aged between 20 and 52 years. All of them admitted without low back pain. In addition, on neurological examination, reflex and motor deficit were not found. However, almost all patients had perianal sensory deficit and sexual and sphincter dysfunction. Magnetic resonance imaging (MRI of three patients displayed a large extruded disc fragment at L5-S1 level on the left side. In fourth patient, there were not prominent disc herniations. There was not statistically significant difference between pre-operative and post-operative sexual function, anal-urethral sphincter function, and perianal sensation score. A syndrome in L5-S1 disc herniation with sexual and sphincter dysfunction without pain and muscle weakness was noted. We think that it is crucial for neurosurgeons to early realise that paralysis of the sphincter and sexual dysfunction are possible in patients with lumbar L5-S1 disc disease. Conclusion: A syndrome with perianal sensory deficit, paralysis of the sphincter, and sexual dysfunction may occur in patients with lumbar L5-S1 disc disease. The improvement of perianal sensory deficit after surgery was

  11. Molecular profile of major growth factors in lumbar intervertebral disc herniation: Correlation with patient clinical and epidemiological characteristics.

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    Tsarouhas, Alexandros; Soufla, Giannoula; Tsarouhas, Konstantinos; Katonis, Pavlos; Pasku, Dritan; Vakis, Antonis; Tsatsakis, Aristides M; Spandidos, Demetrios A

    2017-04-01

    The involvement of growth factors (GFs) in the pathogenesis of lumbar intervertebral disc (ID) herniation and the spontaneous resorption of herniated ID fragments remains only partially elucidated. A simultaneous assessment of the transcript levels of numerous GFs and their association with clinical and epidemiological profiles of human ID herniation would provide valuable insight into the biology and clinical course of the disease. In the present study, we examined simultaneously the transcript levels of vascular endothelial growth factor (VEGF), transforming growth factor β1 (TGF‑β1), basic fibroblast growth factor 2 (bFGF2), platelet derived growth factor (PDGF) isoforms and receptors, epidermal growth factor (EGF) and insulin growth factor‑1 (IGF‑1) in herniated and control ID specimens and investigated their correlation with the clinicopathological profiles of patients suffering from symptomatic lumbar ID herniation. GF mRNA expression levels were determined by RT-qPCR in 63 surgical specimens from lumbar herniated discs and 10 control ID specimens. Multiple positive correlations were observed between the transcript levels of the GFs examined in the ID herniation group. VEGF mRNA expression was significantly increased in the protruding compared with the extruded discs. Intense and acute pain significantly upregulated the PDGF transcript levels. Significant negative correlations were observed between the patient body mass index and the transcript levels of VEGF and PDGF receptors. Our findings support the hypothesis of the involvement of GFs in the natural history of ID herniation. GFs synergistically act in herniated IDs. Increased VEGF expression possibly induces the neovascularization process in the earliest stages of ID herniation. PDGF‑C and ‑D play a role in the acute phase of radiculopathy in a metabolic response for tissue healing. A molecular effect, in addition to the biomechanical effect of obesity in the

  12. Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation: Consideration of the Relation between the Iliac Crest and L5-S1 Disc.

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    Choi, Kyung Chul; Park, Choon-Keun

    2016-02-01

    Percutaneous transforaminal techniques for the treatment of lumbar disc herniation have markedly evolved. Percutaneous endoscopic lumbar discectomy (PELD) for L5-S1 disc herniation is regarded as challenging due to the unique anatomy of the iliac crest, large facet joint, and inclinatory disc space. Among these, the iliac crest is considered a major obstacle. There are no studies regarding the height of the iliac crest and their appropriate procedures in PELD. This study discusses PELD for L5-S1 disc herniation and the appropriate approach according to the height of iliac crest. Retrospective evaluation. 100 consecutive patients underwent PELD via the transforaminal route for L5-S1 disc herniation by a single surgeon. The study was divided into 2 groups: the foraminoplasty group requiring foraminal widening to access the herniated disc and the non-foraminoplasty group treated by conventional posterolateral access. Radiological parameters such as iliac height, the relative position of the iliac crest to the landmarks of the L5-S1 level, iliosacral angle and foraminal height, and disc location were considered. Clinical outcomes were assessed by the Visual Analogue Scale (VAS, 0 - 10) for back and leg pain, the Oswestry Disability Index (ODI, 0 - 100%), and the modified MacNab criteria. The overall VAS scores for back and leg pain decreased from 6.0 to 2.3 and from 7.5 to 1.7. The mean ODI (%) improved from 54.0 to 11.6. Using modified MacNab criteria, a good outcome was 92%. Foraminoplasty was required in 19 patients. Iliac crest height was significantly higher in the foraminoplasty group than the non-foraminoplasty group (37.7 mm vs 30.1 mm, P disc height between the 2 groups. In addition, there were no differences in clinical outcome between the 2 groups. This study is a retrospective analysis and simplifies the complexity of the L5-S1 level and iliac bone using two-dimensional radiography. In high iliac crest cases where the iliac crest is above the mid L5 pedicle

  13. Preoperative retrolisthesis as a risk factor of postdecompression lumbar disc herniation.

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    Takenaka, Shota; Tateishi, Kosuke; Hosono, Noboru; Mukai, Yoshihiro; Fuji, Takeshi

    2016-04-01

    In this study, the authors aimed to identify specific risk factors for postdecompression lumbar disc herniation (PDLDH) in patients who have not undergone discectomy and/or fusion. Between 2007 and 2012, 493 patients with lumbar spinal stenosis underwent bilateral partial laminectomy without discectomy and/or fusion in a single hospital. Eighteen patients (herniation group [H group]: 15 men, 3 women; mean age 65.1 years) developed acute sciatica as a result of PDLDH within 2 years after surgery. Ninety patients who did not develop postoperative acute sciatica were selected as a control group (C group: 75 men, 15 women; mean age 65.4 years). Patients in the C group were age and sex matched with those in the H group. The patients in the groups were also matched for decompression level, number of decompression levels, and surgery date. The radiographic variables measured included percentage of slippage, intervertebral angle, range of motion, lumbar lordosis, disc height, facet angle, extent of facet removal, facet degeneration, disc degeneration, and vertebral endplate degeneration. The threshold for PDLDH risk factors was evaluated using a continuous numerical variable and receiver operating characteristic curve analysis. The area under the curve was used to determine the diagnostic performance, and values greater than 0.75 were considered to represent good performance. Multivariate analysis revealed that preoperative retrolisthesis during extension was the sole significant independent risk factor for PDLDH. The area under the curve for preoperative retrolisthesis during extension was 0.849; the cutoff value was estimated to be a retrolisthesis of 7.2% during extension. The authors observed that bilateral partial laminectomy, performed along with the removal of the posterior support ligament, may not be suitable for lumbar spinal stenosis patients with preoperative retrolisthesis greater than 7.2% during extension.

  14. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain (Review)

    NARCIS (Netherlands)

    van der Windt, D.A.W.M.; Simons, E.; Riphagen, I.I.; Ammendolia, C.; Verhagen, A.P.; Laslett, M.; Devillé, W.; Deyo, R.A.; Bouter, L.M.; de Vet, H.C.W.; Aertgeerts, B.

    2011-01-01

    Background Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care

  15. Clinical Efficacy of Selective Focal Ablation by Navigable Percutaneous Disc Decompression Device in Patients With Cervical Herniated Nucleus Pulposus.

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    Kim, Sung Hoon; Lee, Sang-Heon; Kim, Nack Hwan; Kim, Min Hyun; Park, Hyeun Jun; Jung, Yong Jin; Yoo, Hyun-Joon; Meng, Won Jun; Kim, Victoria

    2017-02-01

    To evaluate the clinical efficacy and safety following percutaneous disc decompression, using navigable disc decompression device for cervical herniated nucleus pulposus (HNP). Twenty subjects diagnosed with cervical HNP and refractory to conservative management were enrolled for the study. The herniated discs were decompressed under fluoroscopic guidance, using radiofrequency ablation device with navigable wand. The sagittal and axial plain magnetic resonance images of the clinically significant herniated disc, decided the space between the herniated base and outline as the target area for ablation. Clinical outcome was determined by Numeric Rating Scale (NRS), Neck Disability Index (NDI), and Bodily Pain scale of Short Form-36 (SF-36 BP), assessed after 48 weeks. After the procedure, we structurally matched the magnetic resonance imaging (MRI) and C-arm images through bony markers. The wand position was defined as being 'correct' if the tip was placed within the target area of both AP and lateral views; if not, the position was stated as 'incorrect'. The average NRS fell from 7 to 1 at 48 weeks post procedure (p<0.05). In addition, statistically significant improvement was noted in the NDI and SF-36BP (p<0.05). The location of the wand tip resulted in 16 correct and 4 incorrect placements. Post-48 weeks, 3 of the incorrect tip cases and 1 correct tip case showed unsuccessful outcomes. The study demonstrated the promising results and safety of the procedure. Thus, focal plasma ablation of cervical HNP with navigable wand can be another effective treatment option.

  16. Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation.

    Science.gov (United States)

    van Helvoirt, Hans; Apeldoorn, Adri T; Ostelo, Raymond W; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W

    2014-07-01

    Prospective cohort study. To report the clinical course of patients with MRI-confirmed lumbar disc herniation-related radicular noncentralizing pain who received transforaminal epidural steroid injections (TESIs) and mechanical diagnosis and therapy (MDT). Noncentralizing symptoms in patients with lumbar disc herniation are associated with poor outcome. Commonly used treatments for these patients include TESIs and MDT. No study has evaluated the outcome of combining both strategies. Consecutive candidates for herniated lumbar disc surgery with noncentralizing chronic pain were eligible. Patients received TESIs followed by MDT. The primary outcomes were pain severity in the leg, disability (Roland-Morris Disability Questionnaire for Sciatica), and global perceived effect (GPE). Outcomes were measured at baseline, discharge, and 12 months. Linear mixed-models and McNemar's tests were used to analyze outcome data. Sixty-nine patients receive TESIs. After TESIs, symptoms were resolved completely in 11 patients (16%). In these patients, symptom resolution was maintained at 12 months. A second subgroup of 32 patients (46%) reported significantly less pain after TESIs and showed centralization with MDT reassessment (significant reductions in leg pain and disability [P TESIs but still showed noncentralization with MDT reassessment (significant reductions in leg pain and disability [P TESIs and received an operative intervention. The results indicate that a course of TESIs followed by MDT may be able to avoid surgery in a substantial proportion of candidates for herniated lumbar disc surgery. Wiley Periodicals, Inc.

  17. The Clinical Results of Percutaneous Endoscopic Interlaminar Discectomy (PEID) in the Treatment of Calcified Lumbar Disc Herniation: A Case-Control Study.

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    Dabo, Xu; Ziqiang, Chen; Yinchuan, Zhao; Haijian, Ni; Kai, Chen; Yanbin, Liu; Qiang, Fu; Chuanfeng, Wang

    2016-02-01

    Percutaneous endoscopic interlaminar discectomy (PEID), which poses advantages for certain types of herniated disc, is gaining wider acceptance in clinical practice. We retrospectively analyzed the efficacy of the PEID technique in treatment of calcified lumbar disc herniation. A retrospective case-control study. University hospital in China. To evaluate the efficacy of the PEID technique in treatment of calcified lumbar disc herniation, and a comparison between calcified and noncalcified disc herniation was drawn to analyze the causes of herniated disc calcification. Data from patients who underwent full-endoscopic lumbar discectomy in our department between March 2011 and May 2013 were collected. Thirty cases with calcified lumbar disc herniation were included in the study group, and 30 age-, gender-, and body mass index (BMI)-matched cases with noncalcified lumbar disc herniation served as controls. Perioperative data, preoperative and postoperative Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) values, MacNab scores, and postoperative low-extremity dysesthesia among patients in the 2 groups were collected. The values of computed tomography (CT) in the calcified group were significantly higher than those in the noncalcified group (P 0.05). Three months after surgery, the rate of low-extremity dysesthesia in the calcified group was significantly higher than that in the control group (P = 0.03) but became similar at 6 months. By applying MacNab criteria the proportions of good and excellent were greater than 90% in both groups, and there was no difference between groups (P > 0.05). The sample size was small in this retrospective study. The PEID technique is an effective method in the treatment of calcified lumber disc herniation, although the rate of postoperative dysesthesia is higher in this group during the early postoperative period. Long-term TCM administration may be related to the calcification of herniated lumbar discs.

  18. Treatment of contained lumbar disc herniations using radiofrequency assisted micro-tubular decompression and nucleotomy: four year prospective study results.

    Science.gov (United States)

    Hellinger, Stefan

    2014-01-01

    Patients with radiculopathy caused by contained disc herniations are less likely to have good outcomes following discectomy surgery than patients with disc herniations that are not contained. The author presents his 4-year results from a prospective trial regarding the efficacy and safety of a tubular transforaminal radiofrequency-assisted manual decompression and annulus modulation of contained disc herniations in 58 patients. Fifty-eight patients with lumbar radiculopathy due to a contained disc herniation were enrolled in a prospective clinical study. Visual analog scores (VAS) for back pain and leg pain, quality of life assessment, Macnab criteria, and SF-12 were collected from patients before treatment, at 2-years and 4-years post-treatment. At 4 years, results were obtained from 47 (81%) of patients. Compared to mean pre- treatment assessments, mean 4-year VAS for back pain improved from 8.6 to 2.3 points, and mean VAS for leg pain improved from 7.8 to 2.3. Eighty-three percent of respondents reported that they were "satisfied" or "very satisifed" with their quality of life at 4-years as per SF-12. At 4 years, recurrence was noted in 3 (6.4%) of respondents and no complications were reported. The 2-year and 4-year study results are nearly identical, suggesting durable benefit out to 4 years. These results also suggest that in carefully selected patients with sustained contained disc herniations who have failed conservative treatments, manual decompression combined with radiofrequency-assisted decompression and annulus modulation are very likely to have good outcomes 4 years post-treatment.

  19. Src-family kinases activation in spinal microglia contributes to central sensitization and chronic pain after lumbar disc herniation.

    Science.gov (United States)

    Huang, Yangliang; Li, Yongyong; Zhong, Xiongxiong; Hu, Yuming; Liu, Pan; Zhao, Yuanshu; Deng, Zhen; Liu, Xianguo; Liu, Shaoyu; Zhong, Yi

    2017-01-01

    Background Lumbar disc herniation is a major cause of radicular pain, but the underlying mechanisms remain largely unknown. Spinal activation of src-family kinases are involved in the development of chronic pain from nerve injury, inflammation, and cancer. In the present study, the role of src-family kinases activation in lumbar disc herniation-induced radicular pain was investigated. Results Lumbar disc herniation was induced by implantation of autologous nucleus pulposus, harvest from tail, in lumbar 4/5 spinal nerve roots of rat. Behavior test and electrophysiologic data showed that nucleus pulposus implantation induced persistent mechanical allodynia and thermal hyperalgesia and increased efficiency of synaptic transmission in spinal dorsal horn which underlies central sensitization of pain sensation. Western blotting and immunohistochemistry staining revealed that the expression of phosphorylated src-family kinases was upregulated mainly in spinal microglia of rats with nucleus pulposus. Intrathecal delivery of src-family kinases inhibitor PP2 alleviated pain behaviors, decreased efficiency of spinal synaptic transmission, and reduced phosphorylated src-family kinases expression. Furthermore, we found that the expression of ionized calcium-binding adapter molecule 1 (marker of microglia), tumor necrosis factor-α, interleukin 1 -β in spinal dorsal horn was increased in rats with nucleus pulposus. Therapeutic effect of PP2 may be related to its capacity in reducing the expression of these factors. Conclusions These findings suggested that central sensitization was involved in radicular pain from lumbar disc herniation; src-family kinases-mediated inflammatory response may be responsible for central sensitization and chronic pain after lumbar disc herniation.

  20. Percutaneous Disc Coagulation Therapy (PDCT) comparing with Automated Percutaneous Lumbar Discectomy (APLD) in Patients of Herniated Lumbar Disc Disease: Preliminary Report.

    Science.gov (United States)

    Park, Cheon Wook; Lee, Joo Yong; Choi, Woo Jin; Chang, Sang Keun

    2012-09-01

    Percutaneous techniques are rapidly replacing traditional open surgery. This is a randomized controlled trial study of clinical outcomes of Percutaneous Plasma Disc Coagulation Therapy (PDCT) in patients with HLD(herniated lumbar disc) as a new percutaneous access in comparison with Automated Percutaneous Lumbar Discectomy (APLD) in its clinical application and usefulness as a reliable alternative method. The authors analyzed 25 patients who underwent PDCT randomized 1:1 to 25 who underwent APLD between June, 2010 and October, 2011. All patients had herniated lumbar disc diseases. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. The age of the patients who underwent PDCT ranged from 29 to 88 years with a mean age of 51.8 years. The age of the APLD undergone patients' population ranged from 30 to 66 with a mean age of 46.0 years. The average preoperative VAS score in PDCT was 7.60 and 1.94 at 7months post-operatively, and in APLD was 7.32, and 3.53 at 7 months post-operatively (pherniated lumbar disc. PDCT showed to be more effective than APLD in this study, allowing stable decompression and safe minimally invasive operation to an area desired by the operator in lumbar disc herniation patients, although further long term clinical evaluations are still necessary.

  1. Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nationwide cohort study.

    Science.gov (United States)

    Kim, Chi Heon; Chung, Chun Kee; Park, Choon Seon; Choi, Boram; Kim, Min Jung; Park, Byung Joo

    2013-04-01

    Retrospective cohort study using national health insurance data. To provide a longitudinal reoperation rate after surgery for lumbar herniated intervertebral disc (HIVD) disease, and to compare the reoperation rates of surgical methods. Herniated intervertebral disc disease is the most common cause of lumbar spinal surgery. Despite improved surgical techniques and instrumentation, reoperation cannot be avoided. The reoperation rates were in the range of 6% to 24% in previous studies. A population-based study is less subject to bias; hence, a nationwide longitudinal analysis was warranted. A national health insurance database was used to identify a cohort of patients who underwent first surgery for herniated intervertebral disc disease in 2003 and 18,590 patients were selected. Individual patients were followed for at least 5 years through their encrypted unique resident registration number. The primary endpoint was any type of second lumbar surgery. After adjusting for confounding factors, 5 surgical methods (fusion, laminectomy, open discectomy, endoscopic discectomy, and nucleolysis [including mechanical nucleus decompression]) were compared. Open discectomy was used as the reference method. Open discectomy was the most common procedure (68.9%) followed by endoscopic discectomy (16.1%), laminectomy (7.9%), fusion (3.9%), and nucleolysis (3.2%). The cumulative reoperation rate was 5.4% at 3 months, 7.4% at 1 year, 9% at 2 years, 10.5% at 3 years, 12.1% at 4 years, and 13.4% at 5 years. The reoperation rates were 18.6%, 14.7%, 13.8%, 12.4%, and 11.8% after laminectomy, nucleolysis, open discectomy, endoscopic discectomy, and fusion, respectively. Compared with open discectomy, the reoperation rate was higher after laminectomy at 3 months, whereas the other surgical methods had similar rates. The cumulative reoperation rate after 5 years was 13.4% and half of the reoperations occurred during the first postoperative year. With the exception of laminectomy, the

  2. Oxygen-ozone therapy for herniated lumbar disc in patients with subacute partial motor weakness due to nerve root compression.

    Science.gov (United States)

    Dall'Olio, Massimo; Princiotta, Ciro; Cirillo, Luigi; Budai, Caterina; de Santis, Fabio; Bartolini, Stefano; Serchi, Elena; Leonardi, Marco

    2014-10-31

    Intradiscal oxygen-ozone (O2-O3) chemonucleolysis is a well-known effective treatment for pain caused by protruding disc disease and nerve root compression due to bulging or herniated disc. The most widely used therapeutic combination is intradiscal injection of an O2-O3 mixture (chemonucleolysis), followed by periradicular injection of O2-O3, steroid and local anaesthetic to enhance the anti-inflammatory and analgesic effect. The treatment is designed to resolve pain and is administered to patients without motor weakness, whereas patients with acute paralysis caused by nerve root compression undergo surgery 24-48h after the onset of neurological deficit. This paper reports on the efficacy of O2-O3 chemonucleolysis associated with anti-inflammatory foraminal injection in 13 patients with low back pain and cruralgia, low back pain and sciatica and subacute partial motor weakness caused by nerve root compression unresponsive to medical treatment. All patients were managed in conjunction with our colleagues in the Neurosurgery Unit of Bellaria Hospital and the IRCCS Institute of Neurological Sciences, Bologna. The outcomes obtained are promising: 100% patients had a resolution of motor weakness, while 84.6% had complete pain relief. Our results demonstrate that O2-O3 therapy can be considered a valid treatment option for this category of patients.

  3. Psychosocial stress factors among patients with lumbar disc herniation, scheduled for disc surgery in comparison with patients scheduled for arthroscopic knee surgery

    Science.gov (United States)

    Cornefjord, Michael; Bergkvist, Leif; Öhrvik, John; Linton, Steven J.

    2007-01-01

    Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of work-related stress, life satisfaction and demanding life events, among patients undergoing first-time surgery for lumbar disc herniation in comparison with patients scheduled for arthroscopic knee surgery. Sixty-nine patients with disc herniation and 162 patients awaiting arthroscopy were included in the study, during the time period March 2003 to May 2005. Sixty-two percent of the disc patients had been on sick leave for an average of 7.8 months and 14 percent of the knee patients had been on sick leave for an average of 4.2 months. The psychosocial factors were investigated preoperatively using a questionnaire, which was a combination of the questionnaire of quality of work competence (QWC), life satisfaction (LiSat9) and life events as a modification of the social readjustment scale. There were no significant differences between the two groups in terms of work-related stress or the occurrence of demanding life events. The disc patients were significantly less satisfied with functions highly inter-related to pain and discomfort, such as present work situation, leisure-time, activities of daily living (ADL) function and sleep. Patients with disc herniation on sick leave were significantly less satisfied with their present work situation than knee patients on sick leave; this sub-group of patients with disc herniation also reported significantly higher expectations in relation to future job satisfaction than knee patients. The results indicate that psychosocial stress is not more pronounced preoperatively in this selected group of disc patients, without co-morbidity waiting for first-time disc

  4. The Association Between Modic Changes of Lumbar Endplates and Spontaneous Absorption of Herniated Intervertebral Discs.

    Science.gov (United States)

    Ding, Lingzhi; Teng, Xiao; Fan, Shunwu; Zhao, Fengdong

    2015-04-01

    Herniated disc (HD) is one of the most common causes of lower back pain. Treatment for HD includes conservative therapy and surgical intervention. Following conservative treatment, spontaneous absorption of HD occurs in some patients. To assess whether modic changes are associated with spontaneous absorption of HD, 85 patients with or without modic changes were followed up after 6 months of conservative treatment. As result, we found modic changes of lumbar endplates are associated with poor absorption of HD after conservative treatment. In addition, patients with modic changes exhibit significantly increased cartilage content and decreased neovascularization and macrophage infiltration in HD tissues, all of which are known to impair spontaneous absorption of herniated tissues. At molecular level, modic changes are associated with decreased expression of matrix metalloproteinase-3 gene, which is a key matrix-degrading enzyme for tissue absorption. Our study established a strong association between modic changes of lumbar endplates and spontaneous absorption of lumbar HD, which provided a potential novel method for prediction of spontaneous absorption.

  5. THORACIC DISC HERNIATION: SURGICAL DECOMPRESSION BY POSTERIOR APPROACH A LA CARTE

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    MURILO TAVARES DAHER

    Full Text Available ABSTRACT Objectives: To present the clinical and radiographic results of patients with thoracic disc herniation treated by the posterior approach, according to location and type of hernia (à la carte. Methods: We evaluated thirteen patients (14 hernias treated by the posterior approach. Eight (61.5% patients were male and the mean age was 53 years (34-81. Clinical evaluation was performed by the Frankel and JOA modified scales. All the patients underwent the posterior approach, which was performed by facetectomy, transpedicular approach, transpedicular + partial body resection, costotransversectomy or costotransversectomy + reconstruction with CAGE. Results: The mean follow-up was 2 years and 6 months (11-77 months. Of the 14 operated hernias, six (43% were lateral, 2 (14% paramedian, and 6 (43% central. Seven were soft (50% and seven were calcified. The transfacet approach was carried out in 5 cases (36%, transpedicular in 1 case (7%, transpedicular + partial body resection in 4 (29%, costotransversectomy in 3 (21%, and costotransversectomy + CAGE in one case (7%. The majority of patients with lateral hernia (5/6 were subjected to transfacet decompression and in cases of central and paramedian hernias, all patients underwent decompression, which is more extensive. Conclusions: The posterior approach is safe and effective, and the best approach must be chosen based on location and type of the herniation and the surgeon's experience.

  6. Cervical brucellar spondylodiscitis mimicking a cervical disc herniation with epidural abscess: a case report

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    Ahmet Aslan

    2014-05-01

    Full Text Available Brucellosis can show many clinical manifestations according to the affected sites of the body, and is usually diagnosed with osteoarticular symptoms. We present a patient with cervical brucellar spondylodiscitis and epidural abscess who presented with severe neck and left upper extremity pain and was referred to our hospital for surgery because of cervical disc herniation. The patient didn’t undergo surgery and was cured with 6 months of medical therapy. Duration of the medical therapy was assessed by magnetic resonans imaging (MRI studies. In endemic regions, brucellar spondylodiscitis should be included in differential diagnoses for patients who have cervical pain with or without neurological deficits. Patients should be attentively questioned concerning occupation, settlement place, subfebril fever, consumption of raw milk or dairy products, travel to endemic regions or past brucellosis history in the family. MRI is an important imaging modality in the diagnosis and response to medical treatment in brucellar spondylodiscitis.

  7. Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature

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    Kapetanakis Stylianos

    2017-12-01

    Full Text Available Cauda equina syndrome (CES is a rare neurologic condition that is caused by compression of the cauda equina. Cauda equina consists of spinal nerves L2-L5, S1-S5 and the coccygeal nerve. The compression of these nerve roots can be caused mainly by lumbar disc herniation (45% of all causes. The diagnosis consists of two critical points: a detailed history and physical examination and b MRI or CT. The gold standard of the treatment of this syndrome is the surgical approach in combination with the timing of onset of symptoms. The surgery as an emergency situation is recommended in the fi rst 48 hours of onset of symptoms. Any delay in diagnosis and treatment leads to a poor prognosis of CES.

  8. Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature.

    Science.gov (United States)

    Kapetanakis, Stylianos; Chaniotakis, Constantinos; Kazakos, Constantinos; Papathanasiou, Jannis V

    2017-12-20

    Cauda equina syndrome (CES) is a rare neurologic condition that is caused by compression of the cauda equina. Cauda equina consists of spinal nerves L2-L5, S1-S5 and the coccygeal nerve. The compression of these nerve roots can be caused mainly by lumbar disc herniation (45% of all causes). The diagnosis consists of two critical points: a) detailed history and physical examination and b) MRI or CT. The gold standard of the treatment of this syndrome is the surgical approach in combination with the timing of onset of symptoms. The surgery as an emergency situation is recommended in the fi rst 48 hours of onset of symptoms. Any delay in diagnosis and treatment leads to a poor prognosis of CES.

  9. Pathogenesis of the discal cysts communicating with an adjacent herniated disc. Histological and ultrastructual studies of two cases.

    Science.gov (United States)

    Kobayashi, Shigeru; Takeno, Kenichi; Uchida, Kenzo; Yayama, Takafumi; Nakajima, Hideaki; Miyazaki, Tsuyoshi; Guerrero, Alexander; Baba, Hisatoshi

    2010-03-01

    Discal cyst of the lumbar spine is a very rare cause of back pain and sciatica. We report two cases of discal cysts communicating with an adjacent herniated disc. From CT and MRI findings, they were diagnosed as having a discal cyst in the epidural space, which compressed the nerve root. After an adequate surgical field was obtained with a microscope and a Casper retractor, the discal cyst could be excised and satisfactory decompression of the adjacent nerve root was obtained. From histological and electron microscopic study, the presence of residual herniated tissues was confirmed in the cyst wall. Macrophages played an important role in the absorption of herniated tissue and the formation of the discal cyst. Hemorrhage in the cyst wall will make the serous hemorrhagic fluid-filled cystic structure in the absorbed spaces of the prolapsed disc. In this study, we confirmed that the discal cyst could have developed from the absorption process of a disc herniation. Copyright 2009 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  10. The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation

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    Ulutaş, Murat; Çınar, Kadir; Seçer, Mehmet

    2017-01-01

    Abstract Persistence of postoperative radicular pain after surgery for multifocal disc herniation (MFDH) is a clinical problem. This study aims to evaluate the effects of a combined treatment approach compared with unilateral stabilization on early postoperative radicular pain in patients with MFDH. Age, sex, level of operation, clinical findings, and radicular pain visual analogue scale (VAS) scores before surgery in the early postoperative period and at 3 months after surgery were retrospectively reviewed for 20 cases of multifocal lumbar disc herniation. The combined approach (translaminar and far lateral) was used for 13 cases. Seven cases underwent transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular stabilization following total facetectomy. The mean age of the sample was 49.4 ± 10.1 years and the female-to-male ratio was 8:12. The mean VAS scores for radicular pain in cases treated with the combined approach were 8.2, 4.07, and 2.3 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean score for radicular pain improved by 50.4% in the early postoperative period and by 72% in the late postoperative period. The mean VAS scores for radicular pain in cases who underwent TLIF and unilateral stabilization after facetectomy were 8.4, 2.1, and 1.4 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean VAS score for radicular pain improved by 75% in the early postoperative period and by 83.3% in the late postoperative period. The combined approach is an effective alternative in cases with MFDH. TLIF and unilateral segmental stabilization provide substantial decompression and eliminate mechanical compression by conserving the height of the intervertebral foramen in the event that sufficient decompression is unable to obtain. We suggest that elimination of chemical mediators, particularly those causing pain in the dorsal ganglion, contributes to

  11. CT-guided steroid injection into disc herniation: a causative therapy for lower back pain due to disc herniation; CT-gesteuerte Prolaps-Steroidinjektion: Eine kausale Therapie des bandscheibenprolapsassoziierten Schmerzsyndroms

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    Vahlensieck, M.; Bruderhofer, A.F. [Radiologie Haydnhaus, Bonn (Germany); Waldecker, B.

    2005-01-01

    Purpose: to evaluate the therapeutic benefit of CT-guided steroid injection into disc herniations. Materials and methods: in 64 patients, 2.5 mg Dexamethasone was injected into a symptomatic disc herniation under CT-guidance. Conservative treatment 3 to 12 months before injection was unsuccessful. Classified as ''complete relief'', ''strong relief'', ''mild relief'' and ''no relief'' of pain, the change of discomfort and pain was registered at 14 days, 3 months and 6 months after injection while the conservative regimen continued. Results: at 14 days after injection, 36 patients (56%) showed complete relief, 5 strong relief (8%), 12 mild relief (19%) and 11 no relief (17%). At 6 months after injection, 25 patients showed complete relief (39%), 16 strong relief (25%), and 23 no relief (36%). One complicating spondylodiscitis was observed. Conclusion: CT-guided steroid injection into symptomatic disc herniation represents a therapeutic alternative with good therapeutic results. It can be recommended as an alterative to other minimal invasive therapeutic regimens. The disc material acts as reservoir for the drug with good long term depot effect. (orig.)

  12. Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3.0 Tesla magnetic resonance study.

    Science.gov (United States)

    Messner, Alina; Stelzeneder, David; Trattnig, Stefan; Welsch, Götz H; Schinhan, Martina; Apprich, Sebastian; Brix, Martin; Windhager, Reinhard; Trattnig, Siegfried

    2017-03-01

    Indicating lumbar disc herniation via magnetic resonance imaging (MRI) T2 mapping in the posterior annulus fibrosus (AF). Sagittal T2 maps of 313 lumbar discs of 64 patients with low back pain were acquired at 3.0 Tesla (3T). The discs were rated according to disc herniation and bulging. Region of interest (ROI) analysis was performed on median, sagittal T2 maps. T2 values of the AF, in the most posterior 10% (PAF-10) and 20% of the disc (PAF-20), were compared. A significant increase in the T2 values of discs with herniations affecting the imaged area, compared to bulging discs and discs with lateral herniation, was shown in the PAF-10, where no association to the NP was apparent. The PAF-20 exhibited a moderate correlation to the nucleus pulposus (NP). High T2 values in the PAF-10 suggest the presence of disc herniation (DH). The results indicate that T2 values in the PAF-20 correspond more to changes in the NP.

  13. MR imaging of lumbar herniated intervertebral disc and spinal stenosis: Correlation with CT

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    Lee, Won Jae; Park, Kil Sun; Chang, Kee Hyun; Han, Moon Hee; Kim, Hyun Jip; Han, Man Chung; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    MR imagings obtained in 40 patients with surgically proven lumbar herniated intervertebral disc (HIVD) and/or spinal stenosis were retrospectively analysed and compared with CT scans, in order to evaluate the MR findings of HIVD and spinal stenosis, and to assess the diagnostic accuracy of MR. The MR imaging was performed on a 2.0 T superconducting unit, using multislice spin echo (SE) and gradient echo (GE) techniques. The results were as follows: 1. The texture of vertebral body with spinal stenosis had the tendency to be more heterogeneous than that with HIVD. 2. The signal intensity of the diseased disc was isointense relative to normal disc in 81 % (60/74) and the remainder (19%) was hypointense on both T1 weighted SE and GE images. There was no significant difference in signal intensity among HIVD, HIVD combined with spinal stenosis and spinal stenosis groups, but there was the tendency of lower signal intensity of the diseased disc in patients with severe degenerative change of spine in both T1 weighted SE imaged and GE image. 3. The diagnostic accuracy of MR was 92%, which was similar to that of CT. 4. T1 weighted SE image appears superior to GE image in evaluation of most of the structural differentiation, but as for differentiating between lumina and ligamentum flavum, and for the vacuum phenomenon, GE image seems to be better than T1 weighted SE image. In conclusion, MR appears to be better than CT as a initial imaging modality in evaluation of the patients with suspected lumbar spinal stenosis or HIVD because MR has the capability of demonstrating rupture of anulus fibrosus in sagittal plane.

  14. New Diagnostic Tool for Far Lateral Lumbar Disc Herniation : The Clinical Usefulness of 3-Tesla Magnetic Resonance Myelography Comparing with the Discography CT

    Science.gov (United States)

    Kim, Duk-Gyu; Park, Jung-Soo

    2012-01-01

    Objective To prospectively assess the diagnostic and clinical value of a new technique (3-tesla magnetic resonance myelography, 3T MRM) as compared to computed tomographic discography (disco-CT) in patients with far lateral disc herniation. Methods We evaluated 3T MRM and disco-CT of 25 patients, whom we suspected of suffering from far lateral disc herniation. Using an assessment scale, 4 observers examined independently both 3T MRM and disco-CT images. We analyzed observer agreement and the accentuation of each image. Results We found complete matching, and observer agreement, between high resolution images of 3T MRM and disco-CT for diagnosing far lateral disc herniation. Conclusion We think noninvasive 3T MRM is an appropriate diagnostic tool for far lateral disc herniation as compared to disco-CT. PMID:23091667

  15. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy.

    Science.gov (United States)

    Kreiner, D Scott; Hwang, Steven W; Easa, John E; Resnick, Daniel K; Baisden, Jamie L; Bess, Shay; Cho, Charles H; DePalma, Michael J; Dougherty, Paul; Fernand, Robert; Ghiselli, Gary; Hanna, Amgad S; Lamer, Tim; Lisi, Anthony J; Mazanec, Daniel J; Meagher, Richard J; Nucci, Robert C; Patel, Rakesh D; Sembrano, Jonathan N; Sharma, Anil K; Summers, Jeffrey T; Taleghani, Christopher K; Tontz, William L; Toton, John F

    2014-01-01

    The objective of the North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy is to provide evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of lumbar disc herniation with radiculopathy. The guideline is intended to reflect contemporary treatment concepts for symptomatic lumbar disc herniation with radiculopathy as reflected in the highest quality clinical literature available on this subject as of July 2011. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder. To provide an evidence-based educational tool to assist spine specialists in the diagnosis and treatment of lumbar disc herniation with radiculopathy. Systematic review and evidence-based clinical guideline. This guideline is a product of the Lumbar Disc Herniation with Radiculopathy Work Group of NASS' Evidence-Based Guideline Development Committee. The work group consisted of multidisciplinary spine care specialists trained in the principles of evidence-based analysis. A literature search addressing each question and using a specific search protocol was performed on English-language references found in Medline, Embase (Drugs and Pharmacology), and four additional evidence-based databases to identify articles. The relevant literature was then independently rated using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were developed via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Level I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline

  16. Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers

    International Nuclear Information System (INIS)

    Ernst, C.W.; Stadnik, T.W.; Peeters, E.; Breucq, C.; Osteaux, M.J.C.

    2005-01-01

    Study design: Prospective MR analysis of the cervical spine of 30 asymptomatic volunteers. Objectives: To evaluate the prevalence of annular tears, bulging discs, disc herniations and medullary compression on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images of the cervical spine in symptom free volunteers. Summary of background data: Few studies have reported the prevalence of cervical disc herniations in asymptomatic people, none have reported the prevalence of cervical annular tears on MR images of symptom free volunteers. Materials and methods: Thirty symptom-free volunteers (no history or symptoms related to the cervical spine) were examined using sagittal T2-weighted fast spin-echo (SE), sagittal gadolinium-enhanced T1-weighted SE imaging and axial T2 * -weighted gradient echo (GRE). The prevalence of bulging discs, focal protrusions, extrusions, nonenhancing or enhancing annular tears and medullary compression were assessed. Results: The prevalence of bulging disk and focal disk protrusions was 73% (22 volunteers) and 50% (15 volunteers), respectively. There was one extrusion (3%). Eleven volunteers had annular tears at one or more levels (37%) and 94% of the annular tears enhanced after contrast injection. Asymptomatic medullary compression was found in four patients (13%). Conclusion: Annular tears and focal disk protrusions are frequently found on MR imaging of the cervical spine, with or without contrast enhancement, in asymptomatic population. The extruded disk herniation and medullary compression are unusual findings in a symptom-free population

  17. Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers

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    Ernst, C.W. [Department of Radiology and Medical Imaging, University Hospital V.U.B., Laarbeeklaan 101, 1090 Brussels (Belgium)]. E-mail: ernstcaroline@hotmail.com; Stadnik, T.W. [Department of Radiology and Medical Imaging, University Hospital V.U.B., Laarbeeklaan 101, 1090 Brussels (Belgium); Peeters, E. [Department of Radiology and Medical Imaging, University Hospital V.U.B., Laarbeeklaan 101, 1090 Brussels (Belgium); Breucq, C. [Department of Radiology and Medical Imaging, University Hospital V.U.B., Laarbeeklaan 101, 1090 Brussels (Belgium); Osteaux, M.J.C. [Department of Radiology and Medical Imaging, University Hospital V.U.B., Laarbeeklaan 101, 1090 Brussels (Belgium)

    2005-09-01

    Study design: Prospective MR analysis of the cervical spine of 30 asymptomatic volunteers. Objectives: To evaluate the prevalence of annular tears, bulging discs, disc herniations and medullary compression on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images of the cervical spine in symptom free volunteers. Summary of background data: Few studies have reported the prevalence of cervical disc herniations in asymptomatic people, none have reported the prevalence of cervical annular tears on MR images of symptom free volunteers. Materials and methods: Thirty symptom-free volunteers (no history or symptoms related to the cervical spine) were examined using sagittal T2-weighted fast spin-echo (SE), sagittal gadolinium-enhanced T1-weighted SE imaging and axial T2{sup *}-weighted gradient echo (GRE). The prevalence of bulging discs, focal protrusions, extrusions, nonenhancing or enhancing annular tears and medullary compression were assessed. Results: The prevalence of bulging disk and focal disk protrusions was 73% (22 volunteers) and 50% (15 volunteers), respectively. There was one extrusion (3%). Eleven volunteers had annular tears at one or more levels (37%) and 94% of the annular tears enhanced after contrast injection. Asymptomatic medullary compression was found in four patients (13%). Conclusion: Annular tears and focal disk protrusions are frequently found on MR imaging of the cervical spine, with or without contrast enhancement, in asymptomatic population. The extruded disk herniation and medullary compression are unusual findings in a symptom-free population.

  18. Biomechanical analysis of press-extension technique on degenerative lumbar with disc herniation and staggered facet joint

    Directory of Open Access Journals (Sweden)

    Hong-gen Du

    2016-05-01

    Full Text Available This study investigates the effect of a new Chinese massage technique named “press-extension” on degenerative lumbar with disc herniation and facet joint dislocation, and provides a biomechanical explanation of this massage technique. Self-developed biomechanical software was used to establish a normal L1–S1 lumbar 3D FE model, which integrated the spine CT and MRI data-based anatomical structure. Then graphic technique is utilized to build a degenerative lumbar FE model with disc herniation and facet joint dislocation. According to the actual press-extension experiments, mechanic parameters are collected to set boundary condition for FE analysis. The result demonstrated that press-extension techniques bring the annuli fibrosi obvious induction effect, making the central nucleus pulposus forward close, increasing the pressure in front part. Study concludes that finite element modelling for lumbar spine is suitable for the analysis of press-extension technique impact on lumbar intervertebral disc biomechanics, to provide the basis for the disease mechanism of intervertebral disc herniation using press-extension technique.

  19. The passive straight leg raising test in the diagnosis and treatment of lumbar disc herniation: a survey of United kingdom osteopathic opinion and clinical practice.

    Science.gov (United States)

    Rebain, Richard; Baxter, G David; McDonough, Suzanne

    2003-08-01

    Postal questionnaire survey. To carry out a confidential postal survey of United Kingdom osteopaths in order to record and assess their use of the passive straight leg raising test in the diagnosis of, and choice of, manipulation for lumbar disc herniation. The study also sought to determine whether an association existed between osteopaths' manipulation of suspected lumbar disc herniation and their use of the straight leg raising test, the length of their working hours, and their use of manipulation for the treatment of other lumbar conditions. The literature is not agreed on important aspects of the straight leg raising test, or on the use of spinal manipulation for suspected lumbar disc herniation. This is thought to be the first study to investigate opinion and practice in a large group of spinal manipulators, in this case United Kingdom osteopaths. A questionnaire was sent to all 1030 United Kingdom osteopaths registered with the General Osteopathic Council in January 2000. It comprised four sections: personal characteristics, professional characteristics, background to low back pain cases, details of straight leg raising test understanding and use within the diagnosis and treatment of lumbar disc herniation. A response rate of 44% was achieved. United Kingdom osteopaths' opinions of low back pain and lumbar disc herniation clinical presentations, details of straight leg raising test mode of action, procedure, and interpretation were in keeping with the literature. Fifty-four percent of respondents sometimes employed manipulation in the treatment of lumbar disc herniation, but most of the others described the practice as "dangerous." The literature is similarly divided on the practice. Chi-square and Cramer V analysis implied that respondents were not influenced in choosing manipulation for lumbar disc herniation by their use of the straight leg raising test (chi2 = 4.002, df = 3, Cramer V = 0.0959, P = 0.261, alpha 0.05, n = 435). A moderate association

  20. Combined Therapies of Modified Taiyi Miraculous Moxa Roll and Cupping for Patients with Lumbar Intervertebral Disc Herniation

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    Chunyue Cai

    2018-01-01

    Full Text Available Lumbar intervertebral disc herniation is a kind of syndrome caused by stimulation or pressure of nerve root and cauda equina due to intervertebral disc disorder, fibrous ring rupture, and pulpiform nucleus protrusion. Application of traditional Chinese medicine (TCM including acupuncture therapy and cupping therapy is unique and effective treatment for lumbar intervertebral disc herniation in China. Hence, we try to investigate the combined clinical efficacy of modified Taiyi miraculous moxa roll and cupping therapy on patients with lumbar intervertebral disc herniation. Seventy patients were randomly assigned into combined treatment group (n=35 and control group (n=35. The treatment group received combined therapy of modified Taiyi miraculous moxa roll and cupping therapy, while control group received acupuncture therapy alone. Diagnostic criteria of TCM syndrome, Japanese Orthopedic Association (JOA score, and simplified McGill pain questionnaire (MPQ were used to evaluate the therapy. 11 and 13 out of 35 subjects in the combined treatment group had improvement > 75% and between 50% and 75%, respectively. The corresponding number was 2 and 22 of 35 subjects in the acupuncture group. There was significant difference in the clinical efficacy between the treatment group and control group (P=0.036. The scores of JOA and MPQ detected in the patients of the two groups (P<0.05 also showed statistically significant differences. Moreover, no serious adverse events occurred in the patients, who received cupping therapy or acupuncture. The combined or alone therapies can effectively improve the treatment efficacy in the patients with lumbar intervertebral disc herniation, while the combined therapies show more comparative effectiveness. Furthermore, the combined therapies are potentially safe and cost-effective and also benefit the improvement of short-term pain. Therefore, the combined therapies of the two ancient TCM deserve further clinical

  1. Radiculopathy due to microfibrillar collagen hemostat mimicking recurrence of disc herniation

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    Doita, M.; Nishida, K.; Kurosaka, M. [Kobe University Graduate School of Medicine, Department of Orthopedic Surgery, Kobe (Japan)

    2006-12-15

    Microfibrillar collagen hemostat (Avitene) is an absorbable topical hemostatic agent prepared from purified bovine corium collagen. A 65-year-old woman presented with left buttock and lower extremity radicular pain. The patient underwent a disc excision in which Avitene was used to control venous bleeding from the epidural space. Leg pain decreased postoperatively, but she developed radicular pain when she started walking 3 days after the operation. Magnetic resonance imaging (MRI) performed post-operatively showed there was a mass lesion located between the dural sac and L5 nerve root. The lesion exhibited high signal intensity on T1-weighted images and higher signal intensity at the rim of the mass on T2-weighted images. A second operation performed 10 days later revealed that the nerve root was adherent to an extradural granulomatous mass associated with Avitene. Macroscopically, the resected mass was found to be composed mainly of microfibrillar collagen hemostat materials. Hemostat agents may produce a clinically symptomatic, radiologically apparent mass lesion. When considering a mass lesion arising after spine surgery, the differential diagnosis should include foreign body granuloma along with recurrent disc herniation and peridural scar formation. (orig.)

  2. Does a herniated nucleus pulposus contribute significantly to a decrease in height of the intervertebral disc? Quantitative volumetrich MRI

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    Holodny, A.I.; Kisza, P.S.; Contractor, S.; Liu, W.C. [Department of Radiology, UMDNJ-New Jersey Medical School, University Hospital C-320, 150 Bergen Street, Newark, NJ 07103-2714 (United States)

    2000-06-01

    A lumbar intervertebral disc with a herniated nucleus pulposus (HNP) often exhibits a decrease in the height of the intervertebral space. Our purpose was to ascertain whether the loss of volume of an HNP is sufficient to cause a perceptible decrease in the height of the intervertebral space. MRI of 44 patients with 51 HNPs were reviewed. The volumes of the herniated material and of the intervertebral discs were calculated for every level from L 1-2 to L 5-S 1. The average volume of the HNP was 503{+-}301 mm{sup 3}. The average volumes of all 220 intervertebral discs and of the 127 normal-appearing discs were 14442{+-}4200 mm{sup 3} and 17476{+-}2885 mm{sup 3} respectively. The average volume of the HNP represented 3.5% of the parent disc. An average HNP caused a decrease in intervertebral space height of 0.35 mm (0.56 pixels). Therefore, the loss of the volume of the HNP does not cause a significant decrease in the intervertebral space height. The average calculated decrease in the disc height is less than that reported in normal diurnal variation. (orig.)

  3. Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century.

    Science.gov (United States)

    Postacchini, F; Postacchini, R

    2011-01-01

    Removal of a herniated disc with the use of the operative microscope was first performed by Yasargil (Adv Neurosurg. 4:81-2, 1977) in 1977. However, it began to be used more and more only in the late 1980s (McCulloch JA (1989) Principles of microsurgery for lumbar disc disease. Raven Press, New York). In the 1990s, many spinal surgeons abandoned conventional discectomy with naked-eye to pass to the routine practice of microdiscectomy. The merits of this technique are that it allows every type of disc herniation to be excised through a short approach to skin, fascia and muscles as well as a limited laminoarthrectomy. For these reasons, it has been, and still is, considered the "gold standard" of surgical treatment for lumbar disc herniation, and the method used by the vast majority of spinal surgeons. In the 1990s, the advent of MRI and the progressive increase in definition of this modality of imaging, as well as histopathologic and immunochemical studies of disc tissue and the analysis of the results of conservative treatments have considerably contributed to the knowledge of the natural evolution of a herniated disc. It was shown that disc herniation may decrease in size or disappear in a few weeks or months. Since the second half of the 1990s there has been a revival of percutaneous procedures. Some of these are similar to the percutaneous automated nucleotomy; other methods are represented by intradiscal injection of a mixture of "oxygen-ozone" (Alexandre A, Buric J, Paradiso R. et al. (2001) Intradiscal injection of oxygen ozone for the treatment of lumbar disc herniations: result at 5 years. 12th World Congress of Neurosurgery; 284-7), or laserdiscectomy performed under CT scan (Menchetti PPM. (2006) Laser Med Sci. 4:25-7). The really emerging procedure is that using an endoscope inserted into the disc through the intervertebral foramen to visualize the herniation and remove it manually using thin pituitary rongeurs, a radiofrequency probe or both (Chiu JC

  4. A prospective analysis of magnetic resonance imaging findings in patients with sciatica and lumbar disc herniation. Correlation of outcomes with disc fragment and canal morphology.

    Science.gov (United States)

    Carragee, E J; Kim, D H

    1997-07-15

    A two-part observational study. In Part 1, consecutive lumbar magnetic resonance imaging scans in patients with sciatica meeting enrollment criteria were prospectively and blindly analyzed by a set protocol. In Part 2, further clinical findings at the time of the magnetic resonance imaging were obtained by retrospective chart review and outcome assessment done at follow-up of more than 2 years. To determine the quantitative magnetic resonance findings of disc and canal measures in patients with sciatica and to analyze the predictive values of these magnetic resonance imaging and clinical variables on outcomes. Part 1: Consecutive patients with a primary diagnosis of sciatica who came to lumbar magnetic resonance imaging were enrolled, and magnetic resonance imaging dimensions of discs and canal at the herniated level were collected. Part 2: Of 186 patients in Part 1, 135 were followed for more than 2 years; 87 were treated conservatively, and 48 were treated surgically. Outcomes were judged on satisfaction, activity level, medication intake, and reported pain at follow-up (mean, 2.6 years). Part 1: Wide ranges of disc and canal measurements were seen in all parameters. Significant differences in all magnetic resonance parameters were noted between male and female patients. Men had proportionately greater canal compromise by the affected disc than women. Positive sciatic tension signs and short duration of symptoms correlated with large disc herniation. Right-sided symptomatic herniations were usually larger than left. Part 2: At follow-up, predictors of outcome were determined independently for the surgery and the nonoperative groups. In the nonoperative group, a shorter duration of sciatica was the most significant predictor of a good outcome (P = 0.0018). Moreover, a duration of symptoms less than 6 months, no involvement with litigation, and younger age were also correlated with a favorable outcome. The only magnetic resonance parameter associated with good

  5. Dual Etiologic Back Pain in Pregnancy: A Case Report with Lumbar Disc Herniation and Transient Osteoporosis of the Bilateral Hip

    Directory of Open Access Journals (Sweden)

    Aynur Aydoğan İzol

    2018-01-01

    Full Text Available Low back pain in pregnancy is a common complaint. It has been reported that the pregnancy is an independent risk factor for lomber disc herniation and may worsen the existing herniation. Transient osteoporosis of the hip (TOH, is a rare, self-limiting and gestational disease of unknown cause. In this article, we report a case of acute lomber disc hernia and later bilateral temporal osteoporosis of the hip that was treated with conservative methods during the same gestational period. With this pathologic case it is emphasized that, two pathological phenomenon can be seen in the same patient at the same time. It should be kept in mind TOH and radiculopathy should be considered in the differential diagnosis in pregnant patients who complains back and hip pain.

  6. Dual Etiologic Back Pain in Pregnancy: A Case Report with Lumbar Disc Herniation and Transient Osteoporosis of the Bilateral Hip

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    Aynur Aydoğan İzol

    2017-08-01

    Full Text Available Low back pain in pregnancy is a common complaint. It has been reported that the pregnancy is an independent risk factor for lomber disc herniation and may worsen the existing herniation. Transient osteoporosis of the hip (TOH, is a rare, self-limiting and gestational disease of unknown cause. In this article, we report a case of acute lomber disc hernia and later bilateral temporal osteoporosis of the hip that was treated with conservative methods during the same gestational period. With this pathologic case it is emphasized that, two pathological phenomenon can be seen in the same patient at the same time. It should be kept in mind TOH and radiculopathy should be considered in the differential diagnosis in pregnant patients who complains back and hip pain.

  7. Clinical study on microsurgical treatment of lumbar disc herniation assisted by METRx system

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    Xin-gang ZHAO

    2016-04-01

    Full Text Available Objective To explore the techniques and curative effect of microsurgical procedures assisted by minimal exposure tubular retractor system (METRx in the treatment of lumbar disc herniation (LDH.  Methods A total of 51 LDH patients, including 24 patients with L4-5 herniation and 27 patients with L5-S1 herniation, underwent discectomy assisted by METRx system. The operation time, intraoperative blood loss, postoperative complications and hospital stay were recorded. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate the degree of low back pain before operation, one week, 3 months after operation, and in the last follow-up. Lumbar MRI was used to evaluate the decompression of spinal canal.  Results The success rate of operations in 51 cases was 98.04% (50/51. The average operation time was 125 min, the average intraoperative blood loss was 50 ml, the mean hospital stay was 5 d, all patients were followed up for 6-48 months (average 24 months. Compared with preoperation, both VAS and ODI scores decreased significantly one week after operation (P = 0.036, 0.029, 3 months after operation (P = 0.018, 0.023 and in the last follow-up (P = 0.007, 0.013. The improvement rate of ODI was 35.37% in the last follow-up. No infection, postoperative cerebrospinal fluid (CSF fistula, neurological defects or incision infection was found. One patient presented acute abdominalgia on the 2nd day after operation, and was diagnosed as annexitis. One patient showed nerve root irritation symptoms after operation caused by thick nerve root during the surgery. They were cured after symptomatic treatment.  Conclusions Microsurgical procedures for treating LDH assisted by METRx system can effectively relieve nerve root compression, protect the dural sac and nerve roots, and reduce surgical complications. DOI: 10.3969/j.issn.1672-6731.2016.04.008

  8. Neurological examination of the peripheral nervous system to diagnose lumbar spinal disc herniation with suspected radiculopathy: a systematic review and meta-analysis.

    Science.gov (United States)

    Al Nezari, Nezar H; Schneiders, Anthony G; Hendrick, Paul A

    2013-06-01

    Disc herniation is a common low back pain (LBP) disorder, and several clinical test procedures are routinely employed in its diagnosis. The neurological examination that assesses sensory neuron and motor responses has historically played a role in the differential diagnosis of disc herniation, particularly when radiculopathy is suspected; however, the diagnostic ability of this examination has not been explicitly investigated. To review the scientific literature to evaluate the diagnostic accuracy of the neurological examination to detect lumbar disc herniation with suspected radiculopathy. A systematic review and meta-analysis of the literature. Six major electronic databases were searched with no date or language restrictions for relevant articles up until March 2011. All diagnostic studies investigating neurological impairments in LBP patients because of lumbar disc herniation were assessed for possible inclusion. Retrieved studies were individually evaluated and assessed for quality using the Quality Assessment of Diagnostic Accuracy Studies tool, and where appropriate, a meta-analysis was performed. A total of 14 studies that investigated three standard neurological examination components, sensory, motor, and reflexes, met the study criteria and were included. Eight distinct meta-analyses were performed that compared the findings of the neurological examination with the reference standard results from surgery, radiology (magnetic resonance imaging, computed tomography, and myelography), and radiological findings at specific lumbar levels of disc herniation. Pooled data for sensory testing demonstrated low diagnostic sensitivity for surgically (0.40) and radiologically (0.32) confirmed disc herniation, and identification of a specific level of disc herniation (0.35), with moderate specificity achieved for all the three reference standards (0.59, 0.72, and 0.64, respectively). Motor testing for paresis demonstrated similarly low pooled diagnostic sensitivities

  9. Predictive value of Modic type II changes in the choice of surgical treatment of lumbar disc herniation.

    Science.gov (United States)

    Figa, R; Morera-Dominguez, C

    2018-02-06

    To evaluate the predictive value of Modic typeII changes on nuclear magnetic resonance (NMR) prior to intervention by discectomy for lumbar disc herniation in patients with radicular symptoms. Retrospective descriptive study of 190 patients (58.2% men and 41.8% women) with a mean age of 43.5 years, treated between December 2005 and January 2013. They were divided into group 1, single disc herniation (n=85), and group 2, with disc herniation and changes Modic typeII (n=80). Variables studied: weight, height, handedness, level of injury, previous neurological deficit, postoperative complications, persistent pain and need for posterior lumbar fusion, with a mean of 67 months (group 1: 68.1; group 2: 66.8). In group 1 there were four hernia recurrences requiring revision surgery and six patients needed lumbar fusion. In group 2, four recurrences were also revised and eight cases requiring arthrodesis were observed. No statistically significant differences were found when comparing the occurrence of relapse (P=.903), the need for subsequent fusion (P=.572) or in the remaining variables. The data obtained and the characteristics of our study, we cannot say that Modic typeII changes were a predictive sign of the result of lumbar discectomy in our study population. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Posterior Decompression, Lumber Interbody Fusion and Internal Fixation in the Treatment of Upper Lumbar Intervertebral Disc Herniation

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    DONG Zhan

    2014-12-01

    Full Text Available Objective: To assess the clinical outcomes of posterior decompression, interbody fusion and internal fixationfor the treatment of the upper lumbar intervertebral disc herniation. Methods: Twelve patients with the upper lumbar intervertebral disc herniation were treated by posterior decompression, interbosy fusion and internal fixation. The time of the operation, the amount of bleeding and the clinical efficacy were evaluated. Results: The time of operation was (143±36 min and the amount of bleeding during operation was (331.5±47.9 mL. There was no spinal cord and injuries, nerve injury, epidural damage and leakage of cerebrospinal fluid. All patients were followed up for 10~19 months with the average being 12.6 months. The functional scoring of Japanese Orthopedic Association (JOA before the operation was (11.4±3.3 scores and final score after follow-up was (22.9±3.1 scores and there were statistical difference (P<0.01. Lumber interbody fusion of all patients completed successfully and the good rate after the operation was 91.7%. Conclusion: Posterior decompression, interbody fusion and internal fixation for the treatment of the upper lumbar intervertebral disc herniation was characterized by full exposure, safety and significant efficacy.

  11. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Surgery for Adjacent Segment Degeneration and Recurrent Disc Herniation

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    Huan-Chieh Chen

    2015-01-01

    Full Text Available Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD and open lumbar surgery for patients with adjacent segment degeneration (ASD and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients or repeated open lumbar surgery (25 patients, due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group P<0.0001. Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group P<0.0001. Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and −0.56 in the open lumbar surgery group P<0.0001. Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.

  12. Microdiscectomy with and without insertion of interspinous device for herniated disc at the L5-S1 level.

    Science.gov (United States)

    Galarza, Marcelo; Gazzeri, Roberto; De la Rosa, Pedro; Martínez-Lage, Juan F

    2014-11-01

    The role of interspinous devices (ISD) after lumbar herniated disc surgery for the prevention of postoperative back pain is controversial. The aim of this comparative prospective study was to determine outcomes in a selective cohort with L5-S1 disc herniation and degenerative disc changes after microdiscectomy with or without insertion of an ISD. One hundred and two consecutive patients underwent an L5-S1 microdiscectomy with or without implantation of an ISD. Group 1 consisted of 47 patients, with mild (n=22), moderate (n=14) or severe (n=11) degenerative disc changes who had microdiscectomy alone. Group 2 comprised 45 patients with similar types of disc changes who underwent microdiscectomy with an ISD implant. The Visual Analogue Scale (VAS) was used to grade low-back pain and postoperative clinical status was rated according to the modified MacNab criteria. Mean VAS score for low-back pain improved significantly at 1 year follow-up from 7.3 at baseline to 2.75 (pdisc changes were more likely to achieve improvement of their low-back pain when treated with both microdiscectomy and ISD insertion. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. [Treatment of lumbar intervertebral disc herniation and sciatica with percutaneous transforaminal endoscopic technique].

    Science.gov (United States)

    Jiang, Yi; Song, Hua-Wei; Wang, Dong; Yang, Ming-Lian

    2013-10-01

    To analyze the clinical effects of percutaneous transforaminal endoscopic technique in treating lumbar intervertebral disc herniation and sciatica. From June 2011 to January 2012,the clinical data of 46 patients with lumbar intervertebral disc herniation and sciatica underwent percutaneous transforaminal endoscopic technique were retrospectively analyzed. There were 28 males and 18 females,ranging in age from 11 to 77 years old with an average of (39.7_ 15.3) years old,20 cases were L5S1 and 26 cases were L4,5. All patients had the symptoms such as lumbago and sciatica and their straight-leg raising test were positive. Straight-leg raising test of patients were instantly repeated after operation;operative time,volume of blood loss,complication, length of stay and duration of back to work or daily life were recorded. The clinical effects were assessed according to the VAS,JOA and JOABPEQ score. All operations were successful,postoperative straight-leg raising test were all negative. Operative time,volume of blood loss,length of stay,duration of back to work or daily life,follow-up time were (93.0+/-28.0) min, (20.0+/-9.0)ml, (3.1+/-1.5) d, (11.6+/-4.2) d, (13.9+/-1.6) months,respectively. VAS score of lumbar before operation and at the 1st and 3rd,6th,12th month after operation were 5.3+/-1.2,1.9+/-1.1,1.0+/-0.8,0.9+/-0.8,0.8+/-0.6,respectively;VAS score of leg before operation and at the 1st and 3rd,6th,12th month after operation were 7.2+ 1.2,0.8+/-1.2,0.5+/-0.8,0.5+/-0.8,0.3+/-0.8,respectively. Five factors of JOABPEQ score,including lumbar pain,lumbar function, locomotor activity,social life viability and mental status,were respectively 27.0+/-30.6,37.3+/-27.4,38.5+/-26.6,33.0+/-13.7,55.4+/-19.0 before operation and 83.6+/-24.8,89.4+/-15.7,87.0+/-17.9,58.4+/-14.6,79.5+/-13.4 at final follow-up. Preoperative and postoperative JOA score were 9.1+/-2.6 and 27.3+/- 1.7, respectively. The postoperative VAS,JOA and JOABPEQ score had significantly improved (Psciatica

  14. Is intervertebral disc pressure linked to herniation?: An in-vitro study using a porcine model.

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    Noguchi, Mamiko; Gooyers, Chad E; Karakolis, Thomas; Noguchi, Kimihiro; Callaghan, Jack P

    2016-06-14

    Approximately 40% of low back pain cases have been attributed to internal disc disruption. This disruption mechanism may be linked to intradiscal pressure changes, since mechanical loading directly affects the pressure and the stresses that the inner annulus fibrosus experiences. The objective of this study was to characterize cycle-varying changes in four dependent measures (intradiscal pressure, flexion-extension moments, specimen height loss, and specimen rotation angle) using a cyclic flexion-extension (CFE) loading protocol known to induce internal disc disruption. A novel bore-screw pressure sensor system was used to instrument 14 porcine functional spinal units. The CFE loading protocol consisted of 3600 cycles of flexion-extension range of motion (average 18.30 (SD 3.76) degrees) at 1Hz with 1500N of compressive load. On average, intradiscal pressure and specimen height decreased by 47% and 62%, respectively, and peak moments increased by 102%. From 900 to 2100 cycles, all variables exhibited significant changes between successive time points, except for the specimen posture at maximum pressure, which demonstrated a significant shift towards flexion limit after 2700 cycles. There were no further changes in pressure range after 2100 cycles, whereas peak moments and height loss were significantly different from prior time points throughout the CFE protocol. Twelve of the 14 specimens showed partial herniation; however, injury type was not significantly correlated to any of the dependent measures. Although change in pressure was not predictive of damage type, the increase in pressure range seen during this protocol supports the premise that repetitive combined loading (i.e., radial compression, tension and shear) imposes damage to the inner annulus fibrosus, and its failure mechanism may be linked to fatigue. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. A PHASED REHABILITATION PROTOCOL FOR ATHLETES WITH LUMBAR INTERVERTEBRAL DISC HERNIATION

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    VanGelder, Leonard H.; Vaughn, Daniel W.

    2013-01-01

    Conservative non-surgical management of a herniated lumbar intervertebral disc (HLD) in athletes is a complex task due to the dramatic forces imparted on the spine during sport participation. The demands placed upon the athlete during rehabilitation and return to sport are unique not only from a sport specific perspective, but also regarding return to the sport strength and conditioning programs utilized for sport preparation. Many prescriptions fail to address postural and motor control faults specific to athletic development, which may prevent full return to sport after suffering a HLD or predispose the athlete to future exacerbations of a HLD. Strength exercises involving squatting, deadlifting, and Olympic power lifts are large components of the typical athlete's conditioning program, therefore some progressions are provided to address potential underlying problems in the athlete's technique that may have contributed to their HLD in the first place. The purpose of this clinical commentary is to propose a framework for rehabilitation that is built around the phases of healing of the disc. Phase I: Non-Rotational/Non-Flexion Phase (Acute Inflammatory Phase), Phase II: Counter rotation/Flexion Phase (Repair Phase), Phase III: Rotational Phase/Power development (Remodeling Phase), and Phase IV: Full return to sport. This clinical commentary provides a theoretical basis for these phases based on available literature as well as reviewing many popular current practice trends in the management of an HLD. The authors recognize the limits of any general exercise rehabilitation recommendation with regard to return to sport, as well as any general strength and conditioning program. It is vital that an individual assessment and prescription is made for every athlete which reviews and addresses movement in all planes of motion under all necessary extrinsic and intrinsic demands to that athlete. Level of Evidence: 5 PMID:24175134

  16. High lumbar disc herniation coexisting with thoracic meningioma – an issue of differential diagnostic

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    Dabija M.

    2017-09-01

    Full Text Available Meningiomas involving the spinal compartment are relatively rare compared to the intracranial ones representing between 7,5% and 12,5% of all CNS meningiomas, most of them being located in the intradural compartment respecting the pial layer of the spinal cord. Affecting ten times more often women rather than men, especially in the 5th and 6th decade of life, they pose a difficult diagnostic setting despite modern neuroimagistic techniques. The matter of correct differential diagnosis becomes even more doubtful, most of the patients of that age having also associative degenerative disorders, e.g. lumbar disc herniation. In this case proper neurological examination is the key as we will furthermore demonstrate - the MRI exam being targeted on the level of the sensorial dysfunction and not on the most common region which gives according pathology. The following case presentation can be considered “classic” representing a patient with all the criteria mentioned above including a long history of rheumatologic and chronic back pain medication for pain relief. We used the Frankel Scale for grading the pre- and postoperative neurological status. Acute neurological deterioration (under 24 hours is an important criteria for admission in emergency unit with around the clock exploration followed by microsurgical operation for the best possible outcome. Coexisting chronic lesions may be left behind and kept under surveillance, operated only when clear signs of health disorder appear. Because there are reported cases of thoracic meningiomas discovered after hernia disc operation and even cases of paraplegia due to a missed lesion, the aim of this article is to emphasize the importance of proper neurological examination preceding any MRI exploration.

  17. [Uncomplicated herniated discs and sciatica: epidemiologic and semiotic aspects in 143 black African subjects].

    Science.gov (United States)

    Ouedraogo, Dieu-Donné; Eti, Edmond; Daboiko, Jean-Claude; Simon, Frankz; Chuong, Van Tuan; Zué, Marcel Kouakou N

    2007-01-01

    To study the epidemiologic and semiotic characteristics of uncomplicated sciatica in patients in a university hospital in Côte d'Ivoire. This retrospective study included 143 patients with an uncomplicated herniated disc hospitalized in the Cocody University Hospital from 1998 through 2002; patients were excluded if they were excessively sensitive to pain, had related motor deficits, cauda equina syndrome, or were resistant to medical treatment. Patients' average age was 42.5 years (range: 15-81), 58% were women, and mean body mass index (BMI) was 26.16. Ninety-nine (69.2%) reported relatively sedentary work. The disorder was characterized by an antalgic position (in 46.9%), an abnormal Schöber index in 117 (81.8%), the "bell sign" (in 63.6%) and a cough impulse in 58.7%. Lasègue's sign was homolateral at 114 (79.7%), and the average amplitude 42.2 degrees (range: 10 to 80). Paresis of 3/5 or higher was observed in 32 patients (22.4%). Radiography showed a disc disorder in 63% of cases; posterior osteoarthritis in 39.2% and a narrowed lumbar channel in 14 %. Computed tomography was performed for 56 patients and confirmed the presence of a hernia (median: 42,8%; paramedian: 48,2%; foraminal: 8,0%) of L4-l5 in 43 patients (77%); a large hernia, defined by a size greater than half of the rachidian channel, was found in eight (14,3%). After medical treatment, the course was favourable during this hospitalisation. Contrary to preconceived ideas, uncomplicated sciatica of black subjects has the same characteristics as in the white population.

  18. Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy.

    Science.gov (United States)

    Chang, Hsuan-Kan; Chang, Huang-Chou; Wu, Jau-Ching; Tu, Tsung-Hsi; Fay, Li-Yu; Chang, Peng-Yuan; Wu, Ching-Lan; Huang, Wen-Cheng; Cheng, Henrich

    2016-04-01

    The aim of this paper was to investigate the risk of recurrence of lumbar disc herniation (LDH) in patients with scoliosis who underwent microdiscectomy. A series of consecutive patients who underwent microdiscectomy for LDH was retrospectively reviewed. The inclusion criteria were young adults younger than 40 years who received microdiscectomy for symptomatic 1-level LDH. An exclusion criterion was any previous spinal surgery, including fusion or correction of scoliosis. The patients were divided into 2 groups: those with scoliosis and those without scoliosis. The demographic data in the 2 groups were similar. All medical records and clinical and radiological evaluations were reviewed. A total of 58 patients who underwent 1-level microdiscectomy for LDH were analyzed. During the mean follow-up of 24.6 months, 6 patients (10.3%) experienced a recurrence of LDH with variable symptoms. The recurrence rate was significantly higher among the scoliosis group than the nonscoliosis group (33.3% vs. 2.3%, p = 0.001). Furthermore, the recurrence-free interval in the scoliosis group was short. Young adults (scoliosis are at higher risk of recurrent LDH after microdiscectomy.

  19. Pitting Oedema in a Patient with Lumbar Disc Herniation: Case report of an unusual association

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    Homa Sadeghian

    2018-01-01

    Full Text Available Oedema refers to the excessive accumulation of fluid within intercellular tissues as a result of disequilibrium between the capillary hydrostatic and oncotic pressure gradients. Lumbar disc herniation (LDH commonly causes lower back pain and radicular leg pain. We report a 57-year-old female who presented to the neurosurgery clinic of the Bam University of Medical Sciences, Bam, Iran, in 2015 with pain and pitting oedema in the bilateral lower extremities. Magnetic resonance imaging confirmed a diagnosis of LDH of the L3–L4 and L4–L5 vertebrae. The patient subsequently underwent a bilateral laminotomy and foraminotomy of the involved vertebrae to relieve her pain. Following the surgery, there was a complete resolution of the LDH-related symptoms as well as the oedema. Although LDH has never before been associated with oedema, it may nevertheless cause lower limb oedema in exceptional and rare cases, as highlighted in this patient.

  20. Preoperative and postoperative evaluation of somatosensorial evoked potentials of upper extremities in cervical intervertebral disc herniation.

    Science.gov (United States)

    Umur, Ahmet Sukru; Selcuki, Mehmet; Selcuki, Deniz; Temiz, Cuneyt; Akbasak, Aytac

    2013-01-01

    This study aims to determine the dysfunction caused by existing pathological condition in structures involved in the transfer of sensory functions of the neural system in cervical disc herniation, and to establish whether or not the level and degree of this anatomical damage can be anticipated by SEP (Somatosensorial Evoked Potentials). We compared the obtained SEP values for statistical significance using the Friedman Variation Analysis. In parameters with statistical significance, the Wilcoxon Signed Rank test was used to identify when significant improvements occurred. The study found that the statistical data of the latency of the N14 wave originating from the dorsal column nuclei of the medulla spinalis and dorsal column gray matter improved (p < 0.05) in the postoperative period compared with the preoperative values. Using the Wilcoxon Signed Rank test, we studied postoperative months separately in regard to the difference in the latency of the N14 wave, and found the statistically significant improvement to be marked particularly in months 3 and 6 postoperatively (p < 0.05). In conclusion, we suggest that SEP is a useful tool to check the functional condition of the dorsal spinal column. The benefit of the SEP utilization is the ability to determine the severity of the pathological condition preoperatively and follow the patient's functional postoperative improvement.

  1. Clinical Effect of Acupotomy Combined with Korean Medicine: A Case Series of a Herniated Intervertebral Disc.

    Science.gov (United States)

    Kim, Hyun-ji; Jeon, Ju-hyun; Kim, Young-il

    2016-02-01

    The aim of this study is to evaluate the effect of acupotomy for treating patients with a herniated intervertebral disc (HIVD). This case series includes five HIVD patients who were treated at the Department of Acupuncture and Moxibustion, Daejeon University Dunsan Korean Hospital, Daejeon, Korea, from January 2015 to April 2015. Acupotomy was performed three times over a 2-week period, along with Korean medical treatment. The outcomes were evaluated by using a numeric rating scale (NRS), physical examination, the Oswestry Low Back Pain Disability Index (ODI), the Short-Form 36-Item Health Survey (SF-36), and the Surgical Safety Checklist. The NRS and physical examination results, as well as the ODI scores, were improved in all cases. No significant differences were noted on the SF-36. No patients had any adverse effects. This study, with its findings of encouraging responses in reducing low back pain and radiating pain and in recovering the kinetic state of soft tissue, supports the potential use of acupotomy for the treatment of patients suffering from HIVD. Copyright © 2016. Published by Elsevier B.V.

  2. COMPARISON OF ENDOSCOPIC AND MICROSURGICAL METHODS IN THE TREATMENT OF LUMBAR DISC HERNIATIONS

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    SERGEY ARESTOV

    Full Text Available ABSTRACT Objective: The development of minimally invasive spine surgery leads us to reflect on the efficiency of new methods compared with older ones. In the case of endoscopic spine surgery, we always seek to compare our results using new techniques with the results of older and trusted microsurgical techniques. Unfortunately, there are few reliable studies measuring endoscopic and microsurgical approaches. We therefore decided to compare our treatment results with those of what are, in our opinion, the best and most thorough studies found. Furthermore, we found no illustrated experience in the usability of endoscopic methods. We therefore analyzed each step of the technique used, according to the practical experience with microsurgical discectomy. Methods: We compared our two-year experience of treatment of 183 patients with lumbar disc herniations using the endoscopic technique, with data reported in the literature on microsurgical minimally invasive methods. Results: Our group achieved good to excellent results in 92.9% of cases (170 patients compared to 90% reported in the literature. We compared the capabilities of endoscopic discectomy with microsurgical methods, and concluded that the endoscopic method is sufficient to perform any movement inside the surgical field that is microscopically possible. It is also possible to perform any type of spinal cord decompression, with better visualization provided by the endoscope. Conclusions: We conclude that endoscopic microdiscectomy is a good and reliable alternative, with better outcomes and more efficient usage of the approach space.

  3. Comparison of diagnostic protocols and the equivalent effective dose in renal cancer and herniated lumbar disc

    International Nuclear Information System (INIS)

    Ruiz Perez de Villar, M.J.; Vano Carruana, E.; Lanzos Gonbzalez, E.; Perez Torrubia, A.

    1994-01-01

    Renal cancer (RC) and herniated lumbar disc (HLD) were the two pathologies selected for the study of the diagnostic protocols applied in different centers to determine how their variability is reflected in the effective equivalent dose (EED) and establish the optimal radiological protocol for diagnostic purposes, while using the lowest possible dose. On the basis of 222 case histories, it was observed that the EED resulting from the diagnosis of HLD can vary as much as a factor of 3(6.2-18.9 mSv). Likewise, the EED related to the diagnosis of RC can be modified by a factor of 1.5(32.6-48.3 mSv), depending on the diagnostic protocol employed. It can be considered that the optimal protocol to reach a diagnosis of HLD includes chest x-ray, lumbar spine x-ray and lumbar CT scan, while that required for the diagnosis of RC involves chest x-ray, IVU, abdominal CT scan and digital subtraction angiography. The optimization of the study protocols-especially the reduction of the number of exposures, modernization and quality control of the equipment, among other aspects, can reduce the EED by a factor of 2. (Author)

  4. Estimates of success in patients with sciatica due to lumbar disc herniation depend upon outcome measure.

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    Haugen, Anne Julsrud; Grøvle, Lars; Brox, Jens Ivar; Natvig, Bård; Keller, Anne; Soldal, Dag; Grotle, Margreth

    2011-10-01

    The objectives were to estimate the cut-off points for success on different sciatica outcome measures and to determine the success rate after an episode of sciatica by using these cut-offs. A 12-month multicenter observational study was conducted on 466 patients with sciatica and lumbar disc herniation. The cut-off values were estimated by ROC curve analyses using Completely recovered or Much better on a 7-point global change scale as external criterion for success. The cut-off values (references in brackets) at 12 months were leg pain VAS 17.5 (0-100), back pain VAS 22.5 (0-100), Sciatica Bothersomeness Index 6.5 (0-24), Maine-Seattle Back Questionnaire 4.5 (0-12), and the SF-36 subscales bodily pain 51.5, and physical functioning 81.7 (0-100, higher values indicate better health). In conclusion, the success rates at 12 months varied from 49 to 58% depending on the measure used. The proposed cut-offs may facilitate the comparison of success rates across studies.

  5. Facet tropism: possible role in the pathology of lumbar disc herniation in adolescents.

    Science.gov (United States)

    Wang, Honggang; Zhou, Yue

    2016-07-01

    OBJECTIVE The role of facet tropism (FT) in lumbar disc herniation (LDH) is ambiguous. The present study aimed to investigate the association between FT and LDH in adolescents. METHODS This study included 65 adolescents with LDH with 1- or 2-level LDH, or both. Facet angles were measured with MRI. FT was defined as asymmetry of 10° between the left and right side. The same levels of 30 healthy persons who had no lumbar lesions were used as controls. Statistical analysis was performed using the chi-square test. RESULTS FT was identified in 16 of 39 patients with LDH in L4-5 and in 3 of 30 controls (p = 0.006, OR 6.261, 95% CI 1.619-24.217). It was also identified in 12 of 27 patients with LDH in L5-S1 and in 4 of 30 controls (p = 0.017, OR 5.200, 95% CI 1.420-19.039). One patient had LDH in both L4-5 and L5-S1. CONCLUSIONS FT is associated with LDH in both L4-5 and L5-S1 levels in adolescents.

  6. Association of facet tropism and orientation with lumbar disc herniation in young patients.

    Science.gov (United States)

    Zhou, Qiang; Teng, Donghui; Zhang, Tao; Lei, Xinwei; Jiang, Wenxue

    2018-02-15

    Facet tropism and orientation are thought to be associated with lumbar disc herniation (LDH), but the relationship is not well established. Moreover, the effect of facet joint on LDH has not been outlined in young patients. The objective of this study was to investigate the associations of facet joint tropism and orientation with LDH in young patients (18-35 years) by computed tomography (CT). Fifty-three patients with LDH and 129 with neither LDH nor low back pain (18-35 years) were included in this study. The facet joint angles were measured for each facet joint by CT as per the method described by Noren et al. We defined facet tropism as a bilateral angle difference > 5°. Young cases with neither LDH nor low back pain were used as the control group. The results showed that LDH was significantly associated with more coronal facet joint orientation at L1-2 (p = 0.009), L2-3 (p = 0.004), and L3-4 (p = 0.004). No association was established between facet tropism and LDH. This study revealed that facet joint orientation was associated with LDH in young patients (18-35 years); they were more of coronal facing at upper levels. Also, the facet tropism was not associated with LDH.

  7. Relationship Between Cervical Disc Herniation and Posterior Longitudinal Ligament in Intra-operative Microscope-Guided 468 ACDF

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    LI Ze-qing

    2016-12-01

    Full Text Available Objective: To observe the relationship between cervical disc herniation (CDH and posterior longitudinal ligament (PLL under microscope-guided anterior cervical decompression and fusion (ACFD, with intention to provide the basis for PLL surgery resection.Methods: Totally 325 patients with CDH (468 levels were performed with microscope-guided ACFD. During the procedure, integrity of annulus, PLL, and dural sac were observed. Meanwhile, the position of the protruded mass was recorded. The actual exploratory results under microscope were documented and compared with preoperative magnetic resonance imaging (MRI presentation.Results: According to disc-posterior anatomic layers and findings under the intraoperative microscope, 468 levels of CDH were classified into five sites. Site I: disc with tearing annulus but intact outmost layer (in 47 levels; Site Ⅱ: ruptured annulus with intact PLL (in 202 levels;Site Ⅲ: herniated mass within or through PLL (in 107 levels; Site Ⅳ: free and sequestered mass posterior to PLL (in 105 levels; Site V: intradural CDH (in 7 levels.Conclusion: This observation of CDH reveals the chronic and dynamic progress of the disease. Though MRI is considered a powerful and sensitive technique for the assessment of CDH, it may not provide the proof for the relationship between CDH and PLL. To ensure the complete anterior decompression, the PLL should be resected routinely to explore if there is free disc mass under PLL.

  8. Serial changes on MR imaging of herniated lumber discs treated by percutaneous laser nucleotomy. Correlation with early clinical results

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    Hiraishi, Kumiko; Ohmori, Naoki; Kosaka, Riya; Yonezawa, Takumi; Onomura, Toshinobu; Adachi, Itaru; Matsuoka, Takae; Honghan, Gong; Narabayashi, Isamu [Osaka Medical Coll., Takatsuki (Japan)

    1996-07-01

    Percutaneous Laser Nucleotomy (PLN) is a new treatment for disc herniation applying neodymium: yttrium-aluminum-garnet (Nd : YAG) laser through inserted needle into the center of the disc, with less invasion and shorter hospitalization than conventional open surgery. Serial MR images were observed in 21 patients before and after PLN. Canal occupying ratio (COR) and signal intensity (S.I.) of herniated disc were measured. Recovery rate of symptoms was 57.2%, based on scoring system proposed by the Japanese Orthopaedic Association for low-back pain (JOA score). The successful group ({>=}30% improvement in JOA score) showed rapid decrease in signal intensity, though the ineffective group (<30% improvement in JOA score) showed unchanged intensity on T{sub 2}-weighted sequence. Increase of signal intensity was observed in some patients whose symptoms had become worse. This may correlate with increase of water content and inner pressure on the disc. There was no significant difference between pre- and post-COR; however, more than 10% COR decrease was observed in 7 patients and symptoms improved in these cases. Thus the prognosis of the patients treated with PLN can be assessed by MR findings. (author)

  9. [Comparison of results between fenestration discectomy associated with annulus repair and fenestration discectomy for lumbar disc herniation in the adolescents].

    Science.gov (United States)

    Li, J; Ma, C; Li, Y M; Wang, Z H; Zhao, M; Feng, J; Dai, W X

    2016-08-23

    To compare the preliminary clinical outcomes of fenestration discectomy associated with annulus repair (FDAR) and fenestration discectomy (FD) for lumbar disc herniation in the adolescents. The data of 26 adolescent patients with single segment lumbar disc herniation who were admitted to the Department of Orthopedics, Xuzhou Central Hospital from October 2012 to October 2014 were retrospectively studied. All patients were divided into 2 groups, including 12 patients undergoing FDAR and 14 patients undergoing FD respectively. The factors including the length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The indentation of dura were measured from MRI. Pfirrmann grading system was used for assessment of lumbar disc degeneration preoperatively and 1 year later. The visual analogue scale (VAS), the oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) scores were used to measure the clinical outcomes. Simultaneously, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded. There were no significant differences in the observational factors such as the skin incision length, amount of intraoperative bleeding, operation time, and duration of hospitalization between the FDAR and FD groups (P>0.05). The indentation of the dura significantly reduced after surgery in each group [FDAR: (7.3±2.6) vs (1.3±0.8) mm; FD: (7.4±3.1) vs (2.9±0.7) mm; both Pdisc degeneration in FDAR group was the same as that of in FD group. The postoperative VAS scores and ODI scores at each follow-up time point in both groups were significantly improved when compared with the preoperative ones (P0.05). According to the modified MacNab criteria, there were no statistically significant differences between the 2 groups in the excellent and good rate (FDAR: 89.3%, FD: 88.5%; P>0.05). There were no dural tears, disc space infection, hematoma formation in the spinal canal and

  10. Complex Regional Pain Syndrome Caused by Lumbar Herniated Intervertebral Disc Disease.

    Science.gov (United States)

    Kim, Se Hee; Choi, Sang Sik; Lee, Mi Kyung; Kin, Jung Eun

    2016-07-01

    Most cases of complex regional pain syndrome (CRPS) occur after some inciting injury. There are a few cases of CRPS after an operation for disc disease. CRPS from a mild herniated intervertebral disc (HIVD) without surgical intervention is even rarer than CRPS after an operation for disc disease.A 22-year-old man was transferred to a pain clinic. He had continuously complained about back and right leg pain. He presented with a skin color change in the right lower leg, intermittent resting tremor, stiffness, and swelling in the right leg. He complained of a pulling sensation and numbness in his right buttock, posterior thigh, lateral calf, and ankle. This symptom was in accordance with L4/5 radiculopathy. Magnetic resonance imaging (MRI) also showed L4/5 HIVD that was central to the bilateral subarticular protrusion.He was diagnosed as having CRPS, which fits the revised International Association for the Study of Pain (IASP) criteria. He fulfilled 4 symptom categories (allodynia, temperature asymmetry and skin color change, sweating changes, decreased range of motion and motor dysfunction) and 3 of 4 sign categories (allodynia, temperature asymmetry and skin color changes, decreased range of motion and motor dysfunction). The bone scan and thermography also revealed CRPS.For the past 2 months, we have performed intensive treatments. But, he never became pain-free and walking for 5 minutes led to persistent leg pain. We decided to perform percutaneous nucleoplasty, which can directly decompress a HIVD. On the next day, he achieved dramatic symptom relief. The visual analog scale (VAS) score improved to 3, compared to the VAS score of 9 at the first visit. The skin color change, allodynia, and tremor in the right leg disappeared, and the temperature asymmetry normalized. Motor weakness of the right leg also recovered.We report an unusual case of CRPS that was caused by L4/5 HIVD without a history of trauma or surgery. It has a clear causal relationship between HIVD

  11. Condoliase for the Treatment of Lumbar Disc Herniation: A Randomized Controlled Trial.

    Science.gov (United States)

    Chiba, Kazuhiro; Matsuyama, Yukihiro; Seo, Takayuki; Toyama, Yoshiaki

    2017-12-18

    A randomized, double-blind, placebo-controlled, multicenter phase III clinical trial. To evaluate the efficacy and safety of chemonucleolysis with condoliase in patients with lumbar disc herniation (LDH). Condoliase is a pure mucopolysaccharidase derived from a bacterium, Proteus vulgaris that has high substrate specificity for chondroitin sulfate and hyaluronic acid in the nucleus pulposus of the intervertebral disc. In this study, patients aged 20-70 years with unilateral leg pain, positive straight leg raise test, and a contained LDH were recruited in Japan. Patients were treated with a single injection of condoliase (1.25 U) or placebo and were followed for 1 year after administration. The primary endpoint was change in worst leg pain from baseline to Week 13. The secondary endpoints included responder rate, and the changes from baseline up to Week 52 in the worst leg pain, worst back pain, Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36), neurologic examinations and imaging parameters. A total of 82 and 81 patients received an injection of condoliase and placebo, respectively. The average changes in worst leg pain from baseline to Week 13 (primary endpoint) were - 49.5 mm in the condoliase group and - 34.3 mm in the placebo group, and the difference of - 15.2 mm was significant (95% confidence interval, - 24.2 to -6.2; P = 0.001). Significant improvements were observed in the condoliase groups, compared with the placebo group, in most secondary endpoints at 1 year after administration. In the condoliase group, back pain, Modic Type 1 change, and decrease in disc height were frequently reported, without any clinically relevant consequences. Condoliase significantly improved symptoms in patients with LDH and was well tolerated. Condoliase is a novel and potent chemonucleolytic drug for treatment of LDH. 1This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial

  12. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

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    Raspe, Heiner

    2005-11-01

    Full Text Available Introduction: In up to 30% of patients undergoing lumbar disc surgery for herniated or protruded discs outcomes are judged unfavourable. Over the last decades this problem has stimulated the development of a number of minimally-invasive operative procedures. The aim is to relieve pressure from compromised nerve roots by mechanically removing, dissolving or evaporating disc material while leaving bony structures and surrounding tissues as intact as possible. In Germany, there is hardly any utilisation data for these new procedures – data files from the statutory health insurances demonstrate that about 5% of all lumbar disc surgeries are performed using minimally-invasive techniques. Their real proportion is thought to be much higher because many procedures are offered by private hospitals and surgeries and are paid by private health insurers or patients themselves. So far no comprehensive assessment comparing efficacy, safety, effectiveness and cost-effectiveness of minimally-invasive lumbar disc surgery to standard procedures (microdiscectomy, open discectomy which could serve as a basis for coverage decisions, has been published in Germany. Objective: Against this background the aim of the following assessment is: * Based on published scientific literature assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery compared to standard procedures. * To identify and critically appraise studies comparing costs and cost-effectiveness of minimally-invasive procedures to that of standard procedures. * If necessary identify research and evaluation needs and point out regulative needs within the German health care system. The assessment focusses on procedures that are used in elective lumbar disc surgery as alternative treatment options to microdiscectomy or open discectomy. Chemonucleolysis, percutaneous manual discectomy, automated percutaneous lumbar discectomy, laserdiscectomy and endoscopic procedures accessing the disc

  13. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

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    Yi, Ji Sook; Cha, Jang Gyu [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Han, Jong Kyu [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of); Kim, Hyun Joo [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of)

    2015-08-15

    To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI.

  14. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

    Science.gov (United States)

    Yi, Ji Sook; Han, Jong Kyu; Kim, Hyun-Joo

    2015-01-01

    Objective To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Materials and Methods Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. Results The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Conclusion Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI. PMID:26175589

  15. Recovery of severe motor deficit secondary to herniated lumbar disc prolapse: is surgical intervention important? A systematic review.

    Science.gov (United States)

    Balaji, V R; Chin, K F; Tucker, S; Wilson, L F; Casey, A T

    2014-09-01

    The natural history of motor deficit due to lumbar disc herniation has been thought to be favourable. However, on closer analysis of seminal articles on this topic, this is not the case for patients with severe motor deficits (MRC grade ≤3). The aim of this study is to answer the following questions: (1) Is surgical intervention beneficial in patients with severe motor weakness (defined by MRC grade of 3 or less) due to herniated lumbar nucleus pulposus? (2) Does time to surgery from onset of motor weakness influence the outcome? (3) Are there any other prognostic factors? A comprehensive search was conducted in MEDLINE and EMBASE from 1970 upto July 2013. Inclusion criteria for studies are: (1) minimum of three patients aged 18 and older, who had symptomatic herniated lumbar disc prolapse and underwent surgery, (2) description of pre and post-operative muscle weakness utilising the Medical Research Council (MRC) muscle power grade or equivalent, such that both reviewers could confidently identify a cohort of patients with at least grade three motor weakness or worse, (3) a minimum of 6 months follow-up. Seven studies were identified with a total of 354 patients. Complete recovery was seen in 38.4% of patients following surgery and 32% following non-operative treatment. Age and grade of motor deficit were identified as significant prognostic factors in some of the studies. The current available evidence is not robust enough to address the questions posed. We have proposed a framework for future studies.

  16. Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?

    Directory of Open Access Journals (Sweden)

    Murat Sakir Eksi

    2015-01-01

    Full Text Available Cervical myelopathy (CM is mostly a degenerative process ending in myelopathic and/or radiculopathic syndromes. On T2-weighted magnetic resonance imaging (MRI, CM appears as a hyperintense area near the spondylotic spine. This high intensity signal depends on the impact of outer forces and their duration. It also determines the prognosis of the surgical candidate. A 40-year-old male patient admitted to our clinic with right upper extremity weakness and hypoesthesia that had started 2 months earlier. On neurological examination there was 2/5 motor weakness of right biceps brachii, and hypoesthesia over right C6 dermatome. Right upper extremity deep tendon reflexes were hypoactive, but lower ones were hyperactive. After clinical and radiological work-up, preliminary diagnosis was directed to a spinal intramedullary tumor. Total resection of the herniated cervical disc fragment and the mass lesion was managed. Pathology of the mass lesion was compatible with subacute infarct tissue and inflammatory response. Final diagnosis was CM under effect of cervical disc herniation. Contrast-enhanced spinal cord myelopathic lesions are very rare and resemble much more tumors and inflammatory processes. However, the principal treatment approach totally differs depending on pathology. When there are both a disc herniation and a high clinical suspicion; biopsy should be delayed. The most probable solution will be surgery for the disc disease with thorough preoperative scanning of vascular malformations; clinical and radiological close follow-up after surgery. Biopsy or surgical resection can be performed if patient deteriorates despite the primary surgery.

  17. Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone.

    Science.gov (United States)

    Zhang, Yafeng; Ma, Yong; Jiang, Jianwei; Ding, Tao; Wang, Jianwei

    2013-01-01

    Oxygen-ozone therapy is a minimally invasive treatment for lumbar disk herniation that exploits the biochemical properties of a gas mixture of oxygen and ozone. The purpose of our study was to prospectively evaluate the clinical effectiveness of oxygen-ozone therapy and compared the therapeutic outcome of injection of oxygen-ozone combined steroid with injection of ozone alone at different follow-up period. From Aug 2005 to Mar 2009, 172 consecutive adult patients (92 men, 80 women; age range: 23-59 years) with low back pain and radicular pain were included in this study and were randomly assigned to two groups. 90 patients (group A) underwent intradiscal and intraforaminal injection of oxygen-ozone and 82 patients (group B) received the same treatment with additional injection of 1ml of compound betamethasone. Visual analogue scale (VAS) and the Japanese Orthopedic Association's evaluation system for lower back pain syndrome (JOA score) were administered before treatment and at 3 weeks, 6 and 12-month follow-up period to evaluate the clinical results. Satisfactory clinical outcomes were obtained in both groups. The reduction of VAS score from baseline to the end of the study was 7.68 to 2.17 and 7.49 to 2.23 in group A and group B respectively, and there were remarkable improvements of mean JOA score and recovery rate in every follow-up time in both groups. Furthermore, in 3 weeks follow-up the JOA recovery rate of group B is higher than that of group A, which there was significant different, but there were no significant differences between two groups in 6 and 12 months. In our study, oxygen-ozone nucleolysis provides excellent pain relief in most herniated disc patients who failed to respond to conservative therapy. And there was no significant statistical difference between treatment of injection of oxygen-ozone combined with steroid and ozone only in the 6 and 12 months follow-up. Therefore, O2-O3 seems to play a role in pain relief, and we suggest the

  18. The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; A double-blind randomised multicenter study

    NARCIS (Netherlands)

    M.P. Arts (Mark); R. Brand (René); B.W. Koes (Bart); W.C. Peul (Wilco); M.E. van den Akker-van Marle (Elske)

    2010-01-01

    textabstractBackground. Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is

  19. Interleukin 6 (IL-6) and IL-10 Promoter Region Polymorphisms Are Associated with Risk of Lumbar Disc Herniation in a Northern Chinese Han Population.

    Science.gov (United States)

    Huang, Xiangye; Chen, Feng; Zhao, Jing; Wang, Dezhang; Jing, Shenfeng; Li, Hongmei; Meng, Chunyang

    2017-01-01

    This study assessed the association of single-nucleotide polymorphisms (SNPs) in the proinflammatory cytokines interleukin 6 (IL-6) and IL-10 with the risk of lumbar disc herniation in a Chinese Han population. We collected blood samples from 267 patients with lumbar disc herniation (case group) and 300 normals (control group) and performed analyses of the IL-6 572C/G and 174G/C SNPs as well as the IL-10 592A/C and 1082G/A SNPs using TaqMan technology. The frequencies of the IL-6-572 GG, GC, and CC genotypes were 5.99%, 42.3%, and 51.6%, respectively, in the case group, and 1.6%, 24%, and 64.3%, respectively, in the control group. Thus, the relative risk of the IL-6-572 G genotype (GG plus GC) was 1.69-fold higher for developing lumbar disc herniation compared to the CC genotype (95% confidence interval: 1.16-2.39, p disc herniation (p disc herniation risk in this Northern Chinese Han population.

  20. Use of Temporary Implantable Biomaterials to Reduce Leg Pain and Back Pain in Patients with Sciatica and Lumbar Disc Herniation

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    Gere S. diZerega

    2010-05-01

    Full Text Available The principle etiology of leg pain (sciatica from lumbar disc herniation is mechanical compression of the nerve root. Sciatica is reduced by decompression of the herniated disc, i.e., removing mechanical compression of the nerve root. Decompression surgery typically reduces sciatica more than lumbar back pain (LBP. Decompression surgery reduces mechanical compression of the nerve root. However, decompression surgery does not directly reduce sensitization of the sensory nerves in the epidural space and disc. In addition, sensory nerves in the annulus fibrosus and epidural space are not protected from topical interaction with pain mediators induced by decompression surgery. The secondary etiology of sciatica from lumbar disc herniation is sensitization of the nerve root. Sensitization of the nerve root results from a mechanical compression, b exposure to cellular pain mediators, and/or c exposure to biochemical pain mediators. Although decompression surgery reduces nerve root compression, sensory nerve sensitization often persists. These observations are consistent with continued exposure of tissue in the epidural space, including the nerve root, to increased cellular and biochemical pain mediators following surgery. A potential contributor to lumbar back pain (LBP is stimulation of sensory nerves in the annulus fibrosus by a cellular pain mediators and/or b biochemical pain mediators that accompany annular tears or disruption. Sensory fibers located in the outer one-third of the annulus fibrosus increase in number and depth as a result of disc herniation. The nucleus pulposus is comprised of material that can produce an autoimmune stimulation of the sensory nerves located in the annulus and epidural space leading to LBP. The sensory nerves of the annulus fibrosus and epidural space may be sensitized by topical exposure to cellular and biochemical pain mediators induced by lumbar surgery. Annulotomy or annular rupture allows the nucleus pulposus

  1. Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up.

    Science.gov (United States)

    Wu, Jau-Ching; Huang, Wen-Cheng; Tu, Tsung-Hsi; Tsai, Hsiao-Wen; Ko, Chin-Chu; Wu, Ching-Lan; Cheng, Henrich

    2012-02-01

    Cervical arthroplasty is a valid option for patients with single-level symptomatic cervical disc diseases causing neural tissue compression, but postoperative heterotopic ossification (HO) can limit the mobility of an artificial disc. In the present study the authors used CT scanning to assess HO formation, and they investigated differences in radiological and clinical outcomes in patients with either a soft-disc herniation or spondylosis who underwent cervical arthroplasty. Medical records, radiographs, and clinical evaluations of consecutive patients who underwent single-level cervical arthroplasty were reviewed. Arthroplasty was performed using the Bryan disc. The patients were divided into a soft-disc herniation group and a spondylosis group. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain and the Neck Disability Index (NDI), whereas HO grading was determined by studying CT scans. Radiological and clinical outcomes were analyzed, and the minimum follow-up duration was 24 months. Forty-seven consecutive patients underwent a single-level cervical arthroplasty. Forty patients (85.1%) had complete radiological evaluations and clinical follow-up of more than 2 years. Patients were divided into 1 of 2 groups: soft-disc herniation (16 cases) and the spondylosis group (24 cases). Their mean age was 45.51 ± 11.12 years. Sixteen patients (40%) were female. Patients in the soft-disc herniation group were younger than those in the spondylosis group, but the difference was not statistically significant (42.88 vs 47.26, p = 0.227). The mean follow-up duration was 38.83 ± 9.74 months. Sex, estimated blood loss, implant size, and perioperative NSAID prescription were not significantly different between the groups (p = 0.792, 0.267, 0.581, and 1.000, respectively). The soft-disc herniation group had significantly less HO formation than the spondylosis group (1 HO [6.25%] vs 14 Hos [58.33%], p = 0.001). Almost all artificial discs in

  2. The prevalence of fibromyalgia among patients with cervical radiculopathy due to cervical disc herniation: a pilot study.

    Science.gov (United States)

    Demir, Saliha Eroglu; Aytekin, Ebru; Karacan, Ilhan; Aydin, Teoman; Kavadar, Gülis Durmusoglu

    2014-01-01

    Cervical disc herniation (CDH) is the most common cause of cervical radiculopathy and could overlap with fibromyalgia (FM). The primary aim of the present study was to investigate the prevalences of FM and widespread pain in patients with cervical radiculopathy diagnosed as CDH in a cross-sectional study. The secondary aim was to analyze the localization of tender points (TPs) and associated symptoms in these patients comparing patients with FM. Fifty-two patients with cervical radiculopathy who carried the diagnosis of CDH and 51 patients with FM included to the study. The patients were questioned for the distribution and the duration of pain and for a group of symptoms related to FM such as headache, fatigue with a two-point scale (0 "no", 1 "yes"). The diagnosis of CDH was made with patients' clinical evaluation and radiological findings with Magnetic Resonans Imaging Study. FM was diagnosed using the American College of Rheumatology criteria. Widespread pain was defined as all of the following parameters were present: pain in the left side of the body; pain in the right side of the body; pain above the waist; pain below the waist; axial skeletal pain; and duration of pain for more than 3 months. The number of TPs were counted by digital palpation. Six female patients (11.5%) with CDH fulfilled the ACR 1990 criteria for FM. Of the patients with CDH 71.8% of TPs were located around the neck and shoulder regions, while 58.7% of TPs of the patients with FM were located around these regions. There were statistically significant differences between the patients with CDH and the patients with FM in terms of the duration of widespread pain, the number of TPs and the localization of TPs (p< 0.05). The prevalences of FM and widespread pain in patients with CDH were found as 11.5% and 78.8% respectively.

  3. Prognostic factors for non-success in patients with sciatica and disc herniation

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    Haugen Anne

    2012-09-01

    Full Text Available Abstract Background Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. Methods The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine–Seattle Back Questionnaire score of ≥5 (0–12 (primary outcome and Sciatica Bothersomeness Index ≥7 (0–24 (secondary outcome. Results Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 − 2.73], smoker (2.06 [1.31 − 3.25], more back pain (1.0 [1.01 − 1.02], more comorbid subjective health complaints (1.09 [1.03 − 1.15], reduced tendon reflex (1.62 [1.03 − 2.56], and not treated surgically (2.97 [1.75 − 5.04]. Further, factors significantly associated with non-success at 2 years were duration of back problems >; 1 year (1.92 [1.11 − 3.32], duration of sciatica >; 3 months (2.30 [1.40 − 3.80], more comorbid subjective health complaints (1.10 [1.03 − 1.17] and

  4. Prognostic factors for non-success in patients with sciatica and disc herniation.

    Science.gov (United States)

    Haugen, Anne Julsrud; Brox, Jens Ivar; Grøvle, Lars; Keller, Anne; Natvig, Bård; Soldal, Dag; Grotle, Margreth

    2012-09-22

    Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine-Seattle Back Questionnaire score of ≥5 (0-12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0-24) (secondary outcome). Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 - 2.73]), smoker (2.06 [1.31 - 3.25]), more back pain (1.0 [1.01 - 1.02]), more comorbid subjective health complaints (1.09 [1.03 - 1.15]), reduced tendon reflex (1.62 [1.03 - 2.56]), and not treated surgically (2.97 [1.75 - 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems >; 1 year (1.92 [1.11 - 3.32]), duration of sciatica >; 3 months (2.30 [1.40 - 3.80]), more comorbid subjective health complaints (1.10 [1.03 - 1.17]) and kinesiophobia (1.04 [1.00 - 1.08]). For the secondary outcome variable

  5. Use of magnetic resonance imaging to identify outcome predictors of caudal epidural steroid injections for lower lumbar radicular pain caused by a herniated disc.

    Science.gov (United States)

    Cha, Sung Oh; Jang, Chul Hoon; Hong, Jin Oh; Park, Joon Sang; Park, Jung Hyun

    2014-12-01

    We used lumbar magnetic resonance image (MRI) findings to determine possible outcome predictors of a caudal epidural steroid injection (CESI) for radicular pain caused by a herniated lumbar disc (HLD). Ninety-one patients with radicular pain whose MRI indicated a HLD were enrolled between September 2010 and July 2013. The CESIs were performed using ultrasound (US). A responder was defined as having complete relief or at least a 50% reduction of pain as assessed by the visual analog scale (VAS) and functional status on the Roland Morris Disability Questionnaire (RMDQ); responder (VAS n=61, RMDQ n=51), and non-responder (VAS n=30, RMDQ n=40). MRI findings were analyzed and compared between the two groups with regard to HLD level, HLD type (protrusion or exclusion), HLD zone (central, subarticular, foraminal, and extraforaminal), HLD volume (mild, moderate, or severe), relationship between HLD and nerve root (no contact, contact, displaced, or compressed), disc height loss (none, less than half, or more than half ), and disc degeneration grade (homogeneous disc structure or inhomogeneous disc structure-clear nucleus and height of intervertebral disc). A centrally located herniated disc was more common in the responder group than that in the non-responder group. Treatment of centrally located herniated discs showed satisfactory results. (VAS p=0.025, RMDQ p=0.040). Other factors, such as HLD level, HLD type, HLD volume, relationship to nerve root, disc height loss, and disc degeneration grade, were not critical. The HLD zone was significant for pain reduction after CESI. A centrally located herniated disc was a predictor of a good clinical outcome.

  6. Lateral lumbar disc herniation: MR imaging findings and correlation with clinical symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Park, So Young; Park, Ji Seon; Jin, Wook; Ryu, Kyung Nam [KyungHee University Medical Center, Seoul (Korea, Republic of)

    2008-03-15

    To evaluate MRI findings of lateral lumbar disc herniations (LLDHs) and to determine whether those correlate with clinical symptoms. The study included 105 patients with LLDHs that were diagnosed by MRI. The distribution and location of the LLDHs (foraminal, extraforaminal, and foraminal and extraforaminal), the displacement of adjacent nerves, and the detection rate of LLDHs from axial and sagittal images were reviewed retrospectively by two radiologists. 36 patients were included in evaluating whether location of LLDHs and displacement of adjacent nerve correlate with radiculopathy. The distribution of the LLDHs were 3.4% at L1-2, 14.4% at L2-3, 33% at L3-4, 33% at L4-5, and 16.9% at L5-S1. The locations were foraminal in 38.6% of cases, extraforaminal in 45.4% of cases, and foraminal and extraforaminal in 16% of cases. In addition, 77.3% of the diagnosed LLDH cases displaced the adjacent nerve. The detection rates of LLDHs in the axial and sagittal images were 100% and 77.3%, respectively. In 36 patients, 47.4% had radiculopathy related to LLDHs. Location of LLDHs and displacement of adjacent nerve had no statistically significant difference between patients with or without radiculopathy. MRI is an effective method for evaluating the location of LLDHs and their influence on adjacent nerves. The axial image is more important than the sagittal image in diagnosing LLDHs. The location of LLDHs and the displacement of adjacent nerve were not found to be related to radiculopathy.

  7. [Efficacy differences between different position in patients treated with electroacupuncture for lumbar herniated disc].

    Science.gov (United States)

    Deng, Qilong; Wu, Yaochi; He, Chengmin; Sun, Yijun; Ma, Guangxing; Tian, Yong

    2016-07-12

    To observe the clinical efficacy differences between modified lateral position and prone position in patients treated with electroacupuncture (EA) for lumbar herniated disc (LHD). Seventy-six patients with LHD were randomly divided into a lateral position group and a prone position group, 38 cases in each one. The acupoint selection and treatment method were identical in the two groups except the position. Mingmen (GV 4), Yaoyangguan (GV 3), Dachangshu (BL 25), Xiaochangshu (BL 27), Zhibian (BL 54) and Huantiao (GB 30) were selected. EA was given three times a week, ten times were taken as one course and totally 20 times were given. The visual analogue scale (VAS) and Japanese orthopaedic association (JOA) scale were taken as efficacy criteria, which were evaluated before and after treatment as well as one month after treatment. After treatment, VAS and JOA were significantly improved in the two groups (lateral position group:JOA 10.60±2.60 vs 18.92±3.87, VAS 8.13±0.99 vs 2.34±0.81; prone position group:JOA 10.94±2.06 vs 17.02±3.96, VAS 8.02±1.05 vs 2.86±0.96, all P <0.01); the VAS and JOA in the lateral position group were higher than those in the prone position group (both P <0.05). One month after treatment, VAS and JOA were significantly improved in the two groups (all P <0.01), which was more significant in the lateral position group (both P <0.05). The treatment position could influence the efficacy of EA for LHD, and lateral position pre-sents certain advantages to prone position group.

  8. Long-term outcomes and quality of lift after percutaneous lumbar discectomy for lumbar disc herniation

    International Nuclear Information System (INIS)

    Liu Wengui; Geng Gaojun; Guo Jinhe; He Shicheng; Deng Gang; Liu Wengui

    2009-01-01

    Objective: To assess the long-term outcomes as well as the living quality of the patients with lumbar disc herniation (LDH) after the treatment of percutaneous lumbar discectomy (PLD), and to discuss the influential factors related to the long-term effectiveness. Methods: During the period of January 2000 to March 2002, PLD was performed in 129 patients with LDH. By using self-evaluation questionnaires of Oswestry disability index(ODI), Short Form-36(SF-36) and Japanese Orthopaedic Association(JOA) through letter or telephone interviews as well as the patients' initial medical records, the related clinical data were collected. Statistical analysis was conducted by using Wilcoxon's rank sum test, Chi-square test. Results: One hundred and eight patients (83.7%) were able to be followed up and 104 effective ques-tionnaires were collected. The mean follow-up time was (6.64±0.67) years, the excellent rate(ODI score, 0-20%) was 71.15%. The average scores of the JOA and SF-36 was 23.66±5.72 and 75.88±25.57, respectively. The scores of quality of life were obviously improved in all follow-up subscales. Conventional operations were carried out subsequently in 9 patients as they failed to respond to PLD. No complications related to PLD occurred in this study. The age,course of the disease and the patient's condition at the time of discharge might bear a relationship to long-term effectiveness. Conclusion: PLD is a safe and minimally-invasive technique for the treatment of LDH with quick and reliable effect. PLD can dramatically improve the quality of life. Many factors,such as the age, course of the disease and the patient's condition at the time of discharge,can affect the long-term outcomes. (authors)

  9. The interaction between aggrecan gene VNTR polymorphism and obesity in predicting incident symptomatic lumbar disc herniation.

    Science.gov (United States)

    Cong, Lin; Zhu, Yue; Pang, Hao; Guanjun, T U

    2014-01-01

    An association between aggrecan gene variable number of tandem repeats polymorphism (VNTR) and symptomatic lumbar disc herniation (LDH) has been reported in Chinese Han of Northern China, and obesity had previously been suspected of causing severe LDH. However, the interaction between aggrecan VNTR and obesity in symptomatic LDH has not been well studied. To examine the interaction between aggrecan VNTR and obesity in the susceptibility of symptomatic LDH, 259 participants participated in this study and donated a blood sample. The disease group comprised 61 patients already diagnosed with symptomatic LDH. The control group consisted of 198 healthy blood donors without symptoms of LDH who were not diagnosed with LDH. The aggrecan gene VNTR region was analyzed using polymerase chain reaction. The data indicated that between the two groups, participants carrying one or two alleles ≤25 repeats who were non-obese people showed a 1.057-fold increase in risk for symptomatic LDH (p = 0.895, changing the number of repeat alleles to 25 repeats who were obese people showed an 1.061-fold higher risk (p = 0.885, adding obesity to the mix alone did not demonstrably increase the risk of LDH), while participants carrying one or two alleles ≤25 repeats who were obese people showed a 4.667-fold increase in risk for symptomatic LDH (p = 0.0003, adding obesity plus changing the repeat allele number significantly increased the risk of LDH by 4.667). Overall, the findings suggest an underlying interaction between aggrecan VNTR and obesity in symptomatic LDH.

  10. Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study.

    Science.gov (United States)

    Hincapié, Cesar A; Cassidy, J David; Côté, Pierre; Rampersaud, Y Raja; Jadad, Alejandro R; Tomlinson, George A

    2017-09-18

    Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians' beliefs regarding the risk for acute LDH associated with chiropractic SMT. Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants' elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT. Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39-1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64-1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95-1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29-0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11-1.59). Clinicians' beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs. These probability distributions can serve as prior probabilities in future Bayesian analyses of this relationship.

  11. Postoperative Clinical Outcome and Risk Factors for Poor Outcome of Foraminal and Extraforaminal Lumbar Disc Herniation.

    Science.gov (United States)

    Bae, Jung Sik; Kang, Kyung Hee; Park, Jeong Hyun; Lim, Jae Hyeon; Jang, Il Tae

    2016-03-01

    We evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes. A total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS). Paramedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0-79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000). This study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes.

  12. Prognostic Value of Impaired Preoperative Ankle Reflex in Surgical Outcome of Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Farzad Omidi-Kashani

    2016-01-01

    Full Text Available Background: Several prognostic factors exist influencing the outcome of surgical discectomy in the patients with lumbar disc herniation (LDH. The aim of this study is to evaluate the relationship between severity of preoperative impaired ankle reflex and outcomes of lumbar discectomy in the patients with L5-S1 LDH. Methods: We retrospectively evaluated 181 patients (108 male and 73 female who underwent simple discectomy in our orthopedic department from April 2009 to April 2013 and followed them up for more than one year. The mean age of the patients was 35.3±8.9 years old. Severity of reflex impairment was graded from 0 to 4+ and radicular pain and disability were assessed by visual analogue scale (VAS and Oswestry disability index (ODI questionnaires, respectively. Subjective satisfaction was also evaluated at the last follow-up visit. Chi-square and Kruskal-Wallis tests were used to compare qualitative variables. Results: Reflex impairment existed in 44.8% preoperatively that improved to 10% at the last follow-up visit. Statistical analyses could not find a significant relationship between the severity of impaired ankle reflex and sex or age (P=0.538 and P=0.709, respectively. There was a remarkable relationship between severity of reflex impairment and preoperative radicular pain or disability (P=0.012 and P=0.002, respectively. Kruskal-Wallis test showed that a more severity in ankle reflex impairment was associated with not only less improvement in postoperative pain and disability but also less satisfaction rate (P Conclusions: In the patients with L5-S1 LDH, more severe ankle reflex impairment is associated with less improvement in postoperative pain, disability, and subjective satisfaction.

  13. Unsuspected spondylolysis in patients with lumbar disc herniation on MRI: The usefulness of posterior epidural fat.

    Science.gov (United States)

    Akhaddar, A; Boucetta, M

    2012-12-01

    Lumbar disc herniation (LDH) at the level of non-displaced spondylolysis (isthmic spondylolisthesis) is an uncommon association rarely evaluated in the literature. In this study, authors examine whether the continuous posterior epidural fat between the dura mater and spinous process (continuous double-hump sign) at the level of LDH is a valuable tool to identify patients with non-displaced spondylolysis on MRI. Eighteen patients (group 1) presented at our department (2000-2010) with a LDH associated with an undiagnosed non-displaced spondylolysis on MRI. Spondylolysis was confirmed by direct visualization of the defect on CT-scan, dynamic radiography, MRI or at surgery. To validate this method, we made the same evaluation in 20 surgically treated patients (group 2) with a one-level LDH without spondylolysis. In all patients of group 1 spondylolysis was unsuspected on the MRI report. However, a positive "continuous double-hump sign" was seen in 16 patients. The spondylolysis was recognized on MRI in six cases, on CT-scan in nine cases and on dynamic radiography in one case. Two cases were diagnosed surgically. In group 2, only one patient had a positive "continuous double-hump sign". This new sign had a specificity of 95%, sensitivity of 88.88%, and accuracy of 92.10% for diagnosis of non-displaced spondylolysis. Non-displaced spondylolysis may be associated with adjacent LDH. Although uncommon, it is important for neurosurgeons to be aware of this association because of its implication on the therapeutical management. MRI is not always sufficient to recognize a non-displaced spondylolysis with certainty; however "continuous double-hump sign" may be used as a simple valuable diagnosis tool. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  14. Hérnia discal: procedimentos de tratamento Disc herniation: treatments process

    Directory of Open Access Journals (Sweden)

    Wilson Fábio Negrelli

    2001-12-01

    Full Text Available A hérnia de disco é um processo em que ocorre a ruptura do anel fibroso, com subsequente deslocamento da massa central do disco nos espaços intervertebrais. É considerada uma patologia extremamente comum, que causa séria inabilidade em seus portadores. Estima-se que 2 a 3 % da população sejam acometidos desse processo, cuja prevalência é de 4,8% em homens e 2,5% em mulheres, acima de 35 anos. São fatores de risco, causas ambientais, posturais, desequilíbrios musculares e possivelmente, a influência genética. A terapia conservadora tem sido a preferida como a primeira escolha de tratamento, cujos objetivos são o alívio da dor, o aumento da capacidade funcional e o retardamento da progressão da doença. Nesta revisão, são abordadas as principais metodologias, de acordo com a literatura, dando ênfase ao uso de fármacos analgésicos e anti-inflamatórios, o uso de órteses, a acupuntura, o repouso e a adoção de um programa de exercícios adequados.The disc herniation is a process where the fibrous ring disrupts, with subsequent central disc mass dislocation. It is considered a extremely common pathology, which causes disability. It is estimated that 2 to 3% of the population have taken with this process whose prevalence is 4.8% in males and 2.5% in female, over 35 years old. Environmental causes, posture, muscular imbalance and possibly genetic influence have been considered as risk factors. The conservative therapy has been preferred as the first choice treatment, aiming pain relief, increase of functional capacity and avoidment of disease progression. In this review, it is approached the main methodologies, according to the literature, focusing on drugs prescriptions, orthesis indication, acupunture, rest and a suitable exercise program.

  15. Progression of lumbar disc herniations over an eight-year period in a group of adult Danes from the general population

    DEFF Research Database (Denmark)

    Kjaer, Per; Tunset, Andreas; Boyle, Eleanor

    2016-01-01

    with MRI-confirmed disc herniations at 41 or 45 years were included. Cross-sectional areas (mm(2)) of the LDH, dural sac and disc height were calculated from measurements performed on sagittal T2-weighted images using a previously validated method. Changes over time for the three MRI findings were defined...... in and associations between the size of lumbar disc herniations, dural sac area and disc height over an eight-year period using MRI at three time-points. METHODS: Individuals from a population-based cohort, the 'Backs on Funen Cohort', had MRIs taken at age 41 years and again at 45 and 49 years. Only disc levels...... people (48 women and 58 men), were included. Over eight years, 65 % of the herniations remained unchanged, 17.5 % decreased, 12.5 % increased, and 5 % had a fluctuating pattern. Increased herniation size was associated with decreased dural sac area (β-0.25[-0.52;0.01]) and increased disc height (β 0...

  16. Are Modic changes related to outcomes in lumbar disc herniation patients treated with imaging-guided lumbar nerve root blocks?

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Cynthia K., E-mail: cynthia.peterson@balgrist.ch [Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich (Switzerland); Pfirrmann, Christian W.A. [Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich (Switzerland); Hodler, Jürg [Department of Radiology, University Hospital, University of Zürich (Switzerland)

    2014-10-15

    Objective: To compare outcomes after imaging-guided transforaminal lumbar nerve root blocks in MRI confirmed symptomatic disc herniation patients with and without Modic changes (MC). Methods: Consecutive adult patients with MRI confirmed symptomatic lumbar disc herniations and an imaging-guided lumbar nerve root block injection who returned an outcomes questionnaire are included. Numerical rating scale (NRS) pain data was collected prior to injection and 20–30 min after injection. NRS and overall improvement were assessed using the patient's global impression of change (PGIC) scale at 1 day, 1 week and 1 month post injection. The proportion of patients with and without MC on MRI as well as Modic I and Modic II was calculated. These groups were compared for clinically relevant ‘improvement’ using the Chi-squared test. Baseline and follow-up NRS scores were compared for the groups using the unpaired t-test. Results: 346 patients are included with MC present in 57%. A higher percentage of patients without MC reported ‘improvement’ and a higher percentage of patients with MC reported ‘worsening’ but this did not reach statistical significance. The numerical scores on the PGIC and NRS scales showed that patients with MC had significantly higher pain and worse overall improvement scores at 1 month (p = 0.048 and p = 0.03) and a significantly lower 1 month NRS change score (p = 0.04). Conclusions: Patients with MRI confirmed symptomatic lumbar disc herniations and MC report significantly lower levels of pain reduction after a lumbar nerve root block compared to patients without MC.

  17. Transpars Microscopic Approach for the Treatment of Purely Foraminal Herniated Lumbar Disc: A Clinical, Radiological, Two-center Study.

    Science.gov (United States)

    De Bonis, Pasquale; Mongardi, Lorenzo; Pompucci, Angelo; Ricciardi, Luca; Cavallo, Michele Alessandro; Farneti, Marco; Lapparelli, Marcello; Capone, Gennaro; Altruda, Carmela; Schivalocchi, Roberta; Campioni, Paolo; Ghisellini, Giulia; Trapella, Giorgio

    2017-03-15

    This is a prospective two-center study. The aim of this study was to assess the safety and efficacy of treating patients with lumbar foraminal disc herniations via a microscopic transpars approach, with a clinical and radiological follow-up evaluation. Purely foraminal lumbar disc herniations comprise about 5% of all lumbar herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial. From January 2012 to January 2015, 47 patients were prospectively recruited. Patients were followed-up as outpatients at 1 week after discharge, then at 1, 6, and 12 months.A clinical multiparametric evaluation of patients including numeric rating scale (NRS), drugs intake, Macnab criteria, and working days lost was used.Postoperative dynamic x-rays (flexion, extension) were performed in all cases 12 months after surgery. No surgery-related complications occurred.Among the 35 patients who were not retired at the time of the study, 29 patients returned to work and to normal daily activities within 60 days after surgery.Pain evaluation at discharge showed a significant improvement of NRS score, from 8.93 to 1.45 at 12 months. Root palsy significantly improved in all cases already at 1-month follow-up. Drugs intake analysis showed that at 6-month follow-up, no patients used steroids, or opioids, 17 patients used non-steroidal anti-inflammatory drugs when needed, and 29 patients (61.7%) used no drugs for pain relief. No significant variations occurred at 12-month-follow-up.At 12-month follow-up, excellent or good outcome (following Macnab criteria) was achieved in 36 (76.6%) and 8 (17%) patients, respectively.There were no cases of spinal instability at 12-month radiological evaluation.No recurrence occurred at follow-up. Transpars microscopic approach is effective and safe for the treatment of FLDH, but larger studies are needed. 3.

  18. Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.

    Science.gov (United States)

    Lebow, Richard; Parker, Scott L; Adogwa, Owoicho; Reig, Adam; Cheng, Joseph; Bydon, Ali; McGirt, Matthew J

    2012-02-01

    Emotional distress and depression are common psychological disturbances associated with low-back and leg pain. The effects of lumbar discectomy on pain, disability, and physical quality of life are well described. The effects of discectomy on emotional distress and mental well-being are less well understood. To assess the effect of microdiscectomy on depression, somatization, and mental well-being in patients with herniated lumbar discs. Patients undergoing surgical discectomy for single-level, herniated lumbar disc were prospectively evaluated preoperatively, and at 6 weeks and 3, 6, and 12 months postoperatively. Back and leg pain, depression, somatic perception, and mental well-being were assessed. One hundred patients were enrolled. All were available for 1-year follow-up. Preoperatively, the visual analog scale for low-back pain (BP-VAS), visual analog scale for leg pain (LP-VAS), Zung Self-Rating Depression Scale (ZUNG), Modified Somatic Perception Questionnaire (MSPQ), and Medical Outcomes Short Form-36 mental component summary scale (SF-36-MCS) were 6.3 ± 2.5, 6.3 ± 2.5, 19 ± 11, 9 ± 7, and 4 ± 14. BP-VAS and LP-VAS significantly improved by 6 weeks. Significant improvement in SF-36-MCS was observed by 6 weeks postoperatively, improvement in MSPQ score was observed 3 months postoperatively, and improvement in the ZUNG depression score was observed 12 months postoperatively. No statistical difference occurred during the remainder of follow-up for any outcome measured once improvement reached statistical significance. Eighteen patients were somatized preoperatively, 67% of which were nonsomatized 1 year postoperatively. Ten patients were clinically depressed preoperatively, 70% of which were nondepressed 1 year postoperatively. Improvement in SF-36-MCS, ZUNG, and MSPQ correlated (P herniated lumbar disc.

  19. Comparison of nerve conduction and injury degree in patients with lumbar disc herniation after microendoscopic discectomy and fenestration discectomy

    Directory of Open Access Journals (Sweden)

    Jun Li

    2017-09-01

    Full Text Available Objective: To study the difference of nerve conduction and injury degree in patients with lumbar disc herniation after microendoscopic discectomy and fenestration discectomy. Methods: Patients with single-segment lumbar disc herniation who were treated in Dazhou Central Hospital between May 2014 and February 2017 were selected as the research subjects, the history data were reviewed and the operation methods were referred to divide them into FD group and MED group who received fenestration discectomy and microendoscopic discectomy respectively. The conduction velocity of common peroneal nerve and tibial nerve were detected before operation and 4 weeks after operation; serum levels of nerve and muscle injury-related molecules as well as inflammation and stress-related molecules were detected before operation and 3 days after operation. Results: MNCV levels of common peroneal nerve and tibial nerve 4 weeks after operation as well as serum CRP, TNF-α, MDA and AOPP contents 3 d after operation of both groups of patients were significantly higher than those before operation, and the MNCV levels of common peroneal nerve and tibial nerve of MED group 4 weeks after operation were significantly higher than those of FD group while serum CRP, TNF-α, MDA and AOPP contents of MED group 3 d after operation were not significantly different from those of FD group; serum NSE, S100B, Tau, pNF-H, CPK, Myo and LDH contents of FD patients 3 d after operation were significantly higher than those before operation while serum NSE, S100B, Tau, pNF-H, CPK, Myo and LDH contents of MED group were not significantly different from those before operation. Conclusion: Microendoscopic discectomy for lumbar disc herniation can relieve the nerve and muscle injury, and is equivalent to fenestration discectomy in activating the systemic stress and inflammatory response.

  20. Epidural steroid following discectomy for herniated lumbar disc reduces neurological impairment and enhances recovery: a randomized study with two-year follow-up

    DEFF Research Database (Denmark)

    Rasmussen, S.; Krum-Moller, D.S.; Lauridsen, L.R.

    2008-01-01

    STUDY DESIGN: We randomized 200 patients after lumbar discectomy to receive epidural steroid or none with a 2-year follow-up. OBJECTIVE: To evaluate the outcome, neurologic impairment and safety of epidural steroid following lumbar discectomy for herniated disc disease. SUMMARY OF BACKGROUND DATA......: Convalescence after discectomy for herniated disc disease is dependent on pain and the inflammatory response. Previous