Cases Of Lumbar Disc Herniation Research Articles

下垂足をきたした腰椎椎間板ヘルニア，腰部脊柱管狭窄症の手術成績

Eighteen cases of lumbar disc herniation (LDH) and thirty two cases of lumbar canal stenosis (LCS) with foot drop were reviewed. The average age at the time of operation was 40.4 years (LDH), and was 59.2 years (LCS). Follow-up period after the operation averaged 30.6 months (LDH), and 31.9 months (LCS).We devised two types of classification according to neurological symptoms, namely cauda equina or nerve root type with operative methods selected for each type. Love's method was mainly performed for LDH, laminectomy for cauda equina lesions, and fenestration for neve root lesions.Operative results were assesed using the JOA score and Hirabayashi's method. Average recovery rate was 84.6% for LDH, and 61.9% for LCS. The main factors influencing the prognosis were morbidity period, bladder bowel disturbance, and the strength of the tibial anterior muscle. Three cases of LDH and nine cases of LCS remained with foot drop postoperatively.Surgery was not as effective for the recovery of foot drop, but was useful for treatment of intermittent claudication and lower extremity pain. Because the symptoms are progressive, the operation should be done as soon as possible even with elderly patients.

腰椎椎間板ヘルニアに対するＭＲＩの有用性 手術施行例において

It is very important that occurate diagnosis of the level and location of lumbar disc herniation is made, before surgery is carried out. Recently, the diagnosis of lumbar disc herniation has been made easier with magnetic resonance imaging.We performed a nucleotomy in 22 cases of lumbar disc herniation, which were only diagnosed by magnetic resonance imaging. All cases achieved a good results post-operatively.We concluded that we could operate upon herniated nucleus pulposus diagnosed only by MRI without myelography or CTM. But care must be taken when there is neurological disagreement, spondylosis deformens, central type herniation, old age, or cases requiring re-operation.It is more important to have static rather than dynamic information from MRI, therefore we should perform nucleotomy, rather than instrument surgery.

Extraperitoneal anterolateral discectomy for lumbar disc herniation: indications, techniques, and time-related clinical results.

We analyzed 80 consecutive cases of lumbar disc herniation who underwent an extraperitoneal anterolateral discectomy according to clinical and radiologic parameters. The average follow-up period was 5 1/2 years (range, 1-10 years). The results of 71 patients (89%) were satisfactory through the mid- and long-term follow-up periods, although a very slight decrease in subjective/objective scores and ADL score was found. Satisfactory results were obtained for adolescent and younger male adults and in isolated central or centrolateral herniations with a broad base. From an analysis of the nine reoperated cases, we determined that the contraindications of this technique are a sequestrated or extruded nucleus pulposus and disc protrusion accompanied by posterior dislocation of a vertebral edge fragment. The relative indications include a small, hard posterolateral herniation located just beneath the nerve roots, double-level herniation, disc herniation accompanied by narrow spinal canal, and bulged disc in elder patients. The absolute indications for this surgery are a centrally or centrolaterally protruded disc with a relatively broad base of herniation at single-disc level that is not accompanied by spinal stenosis in adolescent and younger male adults.

腰部単椎間り患における多根性障害の発現

The purpose of this paper is to describe the double roots involvement at the single intervertebral disc level. Of 69 cases morphologically dianosed as being abnormal at the L4/5 disc level, we compared 38 cases of lumbar disc herniation diagnosed as single root involvement by nerve root infiltration (NRI) with 17 cases of lumbar canal stenosis diagnosed as double roots involvement by NRI.As a result, neurologically both absent or diminished response in ankle jerk and sensory disturbance at S1 root area were noticed in 4 (11%) of 38 cases in lumbar disc herniation, and these cases were suggested to have the double roots involvement (L5+S1 root involvement) at the single level of L4/5 disc.

当科における腰椎椎間板ヘルニアの術後成績 後方術式非固定群において

Forty-six cases of lumbar disc herniation treated by posterior nucleotomy without bone fusion were reviewed. These cases consisted of 28 males and 18 females. The age range was from 14 to 72 with an average of 41 years. The mean follow-up period was 5 years and 4 months.The average improvement rate by the J. O. A. score was 80.6 percent. The improvement rate of S. L. R. was high, but the improvement rate of lumbago was low.On roentgenograms, there was a tendency for an advancing disc space to narrow, which revealed disc degeneration, but no significant correlation was recognized between the rate of improvement and the roentgenographical changes.

腰椎部疾患における術前・術後のｍｙｅｌｏｇｒａｍの検討

In order to investigate the changes of myelographic findings after posterior lumbar surgery, iotrolan myelography was performed in 73 cases of lumbar disc herniation and 25 cases of lumbar spinal stenosis. Postoperative myelography was performed 4 weeks after surgery.In the cases of disc herniation, the findings of cauda equina shifting and double shadow of dural tube were well improved, but the finding of nerve root sleeve defect was poorly improved.In the cases of spinal stenosis, the findings of dural tube stenosis and block were well improved, but the finding of nerve root sleeve defect was poorly improved. It is suspected that the myelographic findings which were due to extradural mechanical compression are well improved, but that the finding of the root sleeve defect which was due to that mechanical compression and adhesion in and around the root sleeve is poorly improved. The improvement of root sleeve defect was observed in 38% of disc herniation and 24% of spinal stenosis. And many of these cases showed good clinical results.

An Observation of Ruptured Annulus Fibrosus in Lumbar Discs

To observe anatomical or pathological changes in lumbar intervertebral discs, discography and computed tomography-discography (CTD) were performed on fresh human cadavers. The results of discograms and CTD were compared with histological findings of cross sections of discs. Preoperative CTD of lumbar disc herniation was investigated based on these results. Ruptures of the annulus fibrosus were divided into two categories: circumferential rupture and radial rupture. In CTD images of fresh human cadavers, most images of rupture of the annulus fibrosus showed anterior to lateral circumferential rupture. As disc degeneration progressed, circumferential rupture tended to coexist with radial rupture in many cases. In CTD cases of lumbar disc herniation, most images of ruptures of the annulus fibrosus showed a posterior radial rupture, which was the route for herniated nucleus. The greater the degree of degeneration, the more the images tended to show radial ruptures coexisting with circumferential ruptures.

高齢者腰部椎間板ヘルニアの術後成績

Lumbar disc herniation in aged patients is relatively rare. Eighteen cases of lumbar disc herniation over 60 years of age treated by Love's operation were evaluated.Pre-operative clinical findings were relatively severe. All patients complained of lumbago and pain of the lower extremity. The average improvement rate by the Japanese Orthopaedic Association Score was 62 percent.

当科における腰部推間板ヘルニアの手術例の検討

Three hundred cases of lumbar disc herniation treated by Love's operation without fusion were reviewed.Clinical evalution above 50% was obtained in 253 cases (84.1%). Low back pain, leg pain and gait disturbance were well improved. Recovery of SLR test and muscle weakess was good, but sensory disturbance and low back pain remained. Relation between type of disc herniation and clinical result was not significantly found. Reoperation was done in 18 cases (6%). Long-term clinical results were good.

腰部椎間板ヘルニアの治療成績

78 cases of lumbar disc herniation treated by Love's operation and Love's operation with postern-lateral fusion were reviewed. The age range was from 17 to 70 years old (average 37.1 years old). The follow-up term ranged from 3.2 years to 12.5 years with an average of 7.3 years. 47% of the patients had herniation of the disc between the 4th and 5th lumbar vertebrae, whereas 44% had between the 5th lumbar vertebrae and the 1st sacrum.The average improvement rate by the JOA score was 80%.Sciatica and Lasegue sign were more improvable than other symptoms.

下垂足を伴う腰椎疾患の臨床的検討

Eight cases of lumbar disorders with drop foot were investigated to determine the level of injured nerve roots and to estimate factors of clinical results.These cases consisted of four cases of lumbar disc herniation, one case fo lumbar canal stenosis, one case of OPLL, one case of idiopathic extra-dural hematoma, and one case of others.The results found in this study were as follows:1) L5 root injury was involved in all cases.2) Cauda equina and/or multiple roots injuries were noted in all cases.3) Cases who had bladder paralysis and/or severe weakness of tibialis anterior muscle did not improve their drop feet.

若年性腰部椎間板ヘルニアの臨床

Eighty-three cases of lumbar disc herniation in the teenager were clinically investigated, classifying into 8 cases under 15 years of age (A) and 75 cases over 16 years of age (B). Results were as follows:1) Induced factors were more commonly encountered in A (50%) than in B (22.6%).2) Low back pain as a chief complaint was more commonly found in B (98.7%) thann in A (62.5%). On the other hand, leg pain was more commonly seen in A (100%) than in B (89.3%).3) As a whole, physical signs were more prominently encountered in A.4) As a matter of course, disc degeneration and disc narrowiing progressed with aging.5) Postoperative course was mostly satisfactory and accounted for “excellent” (77.7%), “good” (5.6%), “fair” (11.2%) and “poor” (5.6%). Particularly in A, all cases were excellent.

Nerve Root Blood Flow in Lumbar Disc Herniation Cases

In twelve cases of lumbar disc herniation, we measured nerve root blood flow after posterior nucleotomy using an electrochemically generated hydrogen clearance method. The blood flow of the nerve roots in these cases was 49±15ml/min/100g. We think this value is reasonable and this method can be used for measurement of blood flows in clinical cases.

スポーツ外傷によるＲｉｎｇ Ａｐｏｐｈｙｓｉｓの解離を伴なう若年者の腰ついつい間板ヘルニアの２症例

We report two cases of lumbar disc herniation with dislocation of ring apophysis. They were boys and ages were 15 and 16. They complained of severe low back pain during basketball and volleyball. Lateral plain X-ray revealed small abnormal shadow in spinal canal at the level of L4/5. Myelogram showed complete block at this level. We operated on them for suspected lumbar disc hernation with dislocation of ring apophysis and results of both were good.13 cases had been reported by other authors. 14 cases of 15 of this disease experienced trauma. We think that trauma plays a more important role in the lumbar disc herniation with dislocation of ring apophysis than other herniation in adolescent children.

Ｌｏｖｅ法における摘出つい間板量と術後Ｘ線的変化の関連について

From May 1977 to March 1982, 81 cases of lumbar disc herniation were operated with Love's method in Isahaya General Hospital. In these operations it was intended to resect the degenerated disc as much as posible.This paper reports the radiological changes resulted from resection of the lumbar disc, especially paying attention to the narrowing of the intervertebral space and decrease of the mobility in lumber spine in relation to the weight of resected disc.As the weight of resected disc increased the intervertebral space narrowed, however the mobility of lumbar spine operated was independent on the weight of resected disc.In conclusion, it is not always necessary for Love's operation to combine with postero-lateral fusion, as the narrowing of the intervertebral space centributed to the stability of the spine.

Metrizamide Myelography and Epidural Venography

This study compares lumbar epidural venography with metrizamide (Amipaque) myelography as diagnostic modalities in the evaluation of lumbar disc herniation and spinal stenosis. The accuracy of epidural venography and metrizamide myelography was evaluated in 30 surgically confirmed cases of lumbar disc herniation and spinal stenosis to determine their relative diagnostic values. Sensitivities of epidural venography and metrizamide myelography were 83% and 97%, respectively, while the specificities were 88% and 100%, respectively. The conclusions of this study were: (1) The accuracy of metrizamide myelography exceeds that of epidural venography in the diagnosis of lumbar disc herniation and spinal stenosis. (2) Metrizamide myelography is indicated as the primary contrast technique in lumbar disc herniation and spinal stenosis. (3) Epidural venography is indicated as a secondary contrast technique in patients with a congenitally short or tapered dural sac.

Metrizamide Myelography and Epidural Venography

This study compares lumbar epidural venography with metrizamide (Amipaque) myelography as diagnostic modalities in the evaluation of lumbar disc herniation and spinal stenosis. The accuracy of epidural venography and metrizamide myelography was evaluated in 30 surgically confirmed cases of lumbar disc herniation and spinal stenosis to determine their relative diagnostic values, Sensitivities of epidural venography and metrizamide myelography were 83% and 97%, respectively, while the specificities were 88% and 100%, respectively. The conclusions of this study were: (1) The accuracy of metrizamide myelography exceeds that of epidural venography in the diagnosis of lumbar disc herniation and spinal stenosis. (2) Metrizamide myelography is indicated as the primary contrast technique in lumbar disc herniation and spinal stenosis. (3) Epidural venography is indicated as a secondary contrast technique in patients with a congenitally short or tapered dural sac.

Trans-femoral lumbar epidural venography.

Epidural venography is a relatively simple, safe and highly accurate method of diagnosing lumbar disc herniations. Good opacification of the epidural venous plexus can be obtained by selective catheterization of the ascending lumbar vein or pre-sacral branches of the internal iliac veins. Experience with 100 cases of lumbar disc herniations is described. The authors think that epidural venography is a more sensitive technique than myelography, particularly with lateral disc herniation at the L5-S1 level. It is not associated with the morbidity or complications of myelography and can be performed as an outpatient procedure. Epidural venography is recommended as the examination of choice in patients with suspected lumbar disc herniation.

Clinical Studies of Surgical Treatment for Lumbar Disc Herniation

234 cases of lumbar disc herniation were operated on by anterior approach (213 cases) and posterior approach (21 cases).Of these operative cases 87 cases, which have elapsed over 1 year after surgery, were followed up and the results of clinical evaluation due to difference of surgical procedure are discussed.[Results]1) Over-all results in anterior approach (78 cases) revealed “Excellent” results in 55 cases (70.5%), Good” results in 21 (26.9%), “Fair” results in 2 (2.6%), in posterior approach (9 cases) “Excellent” results in 5 (55.6%), “Good” results in 4 (44.6%), “Fair” or “Poor” result in none.2) Investigating these results from disc lesion level, anterior approach revealed “Excellent” results in 40 cases (74.4%) in L4-5 disc lesion, on the other hand, posterior approach revealed “Excellent” results of 5 cases (83.3%) in L5-S disc lesion.

Stereoscopic Observation of the Lumbar Peridurography

One hundred forty nine cases of low back pain and sciatica have been examined by peridurography, using Conray 60% as contrast medium. Stereoscopic observation was performed on 89 cases of the patients.By this method, more accurate diagnosis were obtained than the ordinary. 17 cases of lumbar disc herniations were determined by this method, and all cases were confirmed by the operation.Severity of the pain during the procedure was variable, and patients with protruded disc were liable to complain more pain and often reappeared as usual.In the cases with seiatica there were observed more abnormal filling defects. Considerable cases frequently of spondylolysis, spondylolisthesis and low back pain showed abnormal findings in this examination.