Intervertebral Disc Protrusion Research Articles

Management of cervical spondylopathy-associated intervertebral, disc protrusions using metal washers in 78 dogs.

Intervertebral 7.5 mm (n = 75) and 6.0 mm (n = 22) metal washers were used to distract intervertebral spaces in 78 consecutive cases of canine cervical spondylopathy-associated disc protrusions, where myelography had demonstrated traction-responsive spinal cord compression. Nineteen dogs had compressive lesions at two sites. Fifty lesions were evaluated myelographically on immediate postoperative radiographs; of these, 32 compressions had been eliminated and 18 had been reduced. Euthanasia was performed in nine dogs within six months of surgery and 15 dogs had varying degrees of neck pain during this period. Long-term follow-up information was available on 65 dogs nine to 70 months following surgery (median 32 months). Sixty-three of these dogs improved postoperatively. Neurological function subsequently deteriorated in 17 dogs 10 to 59 months following surgery (median 34 months). Eight of these 17 cases had further myelographic investigations and all had additional disc protrusions with no evidence of cord compression at the previous sites of surgery. The remaining nine cases had a deterioration in hindlimb function but were not investigated further.

Diagnostic significance of topical Image of infrared thermography on the patients with lumbar intervertebral disc protrusion —a comparative study on 45 patients with Manipulative treatment and 65 normal control

Objective: To analyse and explore the diagnostic significance of infrared thermography on the patients with lumbar intervertebral disc protrusion.Methods: Forty-five hospitalized cases under conservative treatment (mainly manipulation) and 65 controls were consecutively selected. Both groups were examined with infrared thermography on lower back and lower extremities as well as physical examination before and after treatment. The study statistically analysed the temperature difference between the involved and healthy parts at different areas; and also compared the variation of the temperature difference after the treatment to the decreasing scores of physical examination afterward. Results: The statistic result showed that the temperature difference between two sides on patient group was significantly higher than those of the control group. The further analysis showed that the temperature difference at posterior femur area in the patients’ group correlated significantly to the severity of clinical signs caused by nerve root irritation.Conclusion: The thermogram was uncertain to the segmental diagnosis of lumbar disc protrusion and could only be considered as a reference in the final diagnosis. Nevertheless, it is helpful to discover the severity of radical signs according to the posterior femoral region of hypo- (hyper-) thermogram.

(iii) Decompression surgery for lumbar spinal stenosis

Lumbar spinal canal stenosis is a constriction neuropathy of the cauda equina and nerve roots induced by dynamic factors such as posture and spinal instability. The severity of cauda equina or nerve root constriction varies among cases. Nerve root decompression may be achieved by local immobilization by changing the posture and with an orthosis. However, direct surgical relief of nerve root constriction is needed if severe neurological symptoms such as muscle weakness of the legs and bladder disturbance are present, or symptomatic improvements cannot be obtained even by sufficient conservative therapy, and activities of daily living (ADL) are impaired. Surgery, thus, plays an important role in the treatment for lumbar spinal canal stenosis. According to the international classification by Arnoldi et al, 1 lumbar spinal canal stenosis is divided into central stenosis and lateral stenosis. Central stenosis is due to dural sac compression caused primarily by thickening of the ligamenturn flavum, enlargement of the facet joints, and protrusion of intervertebral discs. Lateral stenosis, on the other hand, is classified as follows according to the site of nerve root constriction (Fig. 1): 2-5

Magnetic resonance imaging of the cervical spine in 27 dogs.

The cervical spine of 27 dogs with cervical pain or cervical myelopathy was evaluated using magnetic resonance imaging (MRI). Spin echo T1, T2, and post-contrast T1 weighted imaging sequences were obtained with a 0.5 Tesla magnet in 5 dogs and a 1.5 Tesla magnet in the remaining 22 dogs. MRI provided for visualization of the entire cervical spine including the vertebral bodies, intervertebral discs, vertebral canal, and spinal cord. Disorders noted included intervertebral disc degeneration and/or protrusion (12 dogs), intradural extramedullary mass lesions (3 dogs), intradural and extradural nerve root tumors (3 dogs), hydromyelia/syringomyelia (1 dog), intramedullary ring enhancing lesions (1 dog), extradural synovial cysts (1 dog), and extradural compressive lesions (3 dogs). The MRI findings were consistent with surgical findings in 18 dogs that underwent surgery. Magnetic resonance imaging provided a safe, useful non-invasive method of evaluating the cervical spinal cord.

BLADDER FUNCTION AFTER SURGERY FOR LUMBAR INTERVERTEBRAL DISK PROTRUSION

Purpose Urodynamic changes following surgical treatment for lumbar intervertebral disk protrusion were prospectively studied. Materials and Methods We evaluated 98 patients with lumbar intervertebral disk protrusion. Urodynamic evaluation was performed in all patients before and after surgery, and included simultaneous measurement of intravesical and abdominal pressure during bladder filling and voiding, and uroflowmetry (pressure flow measurement). Results Of the 27 patients with detrusor areflexia preoperatively detrusor activity was normal in only 6 after surgical treatment. Of the 71 patients with normal urodynamic findings preoperatively the findings became abnormal after surgery in 7. Conclusions Bladder function frequently remains unchanged after surgery for lumbar intervertebral disk protrusion.

BLADDER FUNCTION IN PATIENTS WITH LUMBAR INTERVERTEBRAL DISK PROTRUSION

Purpose We prospectively studied the effect of lumbar intervertebral disk protrusion on bladder function. Cystometry findings were particularly examined according to spinal level of disk protrusion and urological symptoms. Materials and Methods We evaluated 77 men and 37 women 25 to 63 years old with lumbar intervertebral disk protrusion. Urodynamic investigation included uroflowmetry and simultaneous recording of intravesical, abdominal and detrusor pressure during bladder filling and voiding. Results Detrusor areflexia was noted in 31 of the 114 patients (27.2%) while detrusor activity was normal in the remaining 83. According to the spinal level of disk protrusion, detrusor areflexia was evident in 3 of the 8 cases of L3, 10 of the 54 L4 and 18 of the 52 L5 disk protrusion. All 31 patients with detrusor areflexia reported difficult voiding with straining. Conclusions Detrusor areflexia develops in approximately a quarter of the patients with lumbar intervertebral disk protrusion. We did not find that the spinal level of lumbar disk protrusion had an effect on detrusor activity. All patients with detrusor areflexia had voiding disorders that manifested as voiding with straining.

Discography in lumbar scheuermann’s disease

Between 1988 and 1996 102 patients with Scheuermanns disease were observed in Kharkov Institute of Orthopaedics and Traumatology named after M.I. Sitenko. In 40 of those patients (5 women,35 men), aged 16-30, discography was carried out including functional discography in 17 patients. Discography was performed by generally accepted method. On the base of data obtained the classification of discogram types in lumbar Scheuermanns disease is suggested: I. Intradiscal type of contrast matter disposition: 1) intradiscal displacement of nucleus pulposus; 2) protrusion of intervertebral disc; 3)hernia of intervertebral disc; 4) protrusion of the end-plate of the vertebral body - it is one of the specific discographic signs of lumbar Scheuermanns disease and is characterized by slight degeneration of nucleus pulposus. II. Transdiscal type of contrast matter disposition - it is specific for lumbar Scheuermanns disease and reflects the degeneration of the intervertebral disc: 1) extralaminar type (it was observed in segments with the anterior ring apophysis separation and was characterized by the prolapse of nucleus pulposus between the anterior ring apophysis and anterior vertebral body angle. 2) translaminar type (it was observed when contrast matter penetrated into the underlying vertebral body structures through the damaged end-plate. Authors reach the conclusion that in some cases discography is the most preferable method to examine the functional and structural state of the intervertebral disc.

Transient traumatic quadriplegia in a 29-year-old man without predisposing anatomic lesion

A 29-year-old man presented 45 minutes after sustaining a blow to the right side of his head when his motorcycle slid on gravel and flipped on the side of the road. After walking away from the accident, the patient noted burning pain in his neck. Shortly thereafter, complete quadriplegia with a sensory level at C4 developed. The patient was given a high dose of methylprednisolone and transferred to a tertiary care center. En route, neurological testing demonstrated rapid improvement, and on arrival, all abnormal motor and sensory findings had completely resolved. Radiographic examination and magnetic resonance imaging of the entire spine showed no abnormality. Torg's ratio was >1 at vertebral level C3 through C6. There was no evidence of developmental stenosis, congenital fusion, cervical instability, or intervertebral disk protrusion.

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain

Epidemiologic studies document the overuse of surgical procedures in the United States compared with rates in 11 developed countries. Delay in return to work remains an expensive component in the cost of low back pain for workers' compensation claims. Injury to spinal nerve roots may occur secondary to compression with intraradicular edema or from inflammatory phenomena related to phlogistic properties of the nucleus pulposus, independent of nerve compression. Magnetic resonance imaging findings of intervertebral disk bulging and protrusion occur frequently in asymptomatic individuals. Reviews of adult scoliosis, postpartum back pain, diabetic radiculopathy, insufficiency fractures of the sacrum, diskitis, and facet syndrome have appeared in the literature over the past year. Patient education and minimal limitation of activity are associated with the greatest level of patient satisfaction. Long-term follow-up studies of surgical decompression for intervertebral disk herniation and spinal stenosis have resulted in good outcomes in appropriately selected patients.

Revisional lumbar microdiscectomy: an analysis of operative findings and clinical outcome

Forty-one consecutive patients who underwent a revision microlumbar exploration for recurrent or persistent sciatica were reviewed retrospectively to analyse the operative findings and assess the clinical outcome following surgery. Thirty-three (80%) patients were found to have a recurrent intervertebral disc protrusion at the previous site, two patients had a disc herniation at a new site, one had severe perineural scarring, two had lateral recess stenosis, one patient had undergone previous exploration at an incorrect site and in two patients no cause for ongoing symptoms was found. Nineteen of the 33 patients with a re-prolapse presented with persistent or recurrent sciatica within 1 year of their first operation. The other 14 patients presented with a late re-prolapse (after 1 year) and their clinical outcome was better than for those patients with an early re-prolapse (12/14 vs 11/19 satisfactory result, respectively). The result of operating on patients with a late re-prolapse was comparable to the 80-95% satisfactory outcomes following primary lumbar microdiscectomy reported by other authors.

MAGNETIC RESONANCE IMAGING OF THE CAUDAL LUMBAR AND LUMBOSACRAL SPINE IN 13 DOGS (1990–1993)

The caudal lumbar and lumbosacral spine of 13 dogs with pain or neurologic deficits were evaluated using magnetic resonance imaging (MRI). Spin echo T1, proton density, and T2 weighted and gradient echo T2* imaging sequences were utilized. MRI permitted direct, multiplanar, tomographic visualization of the spine facilitating evaluation of all components of degenerative caudal lumbar and lumbosacral stenosis. Abnormalities detected included intervertebral disc degeneration, intervertebral disc protrusion involving both the vertebral canal and intervertebral foramina, articular process osteophytosis, articular process fracture, nerve root impingement by spondylosis deformans, and the presence of low signal material within the vertebral canal of 2 dogs with recurrent pain following previous spinal surgery. In all 7 dogs treated surgically, MRI findings were consistent with surgical findings.

MAGNETIC RESONANCE IMAGING OF CANINE DEGENERATIVE LUMBAR SPINE DISEASES

Degenerative lumbar spine diseases, i.e., sacrolumbar stenosis, intervertebral disk degeneration and protrusion and spondylosis deformans of the canine lumbar spine were studied in eleven canine patients and three healthy controls using radiography and 0.02 T and 0.04 T low field magnetic resonance imaging. The T1 and T2 weighted images were obtained in sagittal and transverse planes. The loss of hydration of nucleus pulposus, taken as a sign of degeneration in the intervertebral disks, could be evaluated in both T1 and T2 weighted images. As a noninvasive method magnetic resonance imaging gave more exact information about the condition of intervertebral disks than did radiography. Sacrolumbar stenosis and compression of the spinal cord or cauda equina and surrounding tissue could be evaluated without contrast medium.

Chemonucleolysis with collagenase. A radiographic and pathologic study in dogs.

Collagenase, a proteolytic enzyme, was injected intradiscally in nine clinically normal, middle-aged beagles. Calcium chloride diluent solution (control), 100 ABC units of collagenase, and 250 ABC units of collagenase, were injected in randomly selected intervertebral discs (T13-L1 to L5-L6). On day 11, the discs injected with collagenase were narrowed radiographically, but there was no significant change in myelograms. Grossly and histologically, there was dissolution of the intervertebral discs, mainly nucleus pulposus, and protrusion of nucleus material in the vertebral body through bony end-plates in discs injected with collagenase. Collagenase chemonucleolysis may be an alternative to spinal surgery for intervertebral disc protrusion in dogs.

Effects of Corticosteroids on Mechanical Strength of Intervertebral Joints and Vertebrae in Dogs

Dogs with hyperadrenocorticism had a higher incidence of intervertebral joint disease, i.e., disc protrusion or spondylosis. In comparing cases of hyperadrenocorticism with age- and breed-matched controls with hypothyroidism, the incidence was significantly greater than expected. This was not seen, however, in beagle dogs in which the incidence was already high and attributed to chondrodystrophoid tendencies in this breed. To investigate the pathogenesis of this association and its possible relationship to steroid-induced osteopenia, adult dogs were given a placebo, prednisone, or prednisone plus calcium for six months. Torque testing of intervertebral joints revealed a consistent trend of lower force to failure in both prednisone-treated groups, but the difference was not statistically significant. In these dogs with mild to moderate hyperadrenocorticism, compression tests of intact vertebral bodies were not significantly different, but blocks of trabecular bone cut from the vertebral bodies failed at significantly lower compressive forces in both prednisone-treated groups compared with controls. Histomorphometric evaluation of lumbar vertebral trabecular bone revealed that the percentage of bone volume was not significantly decreased in the prednisone-treated groups. Nor was there any difference in the thickness or porosity of vertebral end-plates, which might contribute to weakening of intervertebral ligamentous insertions.

Cerebrospinal fluid creatine kinase activity in horses with central nervous system disease: 69 cases (1984-1989)

Summary The csf creatine kinase (ck) activity was determined in 70 csf samples from 69 horses with cns disease. Abnormal values (≥ 1 IU/L) were determined from 32 csf samples, and normal values (<1 IU/L) were found in 38 samples. Increased ck activity was most frequently associated with a diagnosis of equine protozoal myelitis; ck activity was not increased in 11 horses with cervical compressive myelopathy. Other diagnoses, in which csf ck activity was increased included trauma (n = 1), idiopathic epilepsy (n = 2), botulism (n = 2), articular facet fracture (n = 1), intervertebral disk protrusion (n = 1), and toxemia (n = 1).

Results of operation for lumbar disc protrusions in children

Intervertebral disc protrusions are rare in children and adolescents, and we report our experience of 9 cases, all of whom were girls. Diagnostic problems are common and objective findings dominate the clinical picture at this age. Eight patients were treated by operation; no spinal fusions were carried out. Six patients with a follow up of from 6 to 15 years were reviewed. There were no recurrences, but episodes of low back did occur. Radiographs showed a variable diminution in the height of the disc in every case.

Cervical Spinal Stenosis with Cord Neurapraxia and Transient Quadriplegia

Cervical spinal cord neurapraxia with transient quadriplegia is defined as a distinct clinical entity. The authors identify diminution of the anteroposterior diameter of the spinal canal as the factor that explains the described neurologic picture of the injury. Based on the result of a study of 39,377 athletes, the authors conclude that the prevalence of the injury is high and warrants attention. Given that of the patients interviewed, none recalled prodromal experience of transient motor paresis and none sustained further injury, this injury does not predispose individuals to permanent neurologic injury. No definite recurrence patterns have been established that would warrant the restriction of individuals from further activity. Activity restrictions are called for in the case of individuals with stability or chronic degenerative changes. Individuals with developmental spinal stenosis or spinal stenosis should be treated on an individual basis.

Experimental Chemonucleolysis With Chondroitinase ABC

Chemonucleolysis has recently become an established treatment for intervertebral disc protrusion. However, the exact mechanism of chemonucleolysis is still unknown. If mechanisms of chemonucleolysis include diminution of intradiscal pressure followed by subsequent regeneration of the nucleus pulposus, then a more selective enzyme for glycosaminoglycan, chondroitinase ABC, might be used for chemonucleolysis instead of chymopapain. Thus experimental chemonucleolysis with chondroitinase ABC compared with chymopapain was investigated. In rabbits, chondroitinase ABC is as effective for chemonucleolysis as chymopapain, but the chemonucleolysis process with chondroitinase ABC was milder than with chymopapain. At an early chemonucleolysis phase, chondroitinase ABC action was chiefly limited to digestion of the matrix, and a large number of cells in the nucleus pulposus remained. During long-term observations of chemonucleolysis with chondroitinase ABC, nuclear structure was restored to a nearly normal state. Although limited, this study indicates that chondroitinase ABC might be more suitable than chymopapain for chemonucleolysis.

Clinical, urodynamic and neurophysiological findings in patients with neuropathic bladder due to a lumbar intervertebral disc protrusion.

Sacral nerve roots are affected in 1 to 15% of reported cases of lumbar disc protrusions (mainly posterior) (Scott, 1965). Urinary retention is the commonest symptom. In the last 6 years, we have observed 22 patients (18 males and 4 females) with a neuropathic bladder due to this condition in the acute phase. They underwent intermittent catheterisation (IC), and manoeuvres such as Credé and Valsalva's at fixed times. Almost all obtained a balanced bladder. ( 24 months.) The most common urodynamic finding at the onset was bladder areflexia with severe denervation of the perineal floor. At follow-up, 65% still had bladder areflexia and 29% normoreflexia, all with normal compliance. Perineal floor innervation showed a fair recovery, mainly in the efferent part. An hypothesis is presented to explain why this kind of neuropathic bladder has a normal compliance.

Thoracic Intervertebral Disc Protrusion: Experience of 67 cases and review of the literature

Sixty-seven cases of thoracic intervertebral disc protrusion are reported with an analysis of clinical and radiological findings. The findings include the fact that male: female ratio is approximately equal, peak incidence is in the 3rd to 5th decade with another peak at age 30-40 in men. This latter peak appears to be associated with trauma which is otherwise uncommon. Results of surgical treatment indicate that the transthoracic and costotransversectomy routes are almost equally effective; laminectomy is not advised.