Intervertebral Disc Protrusion Research Articles

Operation cooperation for application of lasma knife to cure protrusion of intervertebral disc

目的 探讨等离子刀技术经皮椎间盘消融手术配合的体会.方法针对47例患者的护理特点,从以下几方面进行手术配合:(1)做好患者局麻的心理护理及安慰,引导放松;(2)做好术前的器械准备;(3)熟悉等离子刀的性能与使用配合;(4)摆好手术体位;(5)术中密切观察病情,指导患者配合手术.结果 47例手术疗效满意,消融过程中有3例出现心慌,心率增快;2例因怕痛而加大麻药剂量.结论熟悉等离子刀的使用,掌握手术配合技巧,做好患者心理疏导,是手术成功和预防并发症的关键。

Clinical observation on the treatment of lumbar intervertebral disc protrusion with electroacupuncture, TDP plus Tuina

One hundred and twenty-eight cases of lumbar intervertebral disc protrusion were randomly divided into treatment group, in which 70 cases were treated with electroacupuncture, TDP plus Tuina, and control group, in which 58 cases were treated with electroacupuncture plus TDP. The curative rate in the treatment group was higher than that in the control group (64.3% vs 31.0%,P<0.01). The total effective rate was 100% in the treatment group, 91.3% in the control group; the effect of the former was better than that of the latter (P<0.05).

Myelopathic Presentation of Cervical Juxtafacet Cyst: A Case Report

Case report. Discussion about the nature of the lesion, its various presentations, image characteristics, clinical features, surgical treatment, and patient outcome. Juxtafacet cysts are uncommon intraspinal lesions most frequently found in the lumbar region. They usually originate as monoradicular compression syndrome mimicking disc herniation. In the cervical spine, they are rare and also have similar clinical features to intervertebral disc protrusion. However, the image findings are highly discriminative and often lead to accurate diagnosis. The cyst occupies a posterolateral position within the spinal canal, displacing the nerve root anteriorly. This situation is better seen in magnetic resonance imaging, but computed tomography scan and plain myelography also point to a diagnosis. The posterolateral site in the spinal canal can be accessed directly by a single-level laminectomy or hemilaminectomy. These are epidural lesions, usually cystic, attached to the facet joint and protruding into the intervertebral foramen. Recurrence after surgery is extremely rare and has only been reported in the lumbar spine. In this article, we report the case of a male patient, 64 years of age, who presented with a progressive and severe myelopathy associated with multiple mononeuropathy, which delayed the diagnosis and treatment of the main neurologic condition, a cervical spinal compressive syndrome, proven to have originated as a juxtafacet cyst. The patient underwent complete surgical excision of the lesion. The patient had good recovery of the myelopathy, and 6 months after surgery, he was able to walk. A follow-up of 2.5 years has not revealed any recurrence or new neurologic conditions.

Treatment of protrusion of cervical intervertebral disc by Tuina

Twenty-five cases of protrusion of cervical intervertebral disc were treated by the manipulations of rolling, pressing, pushing with one-finger, traction, obliquely pulling, grasping of five channels, sweeping, etc. The result showed that 10 cases were cured, 14 cases got marked effectiveness and 1 case was improved.

Research progress of treatment of prolapsed lumbar intervertebral disc by acupuncture and moxibustion

This article reviewed information related to the treatment of lumbar intervertebral disc protrusion by acupuncture and moxibustion in recent 10 years, so as to grasp the current situation of this specific topic and provide the reference evidence for the further study. According to the related professional literature of acupuncture and moxibustion, the authors found that acupuncture and moxibustion therapy had definite therapeutic effect on the lumbar intervertebral disc protrusion. But most clinical reports were retrospective and had no uniform therapeutic effect criteria, interfering with the screening of the best therapeutic plan. The authors suggested that the study of action mechanism of acupuncture and moxibustion and the clinical prospective survey should be intensified.

General session abstracts RESULTS OF LAMINECTOMY WITHOUT METHYLPREDNISOLONE SODIUM SUCCINATE (MPSS) FOR ACUTE THORACOLUMBAR DISK DISEASE IN 51 NON‐AMBULATORY DOGS

The administration of MPSS is advocated both for limiting spinal cord injury from Hansen Type I intervertebral disk protrusion (T1‐IVD) and from the potential surgical trauma associated with laminectomy. Recent studies suggest that treatment with MPSS does not significantly alter functional outcome and is associated with significant complications including gastrointestinal bleeding, pancreatic necrosis, and increased rates of infection. The purpose of this prospective study was to report the results of laminectomy without MPSS treatment in non‐ambulatory dogs with T1‐IVD. The study group involved dogs weighing less than 15 kg that had a laminectomy between T11‐T12 and L4‐L5 for T1‐IVD. Dogs included had not been treated with MPSS, were unable to walk but able to sense “deep pain”. The dogs were evaluated post‐operatively for the ability to walk (stand and advance pelvic limbs), pain (reaction to paraspinal palpation or movement), and incontinence (dribbling urine/feces or failure to completely void urine). Fifty‐one dogs met the inclusion criteria. Prior to surgery 0% of the dogs could walk (26 paralyzed, 25 paretic), and 98% were painful. Incontinence was not assessed or was unknown in most cases. Ten days following surgery, 90% were walking, 98% were pain‐free, and 82% were fully continent. By 6 weeks, 100% were walking, 6% were painful, and 86% fully continent. By 16 weeks, 96% were pain‐free, and 88% were fully continent. These results obtained with laminectomy alone are comparable or superior to reports of those with MPSS administration and suggest that MPSS is not necessary for a successful outcome in dogs receiving laminectomy for T1‐IVD.

Lumbosacral disc disease in a cat

SummaryAn eight-year-old male castrated domestic shorthair admitted with a two-day history of acute back pain, flaccid tail, and urinary and faecal incontinence. Diagnostic tests, including myelogram, epidurogram, and CT scan revealed an extradural lesion at the L7-S1 disc space. Exploratory surgery and histopathology confirmed a Type II lumbosacral intervertebral disc protrusion. The cat regained neurological function by six weeks after surgery. This is the first case report of a cat with documented lumbosacral disc disease. Lumbosacral disease should be considered as a differential diagnosis in cats with caudal lumbar pain or neurological signs localizable to the S1-S3 spinal cord segments or peripheral nerves.

Treatment of protrusion of cervical intervertebral disc with Tuina therapy plus acupuncture

In application of the bone-setting Tuina therapy plus acupuncture on Jiaji (Ex-B 2), Tianzong (SI 11). Jianyu (LU 15), Quchi (LI 11), Waiguan (TE 5) and Hegu (LI 4) in the treatment of 8 cases of protrusion of cervical intervertebral disc, all the symptoms disappeared and the movements were free after treatments in the patients.

BACK INJURY- VOLLEYBALL

HISTORY A 15 year-old female high school volleyball player incurred a back injury while playing volleyball 11 weeks prior to presentation. She reports tripping and falling while running, striking her head and back. Since her injury, she has experienced persistent lumbar pain with referred pain to her right lower limb, and numbness over the dorsal aspect of her right lower extremity. Coughing, sneezing, and bending at the waist aggravate her lumbar pain, which she describes as deep, sharp, and achy. Various traditional and COX-2 specific ant-inflammatory agents have not relieved her symptoms. She had not undergone formal physical therapy at the time of our evaluation. PHYSICAL EXAMINATION Normal gait pattern without listing. Full lumbar range of motion with painful flexion and extension. The right lumbosacral paraspinal region was tender to palpation. No tenderness was elicited with sacroiliac joint (SIJ) palpation and SIJ provocative maneuvers did not elicit pain. Straight leg raising reproduced lumbar pain on the right side without radicular symptoms. Full pain-free range of motion was noted in the hips, knees, and ankles bilaterally. Manual muscle testing revealed intact strength in both lower limbs, except 4+/5 right great toe extension. Muscle stretch reflexes were +2 bilaterally at the patella, medial hamstrings, and achilles tendons. Sensation was decreased to light touch and pin prick on the dorsal surface of the right foot. Upper motor neuron signs were absent. DIFFERENTIAL DIAGNOSIS Lumbosacral intervertebral disc herniation w/L/S radiculopathy vs. sclerotomal pain referral pattern Lumbosacral strain/sprain Discitis Vertebral osteomyelitis Spondylolysis/spondylisthesis Tumor TESTS AND RESULTS Lumbosacral MRI: – small 1–2mm disc bulge at L1 – L2 w/o central or lateral canal stenosis or neural element compromise – small paracentral disc bulge at L4-L5 toward the right neural foramen abutting but not compressing the right L5 nerve root Electrodiagnostic evaluation: – No electrical evidence of L/S radiculopathy/plexopathy, focal entrapment, or peripheral neuropathy. FINAL/WORKING DIAGNOSIS Right paracentral L4-L5 intervertebral disc protrusion causing a right L5 radiculopathy affecting primarily sensory fibers. TREATMENT AND OUTCOME Prednisone 70mg taper over 7 days; ultracet 1–2 tabs q6 hr prn. Physical therapy with passive modalities including hot packs, ice message, electrical stimulation. Lumbar stabilization program with instructions on proper body posture and mechanics, as well as a home exercise program. Due to lack of benefit from oral steroids and poor tolerance for therapy due to persistent symptoms, a total of three, L5 transforaminal epidural steroid injections were performed under fluroscopy. Resolution of symptoms enabling patient to complete 12 sessions of physical therapy. Continue home exercise program, gradually increasing activity level while wearing a lumbosacral corset. Avoid heavy lifting and high impact activities.

Acupuncture treatment of 32 cases of lumbar intervertebral disc protrusion

Yaoyangguan (GV 3), Shiqizhui (Ex-B 8) and Yanglingquan (GB 34) were selected as main points and a three-part needle insertion technique was used to treat 32 cases of lumbar intervertebral disc protrusion. The curative rate was 96.9%. Deep puncture is the key to the treatment.

Interobserver Reliability between MRI, CT-myelogram and Myelogram in the Evaluation of Lumbar Spinal Stenosis

Purpose : We designed this study to evaluate the interobserver reliability of magnetic resonance imaging (MRI), post-myelographic computed tomography (CT-myelogram) and myelography for the diagnosis of lumbar spinal stenosis. Materials and Methods : Thirty two patients with lumbar spinal stenosis were evaluated preoperatively by MRI, CT-myelography, and myelography by four observers. For each set of scans, the examiners assessed the presence or absence of; 1) intervertebral disk protrusion, 2) facet arthrosis, 3) ligamentum flavum hypertrophy, and 4) nerve root impingement. The severities of 1) central, 2) lateral, 3) foraminal and 4) entire spinal stenosis were graded using a four-point scale range from 1 (no stenosis) to 4 (severe stenosis). Results : Kappa statistical analysis revealed moderate interobserver agreement in terms of disk protrusion (0.49), nerve root impingement (0.42) and lateral stenosis grade based on MRI. Low levels of agreement were found for facet arthrosis and ligamentum flavum hypertrophy. Relatively higher levels of agreement were found for nerve root impingement, lateral stenosis and entire stenosis, graded by MRI and for central stenosis graded by myelography. Conclusion : The results of this study reflect that MRI showed relatively higher levels of interobserver reliability than the other diagnostic modalities in the evaluation of patients with lumbar spinal stenosis.

Retrospective Analysis of Spinal Arachnoid Cysts in 14 Dogs

Spinal cord dysfunction secondary to spinal arachnoid cysts (SACs) has been reported previously in dogs. This retrospective study reviews the clinical signs, radiographic findings, and outcome after surgical resection of SACs in 14 dogs. Plain vertebral column radiographs and myelography were done in all dogs. Computed tomography (CT) was done in 7 dogs and magnetic resonance (MR) imaging in 3 dogs. Affected dogs were between 1 and 12 years of age, and 8 of 14 were Rottweilers. Abnormalities detected on neurological examination depended on the location of the SAC. Five dogs had bilobed or multiple SACs. SACs were located in the cervical vertebral column in 11 dogs and in the thoracic vertebral column in 4 dogs. All dogs had dorsally or dorsolaterally located SACs. Two dogs also had additional ventrally located SACs. Spinal cord compression secondary to intervertebral disc extrusion or protrusion was demonstrated at the site of the SACs in 2 dogs. Surgical resection of the SACs was completed in all dogs. Eleven dogs were available for follow‐up. Five weeks postoperatively, 7 dogs improved in neurological function, with some residual ataxia and paresis in 6 of these dogs. Neurological function had deteriorated in 4 dogs. It was concluded from this study that Rottweilers have a higher incidence of SACs than other breeds of dog. Furthermore, bilobed or multiple SACs can occur commonly, and myelography effectively localized SACs in dogs. Surgical resection of SACs resulted in improvement in neurological function in the majority of treated dogs.

Relationship between clinical data and urodynamic findings in patients with lumbar intervertebral disk protrusion.

The relationship between voiding disturbances and urodynamic diagnosis in patients with lumbar intervertebral disk protrusion is controversial. The objective of this study was to determine the association between clinical data and urodynamic diagnosis, in order to reveal whether bladder dysfunction can be assessed on the basis of urological symptoms and signs. We prospectively studied 122 patients with lumbar intervertebral disk protrusion. Detrusor areflexia was found in 32 of these patients, while in the remaining 90 detrusor activity was normal. All patients with detrusor areflexia reported difficulty voiding by abdominal straining. The patients with normal urodynamic findings were either free of voiding disturbances (77 patients) or complained of frequent voiding (13 patients). In conclusion, there are cases of lumbar intervertebral disk protrusion in which the presence of bladder dysfunction can be predicted on the basis of clinical urodynamic testing, i.e. clinical neurological alterations, decreased bladder sensation, voiding by straining, increased bladder capacity, residual volume, and intermittent or continuous low flow curve on free uroflowmetry.

Accuracy of localization of cervical intervertebral disk extrusion or protrusion using survey radiography in dogs

Sixty-four dogs with histories and clinical signs consistent with cervical intervertebral disk disease were presented for evaluation. Survey spinal radiographs were obtained, followed by myelography. In 61% of the survey radiographs, evaluators identified sites of disk extrusion or protrusion based on radiographic findings. Of those radiographs where a site was identified, ability to accurately identify the correct site of disk extrusion ranged from 53% to 67%, with an average of 58%. Therefore, the overall accuracy rate for correct identification of the site(s) of disk extrusion for all survey radiographs was 35%. Twelve cases had more than one site of disk extrusion or protrusion evident myelographically. In cases where multiple sites of extrusion were confirmed myelographically, the ability to localize at least one of the sites on the corresponding survey radiographs ranged from 63% to 80%, with an average of 70%. The major site of disk extrusion or protrusion was incorrectly identified in 16% to 31% of the survey radiographs, with an average of 26%. The use of survey radiographs alone is an inaccurate means for localization of cervical intervertebral disk extrusion or protrusion.

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

Low back pain affects a minority of individuals over 65 years of age. Four years after the onset of sciatica, the number of individuals working is independent of their workers' compensation status. A complex interaction of metalloproteinases, cytokines, chondrocytes, and macrophages are necessary for the resorption of herniated intervertebral discs. Positional magnetic resonance imaging in the seated extended posture identifies foraminal narrowing that is not visualized with conventional magnetic resonance studies. Compression associated with cauda equina syndrome must be reversed within 48 hours to preserve neurologic function. The gene for transforming growth factor can be transferred to intervertebral discs, resulting in increased proteogylcan production in a rabbit animal model. An aerobic exercise program is as effective as more expensive exercise programs in the treatment of chronic low back pain. Complementary therapies, willow bark and magnets, have marginal benefit for low back pain. Surgical intervention results in improved function for spinal stenosis patients.

Spontaneous lumbar intervertebral disc protrusion in cats: literature review and case presentations

Reports on intervertebral disc disease in cats are rare in the veterinary literature. It has been postulated that intervertebral disc protrusion is a frequent finding during necropsy in cats, without having any clinical relevance (King and Smith 1958, King & Smith 1960a, King & Smith 1960b). However, a total of six cases with disc protrusions and clinically significant neurological deficits have been reported over the past decade. (Heavner 1971, Seim & Nafe 1981, Gilmore 1983, Littlewood et al 1984, Sparkes & Skerry 1990, Bagley et al 1995). As in dogs, there are also two types of intervertebral disc disease in cats: Hansen's type I (extrusion), and type II (herniation). Cervical spinal cord involvement was more commonly recognised in cats than the lumbar or the thoraco lumbar area. Cats over 15 years were mainly affected (King & Smith 1958, King & Smith 1960a, King & Smith 1960b). We describe two cats with lumbar intervertebral disc protrusions. Emphasis is placed on differential diagnoses, treatment and follow-up.

A chimpanzee genome project is a biomedical imperative.

A near-complete sequence of the human genome is now available, and many efforts are currently focused on the next logical biomedically relevant target — the mouse genome. Given limited resources, which vertebrate genome(s) should be tackled after that? Reasonable candidates include other well-studied model organisms such as Rattus rattus (the rat), Xenopus laevis (the African clawed toad), and Danio rerio (the zebra fish). Over the last few years, some have been advocating a genomic approach toward understanding our closest evolutionary relatives, the great apes (McConkey and Goodman 1997; Paabo 1999; McConkey et al., 2000). Pan troglodytes (the chimpanzee) and Pan paniscus (the bonobo) share nearly 99% of human genomic sequences (see Box 1 for discussion) (King and Wilson 1975; Sibley and Ahlquist 1984; Caccone and Powell 1989; Ruvolo 1997; Goodman et al. 1998; Satta et al. 2000). Thus, it is cogently argued that knowing the complete genome of at least one of these species will give us a window into genes that contribute to humaness (the chimpanzee is the first choice, because we know more about this species than we do about the bonobo). The emergence of humans can be regarded as one of the major transitions in evolution (Szathmary and Smith 1995), and the complete explanation of this phenomenon ranks as one of the greatest unsolved mysteries of science. Taxpaying citizens might argue that, given limited resources, this lofty and anthropocentric pursuit should not take precedence over the pragmatic value of sequencing genomes of model organisms that have already been better studied by a variety of biomedical and genetic approaches. Moreover, it might be suggested that this is a matter for the National Science Foundation (NSF) to deal with, not the National Institutes of Health (NIH). Programs within the NSF are currently considering a Human Origins Initiative (Weiss and Yellen 2000). However, I would like to suggest that there is clear and compelling biomedical value to giving high priority to the complete sequencing of the chimpanzee genome and that of at least one Old World monkey. The experience of primate centers and zoos over the last century indicates that there are many interesting differences in disease frequency and severity between humans and great apes such as the chimpanzee. Whereas the evidence is sometimes fragmentary or inconclusive, the nature and significance of these medical conditions (including AIDS, Alzheimer’s disease (AD), cancer, malaria, and perimenopausal complications) are sufficient to draw attention to the issue. After all, extrapolating findings in physiology and pathology from mice, rats, toads, or fish to humans can be difficult, because of our significant physiological and genetic differences from these species. In contrast, the >99% identity of amino acid sequences of most chimpanzee and human proteins (see Box 1) predict a stronger likelihood of finding genetic explanations for any disease differences. Studies of the chimpanzee genome could be considered a logical extension of the current emphasis on exploiting sequence differences between various human groups to identify important disease susceptibility genes. For this and other reasons, the cost of a chimpanzee genome project should also be much less than for the original Human Genome Project. Also, as discussed below, the knowledge gained could be of much value in our efforts to conserve and care for the great apes themselves. Some pathological states in humans seem to represent the normal situation in chimpanzees, including craniosynostosis (closure of the skull sutures in the perinatal period) (Cohen 1991), general leukocytosis (a high white blood cell count) (Hodson et al. 1967; McClure et al. 1972) and extensive hypertrichosis (hairiness). Several other diseases or physiological states of humans appear to be rare or markedly attenuated in the chimpanzee (Scott 1992). Some of these diseases can be attributed to anatomic differences between the species, including protracted, painful, and dangerous childbirth (resulting from the larger head of the human fetus and the altered pelvis of the bipedal human female), neonatal cephalhematoma (the common subperiosteal blood clot of the new born human skull bones), wisdom tooth impaction (resulting from the reduced jaw size in humans and the lack of a post-molar gap), and various diseases attributed to gravity effects on bipedal humans (vertebral osteoarthritis, intervertebral disc protrusion, varicose veins, and hemorrhoids). There are also a few anatomically unique diseases of great apes that do not occur in humans, such as infection of the pharyngeal air sacs (an organ that is absent in humans) (Strobert and Swenson 1979). The rarity of certain other human conditions such as sexually transmitted diseases and severe hypercholesterolemia in great apes is possibly explained on a behavioral/ cultural basis, as they can be induced experimentally in the latter (Scott 1992). The higher frequency in humans of anatomical disorders of the central nervous system such as hydrocephalus is also inE-MAIL avarki@ucsd.edu; FAX (858) 534-5611. Insight/Outlook

Mechanisms of neurovascular compression within the spinal and intervertebral canals

Objective: To describe some possible causes of encroachment on human spinal and intervertebral canal (foramen) neurovascular structures.Data Selection and Synthesis: A review of some imaging films of patients aged 38 to 52 years and some human autopsy histopathologic sections from 40- to 60-year-old cadavers to determine what structures may be responsible for neurovascular compression in individuals in this relatively young-to-middle-age group and to illustrate some examples.Results: Stenosis of the spinal and intervertebral canal neurovascular structures can be caused by various bony and soft-tissue structures. Stenosis can be related to osteophytosis of the vertebral body, uncovertebral joints, and zygapophysial joints and to intervertebral disc protrusion, ossification of the posterior longitudinal ligament, and ligamentum flavum hypertrophy or buckling.Discussion: Various forms of spinal and intervertebral canal stenosis can cause compression of neurovascular structures that may, in turn, be responsible for symptomatology. Of course, autopsy findings cannot be equated with painful syndromes in patients.

Caudal cervical intervertebral disk disease in the small dog: role of distraction and stabilization in ventral slot decompression.

The clinical outcomes in 112 dogs weighing less than 35 pounds that were presented with cervical intervertebral disk protrusions were retrospectively evaluated. Although the second to third cervical (C2 to C3) intervertebral space was the most common site (27%) of disk protrusion, 57% of disk protrusions presented were caudal to the fourth cervical (C4) vertebra. Dogs with cranial intervertebral disk protrusions, including the C2 to C3 and C3 to C4 intervertebral disk spaces, responded favorably to ventral slot decompression. By comparison, caudal intervertebral disk protrusions (within the C4 to the seventh cervical [C7] intervertebral disk spaces) responded less favorably to ventral slot decompression, demonstrating significantly more severe clinical effects in motor function, comfort, recovery, and long-term outcome following surgery. Significant improvement in clinical results was seen in caudal disk protrusions when additional surgical distraction and stabilization were provided following ventral slot decompression.

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.