Posterolateral Disc Herniation Research Articles

Effect of cervical spine motion on displacement of posterolateral annulus fibrosus in cervical spondylotic radiculopathy with contained posterolateral disc herniation: a three-dimensional finite element analysis

BackgroundPrevious studies on dynamic impingement of nerve root in cervical spondylotic radiculopathy (CSR) have focused on effect of cervical spine motion (CSM) on dimensional changes of intervertebral foramen. However, there are few studies to investigate effect of CSM on displacement of posterolateral intervertebral disc until now. The present study aimed to investigate effect of CSM on displacement of posterolateral annulus fibrosus (AF) in CSR with contained posterolateral disc herniation.MethodsA C5–C6 CSR finite element model with unilateral contained posterolateral disc herniation was generated based on validated C5–C6 normal finite element model. Forward and backward displacement distributions of posterolateral AFs in CSR model and normal model were compared. Changes in forward and backward displacement magnitudes of posterolateral AFs of the herniated side and the healthy side in CSR model, with respect to those of the ipsilateral posterolateral AFs in normal model, were compared. The comparisons were performed under flexion, extension, lateral bendings and axial rotations.ResultsThere was no difference in deformation trend of posterolateral AF between CSR model and normal model. Bilateral posterolateral AFs mainly moved forward during flexion and backward during extension. Left posterolateral AF mainly moved backward and right posterolateral AF forward during left lateral bending and left axial rotation. Left posterolateral AF mainly moved forward and right posterolateral AF backward during right lateral bending and right axial rotation. However, with respect to forward and backward displacement magnitudes of the ipsilateral posterolateral AFs in normal model, those of the herniated side increased relatively significantly compared with those of the healthy side in CSR model.ConclusionsFlexion, lateral bending to the healthy side and axial rotation to the healthy side make posterolateral AF of the herniated side mainly move forward, whereas extension, lateral bending to the herniated side and axial rotation to the herniated side make it mainly move backward. These data may help select CSM or positions to diagnose and treat CSR with contained posterolateral disc herniation. Increase in deformation amplitude of posterolateral AF of the herniated side may also be the reason for dynamic impingement of nerve root in CSR with contained posterolateral disc herniation.

CLINICO- MRI PROFILE OF LUMBAR DISC HERNIATION ON SCIATIC LUMBAR PAIN IN BI-RIVER HOSPITAL SETTINGS (CASES OF KINSHASA AND BRAZZAVILLE)

I. Objective: to highlight the clinico-MRI prole of lumbar disc herniation on sciatic lumboradiculgia in bi- river hospital settings (cases of Kinshasa and Brazzaville). This was aII. Materials and methods: retrospective, documentary and multicenter study of 302 patients who performed lumbar MRI examinations in 18 months in hospitals in Kinshasa and Brazzaville. The mean age of patients was 53.4 years. The most represented age groupIII. Results: was 50 to 59 years old. The female sex was predominant (55.4%) with a ratio of 0.79. The majority of patients (68.2%) came from Kinshasa. Lumboradiculalgia was the most predominant indication with (49.3%), followed by low back pain (48%). The majority of MRI examinations (91.4%) were performed without injection of contrast product. T1 and T2 weightings were performed in 100% of patients. Diseased disc degeneration was found at (41.7%) and lumbar disc herniation at (27.2%). The MRI examination was normal in (47%) of the patients. Based on potentially clinically positive relevance, only 48.7% of our MRI diagnoses were clinically positive. Age (p=0.000), lumboradiculalgia (p=0.000) and specialist physician prescription (0.039) had a statistically signicant relationship with clinically positive diagnosis. HDL is a pathological reality in the hospitals ofIV. Conclusion: Kinshasa and Brazzaville. The MRI prole found mainly corroborates the observations of the literature. Lumbar disc herniation and degenerative disc disease remain the most frequently encountered pathologies on magnetic resonance imaging in hospitals in Kinshasa and Brazzaville. They are at the origin of the lumbar spinal syndrome and affect the young population. The posterolateral disc herniation remains the most frequently encountered subtype with predominance of damage to the oors: L4-L5 and L5-S1.

Statistical morphological analysis reveals characteristic paraspinal muscle asymmetry in unilateral lumbar disc herniation

Growing evidence suggests an association of lumbar paraspinal muscle morphology with low back pain (LBP) and lumbar pathologies. Unilateral spinal disorders provide unique models to study this association, with implications for diagnosis, prognosis, and management. Statistical shape analysis is a technique that can identify signature shape variations related to phenotypes but has never been employed in studying paraspinal muscle morphology. We present the first investigation using this technique to reveal disease-related paraspinal muscle asymmetry, using MRIs of patients with a single posterolateral disc herniation at the L5-S1 spinal level and unilateral leg pain. Statistical shape analysis was conducted to reveal disease- and phenotype-related morphological variations in the multifidus and erector spinae muscles at the level of herniation and the one below. With the analysis, shape variations associated with disc herniation were identified in the multifidus on the painful side at the level below the pathology while no pathology-related asymmetry in cross-sectional area (CSA) and fatty infiltration was found in either muscle. The results demonstrate higher sensitivity and spatial specificity for the technique than typical CSA and fatty infiltration measures. Statistical shape analysis holds promise in studying paraspinal muscle morphology to improve our understanding of LBP and various lumbar pathologies.

CT-Guided Posterolateral Full-Endoscopic Ventral Decompression for Single-Level Cervical Spondylotic Myelopathy

Percutaneous full-endoscopic surgery was recently developed for the treatment of cervical foraminal stenosis and posterolateral disc herniation. However, there are no studies involving endoscopic surgery to treat cervical spondylotic myelopathy (CSM). To observe the safety, feasibility, and efficacy of posterolateral full-endoscopic ventral decompression (PLEVD) via computed tomography (CT)-guided surgery in patients with single-level CSM. A prospective cohort study. The First Affiliated Hospital of Gannan Medical College. From May 2018 to August 2019, 21 patients with single-level CSM underwent CT-guided PLEVD. The posterolateral angle was measured during surgery. The neurologic condition was evaluated via the Japanese Orthopaedic Association (JOA) score and recovery rate, and a Visual Analog Scale (VAS) was used to measure pain relief. The maximum spinal canal diameter (MSCD) was measured on pre- and postoperative CT images. The mean length of follow-up was 11.3 ± 5.3 months. The average posterolateral angle was 36.0° ± 5.6°. The mean VAS score of limbs significantly decreased after surgery. The mean JOA score improved during the follow-up period. Nineteen of the 21 patients achieved good or excellent outcomes, and 2 patients had fair outcomes according to the JOA score 6 months after surgery. The average MSCD was enlarged from 0.55 ± 0.15 cm preoperatively to 1.02 ± 0.18 cm postoperatively. This study was nonrandomized and provides only preliminary clinical results for single-level CSM. Under appropriate indications, PLEVD under CT guidance is an available and safe technique for treating single-level CSM.

Demographic profile of the patients with lumbar disc herniation presented in a tertiary care center, Manipur

Background: Lumbar intervertebral disc herniation presents with a wide variety of demographic profiles among the patients of various regions. Depending on the regional factors such as environmental, socioeconomic and genetic factors, the demography may vary. Objectives: This study aimed to observe the demographic profile of patients with lumbar disc herniation and to find the association and correlation among the different variables. Materials and Methods: It is a cross-sectional study. Descriptive analysis was performed for parameters such as age, weight, height, and body mass index (BMI). Chi-square test was performed to see the association of different variables. A Spearman's regression analysis was performed to see any correlation between the quantitative variables. Results were evaluated with a confidence interval of 95% and significance level at P Results: We had 348 patients with a mean age of 52.49 (±13.34) years, out of which 194 (55.7%) were female. Visual analog scale score ≥7 was found in 194 (55.7%) patients. Of the patients, 228 (65.5%) were overweight and 40 (11.5%) were obese with a mean BMI of 26.99 (±2.61). In the physical activity, 159 (45.7%) fall in heavy group, 135 (38.8%) moderate, and 54 (15.5%) in light activity groups. L4L5 (183, 52.6%) and L5S1 (133, 38.2%) were the most common site of prolapsed. Grade 6 disc degeneration was the most common (101, 29.0%) followed by Grade 7 (96, 27.6%) and Grade 5 (77, 22.1%). 2ab was the most common pattern of prolapsed with 22.4%. Conclusion: Disc herniation is more common among females and in the middle age group. Overweight or obese people are at more risk of disc degeneration. L4L5 and L5S1 are the most common level of prolapse. Grades 6 and 7 of disc degeneration are more symptomatic and are associated with advancing age. Posterolateral disc herniation is the most common type and people engaged with heavy physical activities are at higher risk of disc degeneration.

Radiosurgical Occurrence of Lumbar Disc Herniation Operated in Kinshasa / DRC

<i>Lumbar disc herniation (HDL) is a major public health problem in the world. Objectives: </i>The study aimed to determine the clinical and radiological aspects of the lumbar disc herniation [LDH] operated in Kinshasa environments Hospital. <i>Materials and methods: </i>It was a well-documented 160 cases of LDH operated in Biamba Marie Mutombo hospital from January 2012 until December 2016 was evaluated. <i>Results: </i>The most interesting age group range from 31 to 50 years (68, 8%) with a mean age of 44, 7 ± 12, 3 years in that Females were the most affected with 55.6%. Sciatica L5 was found in 28.8% of cases compared to sciatica S1 (15.6%) and left lateralization in 48, 1%. As for imaging results, the posterolateral type was the most common with 53.8% of cases. The disc level: L4-L5 was the most affected in 61.1% of cases. The single LDH was the most common. The discrepancy between imaging and surgery results was 6.3% for medial herniated discs and 24.4% for posterolateral disc herniation. Conclusion: LDH is a pathological reality in hospitals of Kinshasa. The aspects found mainly corroborate literature observations. The discrepancy between imaging and surgery results was statistically insignificant.

Functional outcome of fenestration discectomy in discogenic lumbar canal stenosis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Annual incidence of significant disc herniation causing sciatica ranges from 14% to 15%. Inspite of various treatment modalities available, fenestration discectomy still remain treatment of choice for discogenic lumbar canal stenosis. The objective of our study is to assess functional outcome and complications associated with fenestration discectomy in patients of discogenic lumbar canal stenosis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Thirty two patients who had unilateral radicular pain with clinicoradiologically confirmed posterolateral disc herniation and who failed to respond to conservative management were treated surgically by fenestration discectomy. Outcome was assessed using Oswestry disability index at 6 months follow up.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Patients with neurological deficits underwent fenestration discectomy with complete relief of radicular pain in 17 patients and mild reduction in 5 patients on follow up. 23 patients had recovery from motor symptoms and 25 patients had recovery from sensory symptoms whereas 9 patients still had motor weakness and 7 patients still had sensory deficit. Oswestry disability index (ODI) score used for functional outcome at 6 months postoperatively showed 63% of the patients were having 0 to 20 ODI score with minimal disability, 34% of the patients had score of 21 to 40% with moderate disability, and 3% were having 41 to 60% ODI score with severe disability. One patient had dural tear and two patients had post-operative discitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Fenestration discectomy is an excellent surgical option for discogenic lumbar canal stenosis. Fenestration discectomy is an easy, economical and effective means of treating lumbar disc prolapse with minimal acceptable complications.&lt;/p&gt;

Proposal of a new anatomical landmark to identify the disc space in endoscopic lumbar discectomy.

Introduction:In endoscopic lumbar discectomy for posterolateral disc herniation, we determined some anatomical landmarks for improved disc space access. These landmarks are based on the beginning of the insertion of the ligamentum flavum (LF) to vertebral lamina.Materials and Methods:In 978 patients operated by posterolateral disc herniation, we measured prospectively the distance between the beginning of the insertion of the LF and space disc rostrally.Results:The distance between the beginning of the insertion of the LF and space disc was broader at the level of L3–L4, with an average of 14 mm. At L4–L5, the average distance was 13.5. At L5–S1, the average distance was 12 mm.Conclusion:Knowing the accurate distance between the insertion of LF and disc space contributes to reducing the average duration of the surgical procedure to avoid empirical search of disc space by a surgeon and avoiding unnecessary and excessive LF and bone removal.

Microsurgical Anterior Cervical Foraminotomy (Uncoforaminotomy) for the Treatment of Compressive Radiculopathy

Cervical radiculopathy is typically caused because of posterolateral disc herniation or spondylotic foraminal stenosis. Most of the times, either direct anterior excision necessitating fusion or indirect posterior decompression is used as a standard surgical treatment for the same. However, anterior decompression has been used widely. Different techniques can be used. The authors report the clinical application of a new microsurgical technique. The cervical anterior foraminotomy (uncoforaminotomy), which is used for the surgical treatment of unilateral cervical radiculopathy secondary to posterolateral disc herniations or spondylotic foraminal stenoses.

Relative Risk of Operation between Lumbar Far Lateral Disc Herniation and Posterolateral Disc Herniation: A Retrospective Cohort Study

Relative Risk of Operation between Lumbar Far Lateral Disc Herniation and Posterolateral Disc Herniation: A Retrospective Cohort Study

A multicenter, prospective, randomized study protocol to demonstrate the superiority of a bone-anchored prosthesis for anular closure used in conjunction with limited discectomy to limited discectomy alone for primary lumbar disc herniation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Same-level reherniation and progressive degeneration with disc height loss are main causes of poor outcome after discectomy and may necessitate reoperation. A novel prosthesis for anular closure was developed to address these causes.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The design of a multicenter, prospective, randomized, post-market superiority trial comparing limited lumbar discectomy augmented with this device (intervention group) with limited lumbar discectomy alone (control group) is presented.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Patients with single-level (L1-S1) posterior or posterolateral disc herniation and radiologic confirmation of neural compression for whom at least six weeks of conservative treatment has failed are eligible. Patients must have posterior disc height ≥5 mm at index level and baseline Oswestry and VAS leg pain scores of ≥40/100. Intraoperatively, subjects meeting anular defect size criteria post-discectomy (4-6 mm tall and 6-10 mm wide) will be randomized to study groups in a 1:1 ratio using centralized, web-based software. A Bayesian statistical approach will be used to enroll 400 to 800 subjects who will be followed for at least 24 months. Two co-primary endpoints will be assessed at 24 months: 1) a composite of leg pain, clinical function, disc height maintenance, and absence of reherniation, reoperation, and device failure; and 2) absence of reherniation based upon independent radiologic analysis. &lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This type of analysis is becoming increasingly important as governments and health insurers continue to be pressured to spend limited healthcare funding wisely.

The relationship between pain and functional disability with morphological changes of psoas major in discogenic low back pain patients

Background/Aims: The psoas major muscle acts not only as a spine flexor, but also as a spine stabiliser. This study was conducted to investigate correlations between pain level and functional disability with morphological changes of the psoas major muscle in chronic low back pain patients with disc herniation. Method: Chronic low back pain patients with disc herniation were examined with routine lumbar MRI. An observational study was carried out using a convenience sample of 30 patients (mean age of 43.6 ± 6.8 years) of chronic low back pain with lumbar posterolateral disc herniation at L4–L5. Outcome measures included pain level, functional disability (ODI score), cross-sectional area, and fatty infiltration of psoas major muscle ipsilateral to the side of disc herniation. Results: There were significant correlations between functional disability with the cross-sectional areas and fatty infiltration of the psoas major muscle (r=-0.42, P=0.02) and (r=0.55, P=0.002) respectively. There was a significant correlation between pain level and fatty infiltration but not in the cross-sectional area of the psoas major muscle (r=0.44, P=0.015) and (r=-0.288, P=0.123) respectively. Linear regression analysis indicated that increasing the fatty infiltration grade by one unit leads to increasing functional disabilities and pain score by 7.3 and 0.8, respectively. Conclusions: Functional disability was correlated with the cross-sectional areas and fatty infiltration of the psoas major muscle, however pain showed a positive relationship with fatty infiltration only. The fatty infiltration of the psoas major muscle might be used as a good predictor for functional performance and pain level in chronic low back pain patients with disc herniation.

Microscopic tubular discectomy for far lateral lumbar disc herniation

Microscopic tubular discectomy (MTD) reduces muscle trauma associated with treatment of far lateral lumbar disc herniation (FLDH), but data from randomised controlled studies concerning its efficacy on posterolateral disc herniation, has failed to demonstrate its superiority over standard open techniques. Importantly concerns have been raised that it may be inferior in terms of relief of leg and back pain. Although several FLDH series show that MTD can deliver excellent outcomes, the volume of literature in this field has remained small and evidence based on health-related quality of life (HRQOL) measures, scarce. In this study we therefore evaluated the role of MTD for FLDH through analysing multiple HRQOL scores collected in a prospective database. We identified 24 patients who underwent MTD through a caudal approach, targeting directly the disc space to minimise traction on the dorsal root ganglion implicated in causing iatrogenic neuralgia. With a mean follow-up of 9.2months, the improvement in Oswestry Disability Index and Short Form 36 physical functioning and bodily pain scores was 32, (95% confidence interval [CI]: 21–43), 40 (95% CI: 30–51) and 35 (95% CI: 26–43) respectively. The improvement on the Visual Analogue Scale was 38mm (95% CI: 23–54) and 35mm (95% CI: 21–48) for leg pain and back pain respectively. There was no postoperative neuralgia noted and no reoperation required. Our data demonstrated clinically meaningful treatment effects and compare favourably with HRQOL surgical outcomes established for posterolateral disc herniation, supporting MTD as a valid treatment option for FLDH.

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

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.

Categorization of Pathology Causing Low Back Pain using Magnetic Resonance Imaging (MRI).

Low backache is the most common ailment flooding the orthopaedic clinic. Most of the population at least once seek medical attention for low back ache. Magnetic Resonance Imaging (MRI) is a non invasive, commonly used diagnosing modality and accurate in diagnosing pathology causing low back ache. To classify and quantify the causes of low back pain referred to radiology department by MRI. Patients with back pain referred to radiology department were subjected to single MRI scan after ruling out any contraindications using the following sequences: T1W Turbo Spin Echo, T2W Turbo Spin Echo, Gradient-echo, Myelogram and short TI inversion recovery (STIR), in all imaging planes. Gadolinium enhanced T1W turbo spin echo sequence was used wherever necessary. Data were analysed using Excel 2007, SPSS 14, Students t-test. Degenerative disc diseases were the commonest pathology followed by congenital and traumatic lesions. Neoplastic lesions were the least common. Commonest herniation type being the disc bulge (79%) followed by disc protrusion (15%), disc extrusion (6%) and disc sequestration (<1%). The posterolateral disc herniation as the commonest and foraminal the least. Sacralisation was the most common congenital spinal anomaly, followed by lumbar scoliosis and perineural cyst. There is no sex difference in disc protrusion but male preponderance in disc extrusion with subligmentous extrusion. MRI is useful in classifying the spinal lesions which again influences the treatment modality and clinical outcome. Degenerative disc disease is the single most common category which accounts for most the Low Back Ache for which a preventing strategy should be drafted.

The Sedimentation Sign for Differential Diagnosis of Lumbar Spinal Stenosis

Cross-sectional cohort study. To evaluate the diagnostic value of the sedimentation sign further by assessing its performance on the differential diagnosis of patients with lumbar spinal stenosis (LSS) and other lumbar conditions with similar clinical presentations. Recently, a new test using MR imaging, the sedimentation sign, was introduced to aid in the diagnosis of LSS. The initial testing demonstrated that the sign was positive in 100% of patients with LSS with decreased walking ability and dural sac cross-sectional areas (CSA) less than 80 mm, and negative in 94% of patients with nonspecific low back pain, no leg pain or claudication and dural sac CSA greater than 120 mm. Fifty patients with central or combined LSS, 22 with lateral stenosis only and 43 with posterolateral disc herniation with unilateral radiculopathy were included. Using axial MR images of the lumbar spine, the sedimentation sign was assessed by 2 observers independently, without knowledge of participant clinical history or diagnosis. Frequencies of a positive sign in each patient group were calculated. The sedimentation sign was positive in 2% of patients with disc herniation, 23% with lateral stenosis, and 54% with central or combined stenosis. When the analysis included only patients with LSS with dural sac CSA less than 80 mm and walking limitations similar to the original study introducing the sedimentation sign (n = 17), the proportion of patients presenting with a positive sign increased to 82%. The sedimentation sign is more prevalent in patients with the clinical diagnosis of central or combined LSS than in patients with lateral stenosis only or posterolateral disc herniation. Yet, whether it enhances current diagnostic practices remains undetermined.

Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology?

Several reports suggest that level- and side-specific multifidus atrophy or fat infiltration may be related to localized spinal pathology and symptoms. In particular, a study using a porcine model reported rapid level- and side-specific multifidus atrophy and adipocyte enlargement resulting from anterolateral disc or nerve root lesions. To investigate asymmetry in cross-sectional area (CSA) and fat infiltration in multifidus and other paraspinal muscles in patients with acute or subacute unilateral symptoms of radiculopathy and concordant posterolateral disc herniation. If multifidus asymmetry is indeed related to local pathology, this may serve as a marker for helping to target the search for less clearly identifiable pathology responsible for low back-related symptoms, which currently remains elusive in approximately 85% of those seeking care. Cross-sectional observational study. Subjects were patients referred to magnetic resonance imaging (MRI) with unilateral leg symptoms of less than 6 weeks onset suggestive of radiculopathy, with a consistent posterolateral lumbar disc herniation verified on imaging. Using T2-weighted axial MRI, measurements were obtained for total muscle CSA and signal intensity, functional (fat-free) CSA, and the ratio of functional CSA to total CSA. Forty-three subjects met the inclusion criteria. The ratio of functional CSA to total muscle CSA was smaller on the side of the herniation than on the unaffected side, both below (mean 0.69 vs. 0.72, p=.007) and at the level of herniation (mean 0.78 vs. 0.80, p=.031). Multifidus signal intensity (fat infiltration) was greater on the side of the herniation at the level below the herniation (p=.014). Contrary to expectation, greater total multifidus CSA was found ipsilateral to the pathology at the level of herniation (p=.033). No asymmetries were found at the level above the herniation or in any other paraspinal muscles, with the exception of higher signal in the erector spinae at the level and side of herniation. Multifidus may be particularly responsive to, or indicative of, localized lumbar disc or nerve root pathology within the first 6 weeks of symptoms as expressed through fat infiltration, but not through CSA asymmetry on MRI. However, such measurements are not reliable markers of lumbar pathology on an individual basis for use in clinical or research settings.

Effects of Lumbar Stabilization Exercise in Management of Pain and Restoration of Function in Patients with Postero Lateral Disc Herniation

Objective: Objective of this study was to assess the effectiveness of lumbar stabilization exercise in mana-gement of pain and restoration of function in patients with postero lateral disc herniation. Methodology: In this randomized controlled trial 100 patients were taken. Using non-probability conveni-ence sampling patients were divided into 2 groups, i.e. In Group A – patients were managed with lumbar sta-bilization exercises and in Group B patients were man-aged with conventional physical therapy. Final assess-ment was based on the following Oswestry scale. Results: Mean age of patients in Group – A was 35.66 ± 6.34 years and in Group-B mean age was 37.96 ± 4.25 years. Before treatment total assessment score in Group – A and in Group – B was 16.13 ± 3.42 and 18.80 ± 3.06. After treatment total assessment score in Group – A and in Group – B was 6.90 ± 2.68 and 13.53 ± 3.07 respectively. According to p-value significant difference was present in both groups. i.e. (p-value = 0.000). Conclusion: The Lumbar Stabilization exercises pro-vide significantly better results compared with conven-tional physical therapy regimen in patients with disc herniation. Lumber stabilization exercises were safe and easy to perform. Keywords: Postero lateral disc herniation, lumbar stabilization, conventional physical therapy.

Lumbar Disc Herniation in Tae Kwon Do Athletic Child

Lumbar disc herniation is extremely uncommon in children below 10 years of age. A 7-year-old boy is reported who presented with low back pain and left leg radiating pain. The pain started seven days prior to presentation and was attributed to performing the jumping kick without any previous warm-up. Magnetic resonance imaging revealed a posterolateral disc herniation at the L3-4 level and multiple degenerative changes. The patient received conservative treatment including limitation of sports activities, anti-inflammatory and muscle relaxant medications as well as physical therapy. After three months of the aggressive treatment the child was symptom free. We present here a lumbar disc herniation in one of the youngest patient.

Foraminal Stenosis With Radiculopathy From a Cervical Disc Herniation in a 33-Year-Old Man Treated With Flexion Distraction Decompression Manipulation

Objective The purpose of this report was to describe the use of Cox flexion distraction decompression manipulation on a patient with radiculopathy from a C6/C7 disc herniation. Clinical Features A 33-year-old man complained of severe neck pain and spasms, pain radiating down his left arm and upper back, and associated numbness in his fingers. Cervical spine plain film radiographs showed mild C6/C7 osseous degenerative changes. Cervical magnetic resonance imaging revealed a moderate-sized left posterolateral disc herniation at C6/C7 causing severe foraminal stenosis. Intervention and Outcome Treatment consisted of Cox flexion distraction decompression manipulation and adjunctive physiotherapy modalities. The patient was treated a total of 15 times over a period of 10 weeks. Subjective findings using a pain scale and objective examination findings supported a good clinical outcome. At 2-year follow-up, subjective and objective findings remained stable. Conclusion This study reports Cox flexion distraction decompression manipulation and physiotherapy modalities showed good subjective and objective clinical outcomes for this patient.