Prolapsed Intervertebral Disc Research Articles

Clinical correlation of Magnetic Resonance Imaging (MRI) with symptom complex in prolapsed intervertebral disc disease in the patients of Tertiary Care Hospital, Kharian.

Objective: To assess the clinical correlation of MRI with the symptoms of prolapsed intervertebral disc disease in the patients of Tertiary Care Hospital, Kharian. Study Design: Cross Sectional study. Setting: Tertiary Care Hospital, Kharian. Period: February 2022 to August 2022. Methods: The patients with age range 18 to 50 years, visiting hospital with complaint of low back pain and radicular pain were included in this study. Physical and neurological examination was conducted followed by MRI. The symptoms were correlated with MRI findings through correlation analysis with p<0.05 as significant. Results: The mean age was 38.09 ± 8.4 years with majority (54.6%) of patients in age range 41 to 50 years. The male patients (69.3%) and hard labor workers (59.3%) were more effected. Protrusion was the most prevalent type (60%). SLR was significantly associated with disc bulge and protrusion (p<0.001). The loss of power (56.6%) had significant correlation with disc protrusion (p < 0.001). Majority (55.3%) of the cases comprised of nerve root compression with more (47.3%) and significant prevalence in protrusion (p < 0.001). The multiple nerve root involvement had significant association with disc extrusion (p<0.001). Conclusion: MRI is a good means of indicating disease level in prolapsed intervertebral disc disease. However, some of the clinical symptoms show high association with the radiological findings, whereas, some are not good indicators.

Correlation Between Direction of Prolapsed Intervertebral Disc (PIVD) And Lumbar Vertebral Alignment

Abstract Purpose: The purpose of this research was to establish a link between direction of a prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment. Methods: This cross-sectional study included 102 participants with prolapsed intervertebral discs in the lumbar segment and lumbar vertebral mal-alignment of both sexes between the ages of 30 and 50 who had undergone MRI and X-ray for the lumbo-sacral spine. The Numerical Pain Rating Scale (NPRS) was used to assess outcome, MRI scans were used to determine the direction and amount of PIVD, and lumbar spinal alignment was assessed using X-rays in the AP and lateral views. SPSS version 26.0 was used for statistical analysis. Findings: Among the 102 participants, The study found that only 2.94% of 102 participants had Prolapsed Intracranial Disc Disease (PID) at the L1-2 level, with many on multiple levels. Prolapsed intervertebral discs were prevalent in 46.07% of individuals, with scoliosis in 33.33%, exaggerated lumbar lordosis in 4 subjects, and anterolisthesis in 20.59%. The study found a significant correlation between posterocentral and anterolisthesis, biforaminal and flatback, right paracentral and left paracentral prolapse and scoliosis (p<0.0001), with biforaminal direction being particularly significant for anterolisthesis and retrolisthesis (p=0.0050, 0.0014). The lumbosacral angle had a mean value of 31.79, and the mean of pain on rest was 1.99±1.38 and during activity was 5.51±1.66. Conclusion: It concluded that there was a significant relationship between the direction of prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment.

Cloward Procedure Outcome using Hashmi Cage for Anterior Cervical Discectomy and Fusion Experience in Pakistan

Abstract: Background: We aim to focus on ACDF patients treated with Hashimi cage filled with autologous bone. We will assess the safety of this approach based on the specific surgical level and its outcome. Objective: Study aims to evaluate the results of the Hashmi cage used in the Cloward Procedure while using odom’s based criteria for the outcome. Materials and Methods: This was a descriptive study researched at the Neuro Spinal Cancer Care Institute in Karachi, time duration from 16 June 2016 to 31 June 2022. The study included patients with a single-level prolapsed intervertebral cervical disc. During the surgery. Bony Fusion was assessed using movement ≤ 1 mm in flexion and extension cervical X-rays, was required. Result: We had 162 patients; among them males were 102 (62.96%) and female patient were 60 (37.03%). The median range for the age was from 23 to 63 years with mean 48 years ± 3.6 age. Clinically the patients presented with radiculopathy, commonly of the C6 level which was patients (63.73%). Odom’s based criteria were used to evaluate the results of the procedure. Among the patients, 92.84% showed excellent outcomes, 4.9% had good results, 1.8% had fair outcomes, and 1.23% had a poor outcome. Conclusion: ACDF with the Hashmi cage and plate application is a highly effective treatment option. This approach not only ensures better removal of the problematic discs but also significantly increases the likelihood of successful fusion and better radiological outcomes.

Acute Pain Management in Vatakaphaja Gridhrasi

Gridhrasi is one of the Vataja Nanatmaja Vyadhi in which the vitiated Vata afflicts the Kandara and Sira of lower limb leading to Stambha, Ruk, Toda along with Spandana starting from Kati Pradesha to Prustha, Janu, Jangha and Pada of either one side or both side of the lower limbs. Due to similarities in the clinical presentation, it can be studied under the spectrum of Intervertebral Disc Prolapse of lumbar spine. It is a condition affecting the spine in which the annulus fibrosus is damaged enabling nucleus pulposus to herniate, due to which there will be compression of Spinal Cord or the exiting nerve roots causing severe pain in the low back radiating to lower limbs. The incidence of Herniated disc is about 5 to 20 cases per 1000 adults annually and is most common in male patients when compared with female. In this case a male patient of age 36 suffering with acute pain in the low back region was effectively managed by Nadi Sweda followed by dry cupping for 7 days, followed by Patra Pinda Sweda for 7 days. The study shows significant relief in the pain and remarkable improvement in the range of movement of lumbar spine.

Comparison Between Clinical Findings and Magnetic Resonance Imaging Findings in Lumbar Prolapsed Intervertebral Disc

Introduction: Lumbar prolapsed intervertebral disc is commonly associated abnormality with lower backache. Disc herniation of same size can be asymptomatic in one patient and agonizing in another patient. Magnetic resonance imaging (MRI) is a gold standard diagnostic investigation for prolapsed intervertebral disc. Despite of high sensitivity sometimes MRI shows abnormal findings even in the asymptomatic individuals indicating a moderate relationship between MRI and symptoms in the patient. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse. Methodology: A descriptive cross-sectional study was conducted from 20 December 2021 to 15 September 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 078/78-009/HG). A convenience sampling method was used. The study consisted of patients with low back pain and radiation to lower extremity or patient with MRI scan of lumbar spine. Clinical and MRI findings were correlated to know the association and significance of MR findings in producing symptoms. Results: The study included 68 patients with back pain between 18 to 55 years (mean 41± 8.79 years). Neurological symptoms were present in 26 (38.23%) patients. Disc bulge in MRI was noticed in 48 (45.28%), protrusion in 46 (43.39%) and extrusion in 10 (11.32%) levels, most seen at L5-S1 level (66.11%). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.69), but not all disc bulges produced symptoms. Conclusion: Clinical features and Magnetic resonance imaging findings of disc prolapse had significant correlation similar to other studies done in a similar setting, but all imaging abnormalities may not have a clinical significance. Keywords: magnetic resonance imaging; intervertebral disc; prolapse; radiculopathy; correlation of data.

RELATIONSHIP BETWEEN THE RISK FACTORS AND LOWER BACK PAIN (LBP) AMONG LOCAL POPULATION OF KARACHI

Low back pain is a widespread issue affecting a significant portion of the population and is a leading cause of work-related absences. Approximately 80% of individuals experience low back pain at some point in their lives. This study involved a sample of 140 subjects selected from three universities. The research was observational, utilizing non-probability convenience sampling. The study comprised 140 patients primarily complaining of low back pain, with 42% attributing their symptoms to specific spinal injuries or lifting heavy objects, while 58% reported non-traumatic pain with a gradual onset. Among the patients, 54% experienced localized pain, while 46% had radiating pain. Magnetic Resonance Imaging (MRI) was conducted on all 140 patients, revealing that 48% suffered from Prolapsed Intervertebral Disc (PIVD), while the remaining 52% dealt with mechanical backaches, degenerative disorders, infective issues, and metabolic disorders. The affected vertebrae levels included L4-L5, L5-S1, L3-L4, and L2-L3. Surprisingly 98% had no awareness of their postural habits, therefore there is need to make the people aware about it.

Functional Outcomes and Successful Predictors of Lumbar Transforaminal Epidural Steroid Injections (LTFESIs) for Lumbar Radiculopathy Under Fluoroscopic Guidance: A Prospective Study.

Lumbar radiculopathy, a common and debilitating condition, often necessitates a multimodal approach for effective management. Lumbar transforaminal epidural steroid injection (LTFESI) has emerged as a valuable therapeutic option when conservative measures fall short. Recent interest in long-acting and non-particulate steroids prompts a critical examination of their impact on LTFESI outcomes. This prospective study aims to evaluate the efficacy of LTFESI in improving pain and functional outcomes in patients with lumbar radiculopathy, focusing on long-acting and non-particulate steroids, and analyse the associated economic burden. The study, conducted from October 2017 to April 2019, involved 52 patients with lumbar radiculopathy meeting specific criteria. LTFESI was administered using a hospital-based prospective design. Functional outcomes were assessed using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) scores at various intervals. Statistical analyses were performed to identify predictors of successful outcomes. Participants (average age 43.22 years, 27 (51.92%) male) exhibited diverse Michigan State University (MSU) grade profiles and predominantly had pathology at the L4-5 level. The study demonstrated a significant and lasting functional improvement in 43 (82.69%) of patients after LTFESI. Patients with 2AB-type intervertebral disc prolapse (IVDP) showed lower response rates, emphasizing subtype influence. The efficacy of LTFESI was sustained for up to six months in almost 82.69% of patients, highlighting its potential for long-lasting benefits. The difference in the mean ODI score pre-injection and six months post-injection is statistically significant (p<0.0001). A total of four patients (7.69%) underwent surgical treatment for lumbar radiculopathy as their symptoms did not improve after injection. For all four patients (7.69%), surgery was done one month after injection. Five patients (9.61%) had ODI scores of more than 40, indicating severe disability at the end of six months. So, in nine patients (17.3%), the injection given was not effective at the end of six months, four (7.69%) of whom were operated on and five (9.61%) patients received conservative treatment. Thus, 43 (82.69%) of patients had a good outcome. The study reinforces LTFESI as an effective and safe intervention, providing substantial and lasting benefits for lumbar radiculopathy. The majority experienced immediate relief, supporting its role as an intermediate option between conservative management and surgery. Identified predictors of decreased success underscore the importance of early intervention and tailored treatment plans. The study emphasizes LTFESI's diagnostic and therapeutic potential, with economic benefits and safety highlighted. LTFESI emerges as a safe and effective intervention for lumbar radiculopathy, offering substantial and enduring pain relief. The study contributes valuable insights into the nuanced outcomes of LTFESI, including the impact of IVDP subtypes, factors influencing success, and the procedure's cost-effectiveness. While acknowledging limitations, this work adds to the growing evidence supporting LTFESI as a crucial component in the management of lumbar radiculopathy.

ULTRASONOGRAPHY AS AN INTRAOPERATIVE TOOL FOR LOCALIZATION OF THE ANATOMICAL LEVEL IN LUMBOSACRAL SPINE SURGERIES

Aims and Objectives: The aims and objectives of the study are to find the effectiveness of ultrasound as a pre-operative adjunct to localize the anatomical intervertebral level of interest and study its accuracy by comparing it with the gold standard intra-operative fluoroscopy and to study factors affecting localization of anatomical vertebral level by ultrasound. Methods: This was a prospective study conducted in the Department of Neurology Department of Neurosurgery and Neuroimaging and Interventional Radiology, NIMHANS Hospital, Bengaluru, over a period of 1 year. 50 cases of lumbosacral degenerative diseases were included in this study on the basis of pre-defined inclusion and exclusion criteria. All patients underwent ultrasonography of the lumbosacral spine followed by pre-operative X-ray of the lumbosacral spine using the C-ARM. The accuracy of good localization of the desired level of the lumbosacral spine by ultrasound as compared to X-ray was determined. p&lt;0.05 was taken as statistically significant. Results: There were 22 (44%) males and 28 (56%) females with a M: F ratio of 1:1.27. The mean age was 46.7±13.5 years. 46 (92%) cases were diagnosed with prolapsed intervertebral disc (PIVD) and 4 (8%) cases with Grade II spondylolisthesis radiologically. Good localization which constitutes exact localization, close upper, and close lower localization added up to 82% of the cases (41/50) and the rest 18% were tagged as poor localization (9/50). The accuracy of good localization in both the groups of PIVD and spondylolisthesis (listhesis) was 82.6% and 75%, respectively. Conclusion: Ultrasound can be used as an exceptionally good and accurate method of localizing the anatomical intervertebral level for patients undergoing various lumbosacral spinal surgeries.

Effect of Agnikarma with Kshoudra over Ankle and Foot in Sciatica due to L4-L5 Intervertebral Disc Prolapse

Sciatica is a syndrome characterized by pain radiating from the low back into the buttock and into the lower extremities along its posterior or lateral aspect and most commonly caused by prolapse of lumbar intervertebral disc. The term is also used to refer the pain anywhere along the course of sciatic nerve. Modern medical practice for sciatica includes oral NSAIDs, opioid and non-opioid analgesics, muscle relaxants, localized corticosteroid injections, physiotherapy and if the above measures fail finally surgery. Sciatica can be correlated with Gridhrasi mentioned under Vata vyadhi in Ayurvedic classics. Various treatment modalities like Snehana, Swedana, Vasthi etc are indicated in Gridharsi. These are very effective treatment procedures but take relatively a more time for pain relief. Agnikarma is very beneficial in painful conditions caused by Vata as it gives immediate relief of pain. Here the patient was treated with Agnikarma using Kshoudra over the tender spots of ankle and foot of affected lower limb. Outcome measures like pain, numbness, tenderness, SLR and ODI were assessed before treatment, after treatment, 7th day and on 14th day. The result showed that Agnikarma with Kshoudra done over ankle and foot gives immediate relief of pain and numbness of sciatica due to L4-L5 intervertebral disc prolapse.

Randomised control trial of epidural platelet rich plasma versus epidural steroids for low back pain

Background: Lower back pain (LBP) is a prevalent medical condition that frequently results in work-related disability and is one of the leading causes of missed workdays. Low back pain (LBP) struck 619 million people worldwide in 2020, and by 2050, it's predicted that there will be 843 million instances worldwide. 70 to 85% of people are predicted to suffer from LBP at some point of time in their lives. 90% of these people will experience multiple episodes, and an intervertebral disc prolapse accounts for a significant portion. Medications and lifestyle adjustments may be used as the first line of treatment. However, if the symptoms do not improve, minimally invasive procedures such as epidural steroid injection and epidural platelet-rich plasma injection may relieve the pain and lessen disability. We therefore aim to conduct a study to analyse the patient’s functional status and satisfaction after epidural platelet-rich plasma infiltration. Methods: Eligible patients with low back pain will be divided into two groups(Group A and Group B). Patients in group A will receive epidural steroid whereas Group B will receive epidural Platelet rich plasma. These patients will be monitored where visual analogue scale will be used to assess relief of pain before and after the procedure, Straight leg raising test will be used to understand the improvement of the patient clinically during examination pre and post procedure. Oswestry disability index will be used to compare the outcome in patient's day to day activities before and after the intervention. Patients will be evaluated with these methods pre-procedure and 1 hour after and later follow up evaluation will be done after 3 weeks and 3 months. The follow-up scores will be taken post one hour, three weeks and three months of the treatment. Protocol version: v1 dated 04/07/23 CTRI registration: REF/2023/06/068736 (12/06/2023)

Clinical and functional outcomes of open versus minimally invasive surgeries in single-level prolapsed intervertebral disc in lumbar region at tertiary care center: A prospective study

Background: Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Modern MIS techniques allow spine surgeons to achieve the same goals of open surgery while minimizing the collateral damage associated with the open approaches. Aims and Objectives: The aim of MIS is to do an efficient “Target Surgery” with a minimum of iatrogenic trauma. Materials and Methods: This is a prospective study done in the Department of Neurosurgery, JA group of hospitals, Gajra Raja Medical College, Gwalior, from July 2021 to July 2022. Study was conducted on 30 randomly selected patients whose presentation and imaging showed indication for surgery. Results: Better symptomatic relief was seen in patients with MIS at 7 days with about 80% of them having a visual analog scale score between 0 and 2; however, not much difference was noted at 1 month. Not much difference was noted for wound status, neurological improvement, and Oswestry Disability Index at 1 month. However, gross difference was noted at the rate of return to work by the patients with approximately 93.3% of patients undergoing MIS returning to work within 1 month in comparison to only 20% in case of open surgery. Conclusion: Minimally invasive techniques are remarkably better option to traditional open surgeries, as these procedures showed a significant reduction in immediate post-operative pain, duration of hospital stay, and return to work by the patient. However, not much difference was noted in status of pain at 1 month, rehospitalization, degree of disability at 1 month, wound status, and neurological improvement of the patient.

Ayurvedic management of Gridhrasi with special reference to Sciatica: A Case Study

Background: About 70% to 80% of people in India report having low back pain, making it one of the most prevalent complaints. The most frequent intervertebral disc prolapse among the many causes of low back pain is referred to leg, buttock, or hip which frequently outlines the characteristics of Sciatica syndrome. Sciatica is similar to Gridhrasi, one of the most prevalent Vata illnesses, according to Ayurveda. Aims &amp; Objectives: The purpose of this study was to evaluate the effectiveness of Ayurvedic treatment in Gridhrasi. Materials and Methods: Single case study of a 44-year-old married man who had been visiting an Ayurvedic hospital for Ghridrasi of the right leg for eight months had previously been diagnosed with a diffuse bulging of the L4-L5 intervertebral disc. He had one month of Panchakarma therapy, which included Abhyanaga Swedana, Patra Pinda Swedana, and Tila Pinda Swedana in combination with Shamana Chikitsa. Results: After a month, the patient's symptoms were assessed, and the outcomes were good. The patient's general quality of life had also greatly improved. Conclusion: The mentioned treatment reduces Gridhrasi symptoms significantly.

A case study of Ayurvedic management of Katishool with reference to Senile Osteoporosis induced compression fracture of vertebrae

Low bone mass and micro architecture bone tissue degeneration that can cause fractures is the hallmarks of osteoporosis. The development of disease is influenced by numerous etiological factors, including physical, hormonal, dietary, and lifestyle factors. Low back discomfort, or Katishool, is one of them. Low back discomfort can have many different causes, including compression fractures, intervertebral disc prolapse (IVDP), lumbar spondylosis, spine tuberculosis, etc. At some point in their life, 39% of people report having low back pain, with females between the ages of 40 and 80 experiencing the condition more frequently. The reason of significant low back pain is one of the vertebral compression fractures (VCF). It is comparable to Katishool in Ayurveda. The care of fractures in modern science includes reduction, immobilization of the broken area, use of NSIAD, calcium supplements, etc. Numerous native substances that can aid in the healing of the fracture have been described in ancient treatises. In this instance, Ayurvedic treatments like Vijaya Extract, medicines and Kati Abhyangam are used to treat lower back pain.

Reabsorption of intervertebral disc prolapse after conservative treatment with traditional Chinese medicine: A case report

Conservative treatments have been reported to diminish or resolve clinical symptoms of lumbar intervertebral disc herniation (LIDH) within a few weeks. Computed tomography and magnetic resonance imaging (MRI) of the lumbar region of a 25-year-old male diagnosed with LIDH showed prolapse of the L5/S2 disc. The disc extended 1.0 cm beyond the vertebral edge and hung along the posterior vertebral edge. The patient elected a conservative treatment regimen that included traditional Chinese medicine (TCM), acupuncture, and massage. During a follow-up period of more than 12 mo, good improvement in pain was reported without complications. MRI of the lumbar region after 12 mo showed obvious reabsorption of the herniation. A conservative treatment regimen of TCM, acupuncture, and massage promoted reabsorption of a prolapsed disc.

EVALUATION OF THERAPEUTIC EFFICACY OF TRANSFORAMINAL EPIDURAL STEROID INJECTION AND SUBPEDICULAR STEROID INJECTION IN PATIENTS WITH PROLAPSED INTERVERTEBRAL DISC (PIVD) WITH CORRESPONDING LEVEL RADICULOPATHY.

Background: Lumber prolapsed intervertebral disc induce radiating pain in lower limbs, for which epidural steroid injection is one of the safe and effective therapeutic option. This prospective study compares the results of 2 different techniques of transforaminal epidural steroid injection (TFESI) and subpedicular steroid injection in patients with prolapsed intervertebral disc (PIVD) in relieving lumbar radicular pain. Methods: Records of 80 patients who had undergone transforaminal and subpedicular epidural steroid injection for lumbar radicular pain were analyzed. Visual analogue scale (VAS) score were measured at before procedure and at 4th day post procedure and 2, 4, 6 and 24 weeks thereafter and straight leg raise test (SLRT) were measured before procedure, 4th day and 4 week post procedure. Results:At 24 weeks, the VAS was signicantly lower than the baseline in both groups; VAS in the TFESI group was signicantly lower than VAS in the subpedicular group at 6 and 24 weeks. SLRT score was signicantly higher in the TFESI group and subpedicular ESI group through the 4-week time point (P= 0.0021 at 4th day; P= 0.0001 at 4 weeks). At the end of 24 weeks, a signicantly greater number of patients in the TFESI group and subpedicular ESI showed difference In VAS (P = 0.0003). Conclusions: At the end of 24 weeks, TFESI appears to be a superior technique in relieving lumbar radicular pain in PIVD patients and could be an alternative to the subpedicular approach in severe spinal canal stenosis when it is hard to place the needle in the anterior epidural space through the safe triangle.

Research on the Medical Knowledge Deduction Based on the Semantic Relevance of Electronic Medical Record

This paper studies the extraction of information from unstructured text data of medical literature and electronic medical records in the field of medicine, and proposes a TCM-KR method of knowledge reasoning based on electronic medical records to enhance association rules, and carries out a study on association characteristics in the field of the electronic medical record. This method abstracts the word bag representation mode of text semantics from the unstructured data representation and integrates the correlation information of the knowledge graph of the medicine domain. The method based on a graph convolutional network was used to predict the unknown associations' relations between viscera, channel tropism, and channel distribution. The experimental results show that the TCM-KR method can efficiently infer a large amount of high-quality triple knowledge from the unstructured text data of medicine, and predict the correlation characteristics of Syndromes-Viscera, Chinese medicinal-Channel tropism, Acupoints-Channel distribution in treating lumbar intervertebral disc prolapse and provide a dedicated machine learning model and guidance for clinical diagnosis and treatment.

A Case report on Spondylolisthesis associated with Inter Vertebral Disc Prolapse

Spondylolisthesis is the most common type of spinal disease which in advance cases requires surgical intervention. It is also known as ‘slipped disc’. It occurs when there is ‘slipage’ of vertebral body above on the vertebral body below. It causes instability and neural compression due to repetitive micro traumas which leads to absent pars interarticularis due to which an additional stress is applied to the facet joints causing advanced degeneration of the disc space. The associated symptoms are muscle spasms in hamstring, numbness and weakness in the foot, difficulty in standing or walking for longer period and back stiffness. Also L4-L5 spondylolisthesis is associated with caudal segment (L5-S1) degeneration which is mostly seen in elderly patients. Early diagnosis and treatment may benefit the patients’ quality of life. The selection of spinal stabilization exercise will be very helpful and safe after the surgery for better recovery in older patients. In this case study, we discussed the case report of patient who has under gone surgical treatment.

Spontaneous regression of a traumatic cervical prolapsed intervertebral disc with myelopathy

We report the case of a 60-year-old male, who presented to us with a 6-month-old quadriparesis (upper limbs 3/5; lower limbs 0/5), secondary to a posttraumatic C5-C6/C6-C7 prolapsed intervertebral disc (PIVD), and a D4-D5 fracture-dislocation, resulting in a physiological dorsal cord transection. The patient had been managed conservatively outside. In view of the insignificant neurological recovery over the past 6 months, the patient consulted for a second opinion. At the time, the patient also had an infected decubitus ulcer. Due to the significant thecal compression at the C5-C6 level, and the partial improvement in upper limbs power, we suspected a possible ongoing dynamic cord injury. The patient was planned for an anterior cervical discectomy and fusion at the C5-C6 level once the decubitus ulcer was managed. After a month, with the patient's pressure sore healed, a repeat magnetic resonance imaging cervico-dorsal spine showed a near-complete spontaneous regression of the C5-C6 PIVD.

A rare case of priapism secondary to intervertebral disc prolapse: Case report and literature review

A rare case of priapism secondary to intervertebral disc prolapse: Case report and literature review

Efficacy of homoeopathic medicine in treating intervertebral disc prolapse with administration of Bryonia ALB 200 potency

Efficacy of homoeopathic medicine in treating intervertebral disc prolapse with administration of Bryonia ALB 200 potency