[Multiple calcification of the intervertebral disks].
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The cause of restricted intervertebral mobility, or joint fixation, has generated much speculation. A number of etiologies have been proposed in the literature by authors addressing this question. The four possible theories that merit further investigation include meniscoid entrapment, displaced intervertebral disc fragments, segmental or intersegmental muscle spasm and periarticular connective tissue adhesions. The two questions to be addressed for each theory are how does each mechanism acutely restrict intervertebral joint movement and how does a high-velocity manipulation restore movement and relieve symptoms? The pros and cons of each theory are presented, citing the relevant literature. In addition, research possibilities to further investigate each mechanism are presented.
Herniated thoracic discs are rare. Many cases present with local radicular or cord symptoms. We describe a case which became symptomatic by a unilateral paresis of the muscles of the abdominal wall. This radicular syndrome has only been described for lumbar disc herniations before. The differential diagnosis is discussed as well as the importance of myelography and the value of Myelo-CT.
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Flexion and extension movements or positions have been advocated in the treatment of various forms of low back dysfunction due to the potential pain relieving effects attributed to displacements of the intervertebral disc (IVD). Objective in vivo determination of the segmental behaviour of the disc to contrasting positions has until recently been difficult. Magnetic resonance imaging (MRI) was used in this study to evaluate the influence of sagittal plane positions on lumbar IVD height and nucleus displacement in a small asymptomatic population.T2-weighted sagittal plane images from L1 to S1 were obtained from 10 subjects (mean age: 30+/-5 years) positioned supine in lumbar flexion, followed by extension. Changes in disc height and localization of nucleus position (determined by peak MRI signal intensity) between the two positions were calculated. Discs were classified for degenerative changes using a semi-quantitative grading scale. The mean range of lumbar sagittal movement achieved in the MRI was 44 degrees (range: 22-77 degrees ). Between flexion and extension, a significant increase in measured anterior disc height of 1.1 mm (P<0.0001) and anterior displacement of the nucleus of 6.7% (P<0.0001) was observed. Despite the anterior displacement of the nucleus in extension observed in the pooled analysis, 30% of discs did not follow this trend. Nucleus degeneration was observed in at least one disc in nine subjects and in 26% of all discs examined. Lumbar spine position was found to be associated with small measured changes in anterior disc height and nucleus position, however, this response was variable within and between individuals. The theoretical concept of a stereotypical effect of spinal position on the lumbar IVD is challenged by these initial data. Since the health of the disc is often unknown in clinical practice, manual therapy treatment for lumbar spine pain should be based on the symptomatic response to movement and position rather than biomechanical theory.
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