[Comment on the contribution by Dr. A. Eckardt et al. "Psychological factors in therapy of lumbar intervertebral disk displacement"].
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The paper contains a clinical analysis of 23 cases of dorsomedial intervertebral disc prolapse in the lumbar spine treated surgically with stress laid on late results, which were evaluated in follow up. The results were compared with the rate of increase of clinical manifestations, clinical conditions of the patients, and time from the onset of prolapse to the operation. The methods of operation were not analysed. The results were compared with those reported in the literature and were found unsatisfactory. Particularly unsatisfactory results were found in the group of patients with sudden onset of the disease and with development of serious neurological manifestations in a short time. It is stressed that early surgical intervention in such cases can prevent development of irreversible changes and can improve significantly the results of surgical treatment of dorsomedial intervertebral disc prolapse with full blockade of the cerebrospinal fluid spaces in the lumbar part of the spine.
A report is given on 10 children and adolescents who were surgically treated because of prolapses of lumbar intervertebral discs. Besides a detailed anamnesis, the preoperative diagnosis was mainly based on general medical and neurological findings as well as X-ray pictures of the lumbar vertebral column. In case of the absence of radicular neurological failures and pecularities in the X-ray picture, e.g. signs of a spinal process of displacement, destructive changes in the osseous structures of the vertebral column, assimilation disturbances in the lumbosacral transition region, there is the indication for Dimer-X myelography. For all patients, histologically distinct to high-degree degenerative changes in the withdrawn vertebral disk material were found. Reliable signs of a traumatic genesis of the intervertebral disk prolapse were not seen.
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Based on the analysis of the results of 297 contrast myelographies (MG) by means of water soluble agents made in patients with posterior hernias of lumbar intervertebral disks (PHLID), the authors define the potentialities of this technique in the diagnosis of PHLID. Additionally, two oblique X-ray films have been included into the exciting filming routine, which may detect all specific features of intervertebral disk damage at MG. The authors make additions into the well-known myelographic symptomatology of PHLID, by outlining the abnormal anterior configuration of a contrast column at the level of a diseased disk in PHLID at the foraminal site. The findings suggest that contrast MG with nonionic water-soluble agents is a rather effective technique in the diagnosis of PHLID.
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