[Proceedings: Optimal positioning for lumbar intervertebral disk displacement surgery].
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Between 1983 and 1986, a total of 1012 patients were treated in our rehabilitation clinic after intervertebral disc surgery, either admitted shortly post op, or at a later time. Males outweighed females in proportion by 56 vs. 44%; the average age at surgery was 44 yrs. for male, and 42 yrs for female patients. 966 patients (95%) had undergone lumbar surgery, 46 (5%) surgery in the cervical region; 12% of the patients were operated twice and 2% for a third time. Except for those admitted shortly post-surgery, an average period of 6 to 7 months elapsed between the family doctor's, or specialist's, application for a rehabilitation measure and admission to the rehabilitation clinic. Average duration of incapacity for work totalled 6.2 months (males 5.6 months, females 6.8 months). Of the 228 patients with "incapable for work" status on admission to the clinic, 160 were discharged home capable for work, another 34 were recommended for work trial. The remaining 34 patients were referred back to the acute clinics for further diagnosis, or renewed surgery. The advantages of in-patient rehabilitation measures, among them post-surgery postural etc. training ("back training"), are set out, along with ways how the rehabilitative procedures should be dovetailed with the course of management.
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Upper lumbar nerve root compression or a femoralgia is often caused by extreme lateral lumbar disc herniation. This type of lumbar disc herniation compresses the nerve root inside or laterally to the intervertebral canal, while mediolateral disc herniations squeeze it in the lateral recess. Pain radiating obliquely over the thigh is the dominant clinical symptom. Bending the body to the ipsilateral side usually increases the pain. When neurologic signs are present, motor deficits tend to be more prominent than sensory and the deficits never affect more than one nerve root. Most frequently a weakness of knee extension occurs.
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UNLABELLED: In a prospective clinical study, 102 patients suffering from low back pain were examined by ultrasound. In all patients the segments L3/4, L4/5, and L5/S1 were evaluated. We analysed a total of 306 lumbar disc segments. Ultrasound evaluation was transabdominally performed by using a 3,5 MHz scanner. The results of the ultrasound documentation were compared to MRI or if the patient was operated on with the intraoperative findings. In 25 disc the dorsal border of the disc could not be demonstrated by ultrasound. The statistical analysis resulted in the following values: [table: see text] Comparing these results with the results of other imaging modalities like myelography, CT, or MRI, ultrasound scores are significantly inferior. CLINICAL RELEVANCE: With the present technique ultrasound does not seem to be of diagnostic value for patients with herniated disk.