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At least 127 records · Page 7Linked to original sources
PubMed1992

[Lumbar intervertebral disk displacement. Results of conservative treatment].

Among 120 patients with lumbar disk prolapse treated conservatively over a seven-year period, 72 patients were submitted to follow-up examination, and questionnaires completed by 92 patients were evaluated. Some 23.8% of the patients reported freedom from pain following treatment in hospital. Sciatica cleared up in 43.2%. After discharge from hospital, the average working time lost in 54 patients was 11.1 weeks. Ninety-five percent of the patients reported a return to work within one year. Eighty percent were able to return to their original workplaces. Some 73.8% of the patients surveyed were satisfied or very satisfied with the results of treatment. With respect to sensory disorders 37%, and with respect to paresis 32%, of the patients, reported improvement. Overall, the general and local symptoms, such as changes in gait and posture, percussion pain and tenderness, all showed an appreciably greater tendency to regress than did the neurological deficits.

Adult↗
PubMedDate not supplied

[Radiological diagnosis of iatrogenic stenosis of the lumbar spine in patients after surgical treatment of intervertebral disk displacement].

Iatrogenic stenosis of the vertebral canal arises as a result of inflammatory changes of the arachnoid with formation of adhesions following irritation of the meninges with chemicals, such as drugs and contrast media, or extension of the intracranial scar tissue, usually after operations. This stenosis is a serious diagnostic and therapeutic problem being often the cause of lacking improvement or recurrence of radicular pains after operations for herniated nucleus pulposus. On the basis of a literature review and own experiences the authors discuss the aetiology, pathogenesis, radiological diagnostic methods and methods of treatment in cases of iatrogenic postoperative stenosis of the lumbar vertebral canal.

Adult↗
PubMedDate not supplied

[New aspects in the diagnosis of intervertebral disk displacement of the upper lumbar spine with special reference to magnetic resonance tomography].

A report is presented on two patients who received surgery on a disc prolapse between the lumbar vertebrae 4 and 5 as treatment for compression of the fifth lumbar root, but in whom the clinically relevant disc prolapse was located higher (lumbar vertebrae 1/2 or thoracic vertebra 12/lumbar vertebra 1). Magnetic resonance tomography made a major contribution to the later diagnosis of the high disc prolapses. Besides precise localization of the lesion, MRT made it easier to understand why such a high disc prolapse can cause a compression syndrome of the fifth lumbar root.

Aged↗
PubMed1985

[Surgical treatment of cervical intervertebral disk displacement].

Between 1977 and 1983, 51 patients underwent operative treatment of cervical disc herniation. The operation were made by ventral approach, with discectomy, resection of the posterior longitudinal ligament and of the bone osteophytes, as well as with spinal fusion with autologeous bone graft. In the group with radicular syndromes 82.6% had an excellent or good result, and 69.9% of these attained the working capacity. In cases with cervical myelopathy good results were stated in 34.6%, however by patients with intraoperative findings of sequester in spinal canal the results are better. 69.2% of the patients with cervical myelopathy obtained disablement pension. In all cases of cervical disc disease with radicular and/or medullary syndromes the callenge to early operative intervention are accentuated.

Adult↗
PubMed1999

[Thoracic intervertebral disk displacement: a rare differential diagnosis of segmental irritation--guidelines for use of chiropractic therapy].

Thoracic disc herniations rarely occur; they vary with respect to the clinical symptomatic and do not always lead to neurological deficit. A patient is being reported on with first symptoms of unspecific back pain. The patient has been frequently treated within 12 months (at regular intervals) exclusively by chiropractic manipulation without a considerable success. It is the objective of this case report that in persistent and therapy resistant back pain without obvious neurological deficite beside native radiographs further diagnostic investigation (MRI) is indicated. Concerning chiropractic manipulations (mobilisation techniques with impulse) this paper recommends testing maneuvers, the consideration of contraindications (structural lesions, neurological deficite) and emphasizes the use of atraumatic manipulation techniques.

Adult↗
PubMed1991

[Surgical treatment of cervical intervertebral disk displacement].

The aim of operative treatment in degenerative cervical disc disease is the decompression of nerval structures. Generally this can be achieved either by an anterior or posterior approach. In our opinion the anterior way seems to be more favourable because the protruded vertebral disc can be totally removed in a direct approach. Besides this you can get a better survey of the spinal cord and the nerve roots. Fusion or not fusion after discectomy is discussed controversially. We prefer fusion to avoid pain caused by temporary instability. Since 1968 we treated 1,112 patients by this way and we used PMMA for fusion instead of a bone graft. No disadvantage of this method could be noticed. The results and complications are compared to those reported in the literature.

Cervical Vertebrae↗
PubMed1991

[Surgical treatment of cervical intervertebral disk displacement].

Between the years 1976 und 1989 147 patients were operated on cervical disc herniation at the Neurosurgical Clinic of Innsbruck. 122 of these cases underwent a posterior approach according to Frykholm, 25 patients were treated by an anterior approach according to Cloward and Smith and Robinson, respectively. All patients received a descending myelography followed by a CAT-Scan of the questionable cervical segments the latter was available. In patients with disc herniation and only mild degenerative changes of the cervical spine a dorsal foraminotomy was chosen whereas the cases with nerve root compressions primarily due to spondylosis the ventral approach was preferred. Patients revealed a convincing benefit of motoric deficits after foraminotomy whereas disturbances of sensibility showed minor improvement either by ventral or posterior approach.

Adult↗
PubMed1989

[Exertion, spinal fracture, intervertebral disk displacement].

If causes which cannot be clearly defined as traumatic, result in vertebral fractures or disc ruptures, the expert frequently finds himself confronted with considerable problems. He must carefully establish the relation between what is due to the trauma and what must be attributed to the pre-existing damage. This requires the pre-existing nox to be objectively cleared, especially with regard to osteoporosis. The diagnosis "osteoporosis" should be subjected to particularly careful investigation, especially if the patient is a male. X-ray photographs, taken at an early stage, are insufficient. As consequences for the patient might be heavy, intensive methods of examination are justified. Anamnesis, progress and effect must be critically weighted, exceptions from the rule must be founded on careful and logical reasoning. The above article deals with such an exception.

Accidents, Occupational↗
PubMed1999

[Surgical treatment of lumbar intervertebral disk displacement. Indications and methods].

The decision about operative or non-operative treatment of herniated lumbar discs has to be based on the results of clinical and neurological examination. Results of imaging techniques as CT or MRI are secondary. Various percutaneous endoscopic or open techniques have been described. The most appropriate technique is determined by the anatomical situation of the dislocated lumbar disc tissue. Intradiscal percutaneous therapies such as percutaneous nucleotomy and laser decompression are possible, but they revealed poor results in prospective randomized and controlled studies. Chemonucleolysis remains as an effective intradiscal technique at the time, but is afflicted with side effects and complications. Endoscopic transforaminal or interlaminary techniques are still experimental. Whenever open surgery is necessary, microsurgical techniques are preferred. If a certain technique is to be applied, there has to be the correct indication, technical support for and experience in using the choosen method.

Diskectomy↗
PubMed1999

[Surgical approach in lumbar intervertebral disk displacement. Topographical principles and characteristics].

For the operative procedure in lumbar disc extrusion it is important to expose the prolapsed disc and sequestrum without disintegration of the musculature and branches of r. dorsalis nervi spinalis or provoking lesions in the spinal canal. A classification helps to determine exact description of localization of disc material in craniocaudal and mediolateral directions. It can be correlated with the interlaminar window as a structure seen in the operative procedure. A speculum helps to limit the exposure for an interlaminar as well as a lateral access, thus reaching the structures concerned in the spinal canal with minimal irritation of the surrounding tissues. For interlaminar access partial excision of the lig. flavum is sufficient. The extrusions in the foraminal region that can be exposed laterally from a medial skin incision, as well as from a paramedial are between m. multifidus and m. longissimus. In revision surgery, the upper laminar corner is advantageous for entering the spinal canal.

Diskectomy↗
PubMed1987

[Diagnosis and surgical treatment of cervical intervertebral disk displacement and cervical myelopathy].

Despite the availability of excellent neuroradiological examination techniques, a decision to operate is usually still reached largely on the basis of a diagnosis of radical and/or medullary cervical compression syndrome made by clinical neurological examination. Computer tomography has allowed a decisive improvement in the diagnosis of these processes, since the position of parts of discs that have prolapsed or sequestrated dorsally or dorsolaterally relative to the spinal cord and the nerve roots can be visualized directly. Since core spin tomography does not yield information that is any more helpful in the diagnosis, despite the considerably higher level of technical sophistication and higher costs, we are of the opinion that there is no call to apply this procedure routinely for the diagnosis of medial and lateral cervical disc rupture. Since the neurological symptoms do not always allow localization of the radicular or medullary damage to the segment or segments affected, it is sometimes necessary to perform myelography with water-soluble contrast media for this purpose. The microsurgical procedures available are restricted foraminotomy for the relief of cervical nerve root compression and ventral diskectomy for the relief of spinal cord compression.

Adult↗
PubMed2005

[Correlation of degenerative intervertebral disk displacement using MRI with discography findings in patients with back pain].

BACKGROUND: MRI can be too sensitive for detecting degenerative changes and commonly displays pathology that is not necessarily responsible for the patient's symptoms. METHODS: Retrospectively, we investigated MRI findings and results of discography in 23 patients with lower back pain. MRI investigations were performed with a 1.0 and 1.5 Tesla device using T1-weighted and T2-weighted sagittal plane imaging and T2-weighted transverse plane imaging. RESULTS: Of the 35 degenerated discs, 16 were detected on MRI as having a high intensity zone (HIZ). Eleven of the 35 segments had previous lumbar disc surgery with a HIZ rate of 81.8%, whereas the HIZ rate for unoperated segments was only 29.2%. CONCLUSIONS: HIZ is known to be a common lesion found using MRI in lower back pain patients. In operated segments, we found an incidence of 81.8% and in unoperated segments of 28.2%. Discography can discriminate between painful and non-painful discs. With the help of additional parameters such as contrast mean volume and pain characteristics during puncture, the number of false positive discograms can be reduced.

Contrast Media↗
PubMed1990

[Aneuralgic root paralyses caused by lumbar intervertebral disk displacement. Follow-up of surgical therapy].

It is a controversial issue whether or not a painless paralysis caused by a lumbar disc herniation should be managed surgically because of the possible fatal destruction of the nerve root. In a retrospective study we examined 46 patients concerning the reversibility of their neurological deficits. Our results show that the so called "aneuralgic state" of the lumbar root compression syndrome and the death of the nerve root are not identical. More than half of the patients with the symptoms of nerve root death gained significant improvement above their preoperatively existing paralysis sometimes even up to several years later. The appearance of the compressed root at the time of surgery is of special importance because it allows conclusions concerning the remission of preexisting paresis. Defects of sensibility or the reflex status never improved without simultaneous improvement of paresis. The damage of the nerve root due to disc herniation is discussed with the help of literature sources with special consideration as to the time of reinnervation. Our results demonstrate that patients with an "aneuralgic state" can benefit from disc surgery and thus surgery could be recommended for these patients. Two cases are described.

Female↗
PubMed1987

[Clinical experience with intradisk chymopapain administration in lumbar intervertebral disk displacement].

In a retrospective study, complications following 157 chemonucleolyses (CNL) with chymopapain in 139 patients wer studied and the kind of pathological changes as found in the operation after CNL compared with those found in patients who were operated on because free sequesters were suspected on discography. The indications for CNL followed the accepted criterion of clinically, neuroradiologically or electromyographically detected alteration of a lumbar nerve root with clinical signs of sciatica. Free sequesters were found at subsequent operation much more often in those cases with primary indications for CNL, which showed signs of sequestration at discography, than in those who had had poor results after CNL. Discography as a means of finding previously undetected free sequesters should not be abandoned. In addition to procedure-related reactions and unspecific complications, as well as immediate or delayed occurrence of severe backache, significant leucocytosis was observed on the first postoperative day. Probably immunological reactions such as severe hypotension after several hours, nausea and vomiting or rise of temperature, also occurred. In ten cases delayed urticarial or large erythematous efflorescences were observed. These reactions do obviously not correspond to the picture of anaphylaxis of the reagine-type such as is mostly described in the mechanism of chymopapain allergy.

Adult↗
PubMed1999

[Percutaneous nucleotomy procedures in lumbar intervertebral disk displacement. Current status].

The discussion on the results of open spinal surgery, in particular, on complications as a result of open surgery, e.g., the so-called post-discotomy syndrome, has led to the development of less invasive methods, especially for treatment of lumbar disc prolapses. Percutaneous nucleotomy procedures are based on a variety of intradiscal diagnostic and therapy methods, such as discography, retroperitoneal spinal disc fenestration or chemonucleolysis. Since the 1970s, various methods such as mechanical percutaneous nucleotomy, automated percutaneous nucleotomy, intradiscal laser procedures and, in part, endoscopic intradiscal procedures have been developed and also used clinically. The clinical results vary from 30% good/very good results to almost 100% good/very good results, depending on the author and study. It is obvious that not many prospective randomized studies using either conservatively or surgically treated control groups have been conducted. The results of these studies on intradiscal therapy methods are often analyzed more critically and with lower success rates than the partially retrospective stuides of a single method, which often have large case numbers, but do not always meet the demanding criteria for scientific study design. To attain good results, percutaneous nucleotomy procedures can only be used to treat select cases of lumbar disc disorders according to strict indication criteria. At the present time it can be concluded that, in comparison to endoscopic und microsurgical methods, percutaneous nucleotomy procedures must be restricted to a small number of cases.

Diskectomy, Percutaneous↗