Influential factors related to functional status after full-endoscopic lumbar discectomy / 北京大学学报(医学版)

OBJECTIVE@#To explore the influential factors associated with functional status of those patients who undertook a full-endoscopic lumbar discectomy operation.@*METHODS@#A prospective study was conducted. A total of 96 patients who undertook a full-endoscopic lumbar discectomy operation and met inclusive criteria were enrolled in the study. The postoperative follow-up was held 1 month, 3 months and 6 months after operation. The self-developed record file was used to collect the patient's information and medical history. Visual analogue scale (VAS) score, Oswestry disability index (ODI) score, Gene-ralised anxiety disorder-7 (GAD-7) scale score and patient health questionnaire-9 (PHQ-9) scale score were applied to measure pain intensity, functional status, anxiety status and depression status. Repeated measurement analysis of variance was used to explore the ODI score 1 month, 3 months and 6 months after operation. Multiple linear regression was recruited to illuminate the influential factors associated with functional status after the operation. Logistic regression was employed to explore the independent risk factors related to return to work 6 months after operation.@*RESULTS@#The postoperative functional status of the patients improved gradually. The functional status of the patients 1 month, 3 months and 6 months after operation were highly positively correlated with the current average pain intensity. The factors influencing the postoperative functional status of the patients were different according to the recovery stage. One month and 3 months after operation, the factors influencing the postoperative functional status were the current average pain intensity; 6 months after operation, the factors influencing the postoperative functional status included the current average pain intensity, preoperative average pain intensity, gender and educational level. The risk factors influencing return to work 6 months after operation included women, young age, preoperative depression status and high average pain intensity 3 months after operation.@*CONCLUSION@#It is feasible to treat chronic low back pain with full-endoscopic lumbar discectomy operation. In the process of postoperative functional status recovery, medical staffs should not only take analgesic mea-sures to reduce the pain intensity experienced by the patients, but also pay attention to the impact of psychosocial factors on the recovery. Women, young age, preoperative depression status, and high average pain intensity 3 months after operation may delay return to work after the operation.

Effect of fatigue load on internal mechanical properties of the intervertebral disc / Efecto de la carga de fatiga en las propiedades mecánicas internas del disco intervertebral

SUMMARY: Lumbar disc herniation is considered to be the main pathological factor for the common clinical disease of low back pain. Biomechanical factor is an important cause of lumbar disc herniation, so it is urgent to analyze the stress/strain behavior of intervertebral disc under different loading condition. Slow repetitive loading is considered to be an important factor of spine and disc injuries, and the effect of fatigue load on internal displacement in the intervertebral disc was investigated by applying the optimized digital image correlation technique in this study. The first finding was that fatigue load had a significant effect on the displacement distribution in the intervertebral disc under compression. Superficial AF exhibited the largest axial displacements before fatigue load, while it exhibited the smallest axial displacements after fatigue load. Inner AF exhibited slightly smaller radial displacements than outer AF before fatigue load, while it exhibited significantly greater radial displacements than outer AF displacements after fatigue load. The second finding was that fatigue load had a certain effect on the internal displacement distribution in the flexed intervertebral disc under compression. Middle AF exhibited the smallest axial displacements before fatigue load, while deep AF exhibited the smallest axial displacements after fatigue load. The radial displacement distribution did not change before and after fatigue load, as the radial displacement in outer AF was the smallest, while the radial displacement in inner AF was the largest. The third finding was that with the increase in fatigue time and amplitude, the Young's modulus of the intervertebral disc increased significantly. This study can provide the basis for clinical intervertebral disc disease prevention and treatment? and is important for mechanical function evaluation of artificial intervertebral disc as well.

RESUMEN: La hernia de disco lumbar se considera el principal factor patológico para la enfermedad clínica común del dolor lumbar. El factor biomecánico es una causa importante de hernia de disco lumbar, por lo que es urgente analizar el comportamiento de esfuerzo / tensión del disco intervertebral bajo diferentes condiciones de carga. La carga repetitiva lenta se considera un factor importante de lesiones de columna y disco, y en este estudio el efecto de la carga de fatiga sobre el desplazamiento interno en el disco intervertebral se investigó mediante la aplicación de la técnica de correlación de imagen digital optimizada. El primer hallazgo fue que la carga de fatiga tuvo un efecto significativo en la distribución del desplazamiento en el disco intervertebral bajo compresión. El AF superficial exhibió los desplazamientos axiales más grandes antes de la carga de fatiga, mientras que exhibió los desplazamientos axiales más pequeños después de la carga de fatiga. El AF interno exhibió desplazamientos radiales ligeramente más pequeños que el AF externo antes de la carga de fatiga, mientras que exhibió desplazamientos radiales significativamente mayores que los desplazamientos AF externos después de la carga de fatiga. El segundo hallazgo fue que la carga de fatiga tenía un cierto efecto sobre la distribución del desplazamiento interno en el disco intervertebral flexionado bajo compresión. El AF medio exhibió los desplazamientos axiales más pequeños antes de la carga de fatiga, mientras que el AF profundo exhibió los desplazamientos axiales más pequeños después de la carga de fatiga. La distribución del desplazamiento radial no cambió antes ni después de la carga de fatiga, ya que el desplazamiento radial en la FA externa fue el más pequeño, mientras que el desplazamiento radial en la FA interna fue el más grande. El tercer hallazgo fue que con el aumento del tiempo de fatiga y la amplitud, el módulo de Young del disco intervertebral aumentó significativamente. Este estudio puede proporcionar la base para la prevención y el tratamiento clínico de la enfermedad del disco intervertebral, y también es importante para la evaluación de la función mecánica del disco intervertebral artificial.

Hernia de disco lumbar en un niño con fibrosis quística: caso clínico / Lumbar disc herniation in a child with cystic fibrosis: case report

Presentamos el caso de un niño con fibrosis quística y hernia de disco lumbar. Un niño de 8 años de edad consultó por dolor lumbar que aumentaba con la tos, al sentarse, caminar o inclinarse, y disminuía al acostarse. La prueba de levantamiento de la pierna en extensión fue positiva cuando el miembro inferior derecho llegó a 60 grados. La prueba contralateral fue negativa. La resonancia magnética nuclear mostró una protrusión central del disco intervertebral entre L5-S1. El tratamiento conservador no fue efectivo, por lo cual se efectuó tratamiento quirúrgico, que hizo desaparecer el dolor. Según nuestro conocimiento, este es el primer caso comunicado de hernia de disco lumbar en un niño con fibrosis quística. Aunque este caso podría ser una coincidencia, se debe realizar una investigación detallada ante el dolor de espalda, síntoma frecuente en pacientes con fibrosis quística.

We report a case of child with cystic fibrosis and lumbar disc herniation. An 8-year-old boy presented with low back pain that exacerbated on coughing, sitting, walking, or bending and diminished when lying down. The straight leg raising test was positive when the right leg was lifted at 60 degrees. Crossed leg raising test was negative. Lumbar MRI revealed a L5-S1central disc protrusion. Conservative treatment was not effective and the patient underwent surgery. Postoperatively the patient experienced regression of the pain. To the best of our knowledge this is the first reported case of lumbar disc herniation in a child with cystic fibrosis. Although this case might be coincidental, thorough investigation of back pain, which is frequent in patients with cystic fibrosis, should be performed.

Hérnia discal lombar na infância / Disc herniation in infancy

Introdução: A hérnia discal na infância é rara. Apresenta etiologia controversa. As principais manifestações clínicas são dor e dificuldade na deambulação. A ressonância magnética tem sido considerada exame de eleição no diagnóstico e conduta. O tratamento inicial é conservador e, em caso de cirurgia, usar técnica minimamente invasiva. Metodologia: Artigo de revisão realizado com levantamento em base de dados Medline/Pubmed, SciELO e LILACS, incluindo um período de 1946 a 2010, com prioridade para artigos com maior relevância. Resultados: Foram analisados artigos relacionados à hérnia discal na infância, dos quais 39, revisados, resultaram no presente trabalho. Conclusões: Deve-se pensar na possibilidade de hérnia discal quando as crianças apresentam lombalgia ou restrição à deambulação, principalmente se houver história recente de trauma. Ressonância magnética é o exame de eleição no diagnóstico e conduta. O tratamento cirúrgico, através de técnicas minimamente invasivas, apresenta resultados satisfatórios.

Introduction: Disc herniation in childhood is a rare disease, and its etiology is still controversial. The main clinical features are back pain and walking difficulty. Magnetic resonance is considered the method of choice for diagnosis and therapeutic decision. Initial treatment is conservative and in surgical cases, minimally invasive techniques should be used. Method: Review article of a survey conducted in the Medline/PubMed, SciELO and LILACS databases, including a period from 1946 to 2010, giving priority to the most relevant articles. Results: We reviewed articles related to disc herniation in childhood, of which 39 have been revised and resulted in this work. Conclusions: Due to its low prevalence in the pediatric group, the hernia is often misdiagnosed. However, the presence of low back pain and restriction in walking, especially if there is a recent history of trauma associated, should alert health professionals to this etiologic possibility. MRI is the method of choice for diagnosis and management. Surgical treatment using minimally invasive techniques provides satisfactory results.

Discectomía cervical anterior con artrodesis intersomática con cesta de titanio: experiencia en 102 casos (2002-2008)

La elevada frecuencia de pacientes con trastornos cervicales, ha llevado a estudiar estas afecciones, cuya diferenciación de otras enfermedades en muchas ocasiones resulta difícil. En la práctica neuroquirúrgica las enfermedades cervicales y degenerativas son unas de las más frecuentes, las hernias de columna cervical representan el segundo lugar de frecuencia de la patología discal. Este trabajo está basado en la revisión de la técnica de artrodesis cervical anterior posdiscectomía y fusión utilizando la cesta roscada de titanio, sin uso de injertos óseos, placas o tornillos, el cual es continuación de una revisión realizada dada la experiencia del autor en el 2004. Se analizan los procedimientos diagnósticos más frecuentemente utilizados y los criterios para la selección del tratamiento quirúrgico. Se presenta la experiencia en 102 casos. Las principales ventajas que ofrece esta técnica son: menor instrumentación; acortamiento del tiempo quirúrgico; estabilización inmediata de la columna cervical con recuperación y deambulación precoz de los pacientes, con retorno precoz a sus actividades normales, con mínimas complicaciones y reducción de costos

Cervical spinal degenerative and discal diseases are among the most common conditions encountered in medical practice. Herniated discs are more common in patients under 40 years of age and degenerative processes are more common after that age. In this study, the most common diagnostic methods and the current criteria for surgical management are reviewed. The author presents his experience of 102 cases with cervical discal and degenerative disease treated by discectomy and fusion through anterior approach, using the titanium cage without use of bone grafts, plates or screws. The main advantages of this technique include shortening of surgical time and fewer instrumentation, immediate stabilization of the cervical spine, early functional recovery and return to normal activities within two weeks with minimal complications, and lower cost

Relationship of Facet Tropism with Degeneration and Stability of Functional Spinal Unit

PURPOSE: The authors investigated the effect of lumbar facet tropism (FT) on intervertebral disc degeneration (DD), facet joint degeneration (FJD), and segmental translational motion. MATERIALS AND METHODS: Using kinetic MRI (KMRI), lumbar FT, which was defined as a difference in symmetry of more than 7degrees between the orientations of the facet joints, was investigated in 900 functional spinal units (300 subjects) in flexion, neutral, and extension postures. Each segment at L3-L4, L4-L5, and L5-S1 was assessed based on the extent of DD (grade I-V) and FJD (grade 1-4). According to the presence of FT, they were classified into two groups; one with FT and one with facet symmetry. For each group, demographics, DD, FJD and translational segmental motion were compared. RESULTS: The incidence of FT was 34.5% at L3-L4, 35.1% at L4-L5, and 35.2% at L5-S1. Age and gender did not show any significant relationship with FT. Additionally, no correlation was observed between DD and FT. FT, however, wasfound to be associated with a higher incidence of highly degenerated facet joints at L4-L5 when compared to patients without FT (p < 0.01). Finally, FT was not observed to have any effects upon translational segmental motion. CONCLUSION: No significant correlation was observed between lumbar FT and DD or translational segmental motion. However, FT was shown to be associated significantly with the presence of high grades of FJD at L4-L5. This suggests that at active sites of segmental motion, FT may predispose to the development of facet joint degeneration.

Disfunción temporomandibular: el desplazamiento discal asociado a asimetría por alteración de crecimiento cóndilomandibular: dos casos clínicos / Temporomandibular dysfunction: disc displacement associated with asymmetry due to mandibular condyle growth alteration: two clinical cases

El desplazamiento discal en la articulación temporomandibular es una afección habitual. En algunos casos, el disco desplazado sin reducción, puede producir, si la manifestación ocurre durante el período de crecimiento, alteraciones de desarrollo cóndilo mandibular, tales como asimetrías y disminución del tamaño de esas estructuras a partir de procesos degenerativos a nivel condilar. Estos hechos han sido observados en otros estudios de los que se hace una breve reseña. A continuación se presentan dos casos clínicos en pacientes con DDsR, proceso degenerativo condilar, alteración de crecimiento y asimetría.

age a prognostic factor of postoperative outcome of lumbar disc herniation operations?

To evaluate the influence of the patients age on preoperative symptoms and outcome. The general data, symptoms, signs, and neurological examination findings were recorded from 511 patients between 2000 and 2006 at Vakif Gureba Hospital and Afyon Kocatepe University Neurosurgery Departments, Afyonkarahisar, Turkey. The mean follow-up of the patients was 44.7 months. All patients younger than 64 were defined as younger patients [n=449]. The others were defined as elderly patients [n=62]. The measuring method of the outcome was visual analogue rating scale [VAS]. Preoperative and postoperative VAS values were found similar in both the younger and older group. Only preoperative differences were found in the older group, due to systemic disease. The outcome was not statistically different in both groups, indicating that age is not a valuable prognostic factor for lumbar discectomy

Assessment of the atlanto-occipital junction in the MRI of subjects with cervical disc herniation

To demonstrate the normal limits of Powers ratio and basion dens interval in patients with disc herniations. The MRI of patients were retrospectively evaluated by 2 radiologists. Four hundred and forty-five patients who were admitted to Duzce University Hospital with neck pain without history of trauma were chosen between January 2004 and July 2006 in this retrospective study. The patients were between the ages of 14-80 years. Four group were identified according to the number of disc herniations The normal of Powers ratio and dens interval were 0.77 +/- 0.15 and 0.80 +/- 0.66 in group 0, 0.76 +/- 0.14 and 0.81 +/- 0.76 in group one, 0.75 +/- .013 and 0.80 +/- 0.71 in group 2, 0.76 +/- .014 and 0.81 +/- 0.74 in group 3, and 0.77 +/- 0.16 and 0.81 +/- 0.66 in group 4. The relationship between the number of disc herniations and Powers ratio and basion dens interval was not statistically significant. Our results were in concordance with the previous studies concerning the Powers ratio and basion dens interval. These 2 methods can be used in the MRI of atlantooccipital dislocation suspected patients with disc herniations

The study on relativity of the time of traumatic diskal hernia and the change of CT rate / 法医学杂志

OBJECTIVE@#To find out the relativity between the time when the traumatic prolapse of intervertebral disc occurred and the change of the CT numerical value.@*METHODS@#The CT numerical value of the vertebral pulp of herniation (denoted as A) and the CT numerical value of the vertebral pulp without herniation (denoted as B) were measured in for 198 patients and analyzed the relation between this parameter and the time when the prolapse of intervertebral disc occurred.@*RESULTS@#It's found find out that there is relativity between the parameter and the time when the prolapse of intervertebral disc occurred, and this difference has the value for the statistics, when the parameter is at about -12 to -40 HU, the average value is -25.8 HU (A < B), it can be determined the prolapse of intervertebral disc occurred within 3 months ago. When the parameter is at about -13 to 0 HU, the average value is -6.6HU (A is similar with B), it can be determined the prolapse of intervertebral disc occurred at about 4-6 months ago. When the parameter is at about 37 to 289HU, the average value is 96.1 HU (A > B). It can be determined the prolapse of intervertebral disc occurred more than 12 months ago.@*CONCLUSION@#The approximate time can be determined when the prolapse of interverterbral disc occurred by the paremeter.

Neurologic compression by tharacic disc in a case of scheuremann kyphosis - an infrequent combination

Scheuermann disease is a rigid kyphosis due to vertebral wedging in the thoracic or lumbar spine. It is very rarely associated with neurologic compromise. Thoracic disc herniation leading to dural sac compression is also an infrequent pathology. We describe here a young man with Scheuermann disease who presented with symptoms and signs of neural compression. The cause of compression was a thoracolumbar disc, rendering him non-ambulant without support. He required transthoracic surgical decompression. The neurological status of the patient improved rapidly after surgery. At his latest follow-up he was independently ambulant with full restoration to activities of daily living

Fraturas com arrancamento do anel apofisário ("limbus") póstero-superior da vértebra L5, associado com hérnia discal pré-marginal em atletas / Avulsion fractures of apophysial ring (

O aumento de adolescentes praticando esportes de forma cada vez mais competitiva tem causado o aumento de lesões relacionadas à prática desportiva. A dor lombar é uma queixa freqüente entre os atletas, geralmente relacionada a contraturas da musculatura paravertebral e fraturas ( espondilólise ) devido ao excesso de treinamento e aplicação de técnicas incorretas. Porém, outras etiologias podem causar a dor lombar, como processos infecciosos, tumorais e fraturas. As fraturas com arrancamento do anel apofisário são lesões incomuns e raramente ocorrem na região póstero-superior da vértebra L5. Os relatos da literatura mostram que o local mais acometido é a região póstero-inferior da vértebra L4. Apresentamos dois casos de atletas jovens com esta incomum lesão. O objetivo deste trabalho é discutir a possível etiologia, os melhores métodos para o diagnóstico e possíveis formas de tratamento desta patologia.

Degenerative disk disease at lumbosacral junction: plain film findings and related MRI abnormalities.

Due to a wide range of normal disk space heights at lumbosacral (LS) junction, we conducted this study to evaluate how to diagnose degenerative disk disease (DDD) of LS junction and how much information we can obtain from plain radiography regarding this condition. We retrospectively reviewed lateral LS spine films and magnetic resonance (MR) imaging in 100 patients presented with low back pain. Anterior disk height (ADH) and posterior disk height (PDH) were directly measured from plain radiographs. Signs of DDD were recorded from both plain radiographs and MR imaging. We found that ADH < 11.3 mm or PDH < 5.5 mm indicate DDD at LS junction with 95 per cent confidence interval. When spondylolisthesis presented, disks were all degenerated. Endplate sclerosis had significant relative risk (p < 0.05) for lateral neural canal stenosis and disk herniation. No radiographic finding showed significant relative risk for nerve root compression.

Ligamentum flavum thickness in degenerative disc disease

This hospital based study was carried out over a period of 03 months, to assess the thickness of the ligamentum flavum in degenerative disc disease. Forty eight patients with backache and sciatica were selected at random and entered into the study. Majority of the patients fell into the age bracket of 30-40 years. Fifty Eight of patients had sciatica on the right side and 81% on the left side. They were investigated with the help of myelography and MRI scan. At the operation, the ligamentum was meticulously excised and its thickness in millimeters was measured. The thickness of ligamentum flavum so obtained was analysed in relation to age, duration of symptoms and the condition of disc whether protruded, prolapsed or sequestrated. A clear cut relationship was found between the degree of the prolapse and the thickness of the ligamentum flavum

Hérnia discal traumática lombar / Traumatic lumbar disc herniation

Relata-se caso de paciente vítima de queda de altura, apresentando lombalgia e coxalgia direita leve que, após aproximadamente três semanas, evoluiu com déficit sensitivo-motor em membro inferior direito. A investigaçäo com exames neuro-radiológicos apropriados, permitiu o diagnóstico de hérnia discal traumática lombar, entre a quarta e quinta vértebras. Salientam-se os aspectos etiopatogênicos desencadeante desta afecçäo, assim como a necessidade de investigaçäo cuidadosa de pacientes com queixas neurológicas, evolutivas, após trauma, mesmo na vigência de exames radiológicos simples sem anormalidades evidentes; observa-se que o envolvimento mielo-radicular por patologia discal traumática, independe da existência de fraturas ósseas ou alteraçöes grosseiras da estrutura da coluna vertebral

Hérnias discais dorso-lombares e síndrome da cauda equina como complicaçöes da doença de Scheuermann: relato de caso / Back-lumbar herniated discs and cauda equina syndrome as complications of Scheuermann's disease: a case report

É descrito o caso de um paciente com compressäo medular por hérnia discal torácica sem paraplegia e síndrome da cauda equina por lesöes espondilodiscais, com pequenas protrusöes em L4-L5 e L5-S1, associadas à doença de Scheurermann. O paciente recuperou-se com tratamento clínico em seis meses. O estudo radiológico do caso com radiografias simples, mielografia, tomografia computadorizada e ressonância magnética da coluna vertebral e o estudo eletroneuromiográfico indica haver correspondência precisa entre o quadro clínico e as degeneraçöes ósteo-disco-ligamentosas da coluna lombar com as raízes espinhais afetadas e hérnias lombares, assim como as sequelas ósseas da distrofia raquídea da doença de Scheuermann

Dolor lumbar / Low back pain

Son muchos los factores que hacen que la región lumbosacra sea mucho más vulnerables que otras regiones del cuerpo a las diversas fuerzas desestabilizantes implicadas en la conservación de la posición erecta. Dichas fuerzas desestabilizadoras tienen un origen único: la fuerza de gravedad. Esta alteración es muy frecuente en las personas de vida sedentaria, especialmente en aquellas que laboran sentadas.

Hernia de disco lumbar. Diagnóstico y tratamiento quirúrgico / Lumbar herniated disc. Diagnosis and surgical treatment

En el módulo de cirugía de columna, del Hospital de Traumatología y Ortopedia Lomas Verdes del IMSS, durante el período de febrero de 1987 a septiembre de 1989, 100 pacientes fueron tratados de disquectomía lumbar, por hernia de disco, de los cuales sólo tres correspondieron a hernia foraminal. Todos los pacientes fueron evaluados clínicamente y con estudio electrofisiológico; 80 con hidromielografía, 20 hidromielografía y TAC y en cinco pacientes se realizó discografía-TAC, de acuerdo al algoritmo para el manejo de la enfermedad discal lumbar del servicio. El tratamiento quirúrgico consistió: con el paciente en decúbito prono, abordaje medio posterior en todos los casos; en 75 se realizó fenestración, en 20 hemilaminectomía y en cinco casos liberación radicular bilateral, tres con facetectomía doble vertical, unilateral; disquectomía subtotal y colocación de tejido adiposo autólogo, como membrana de interfase. La evaluación clínica postoperatoria, se llevó a cabo en cuatro meses como mínimo y dos años y medio como máximo; obteniendo el 74%de excelentes resultados, 15%de buenos, 8%regulares y 3%de malos resultados.