Lumbar disk herniation combined with epidural hematoma. A case report

We examined the protective effect of nicotine against neuronal cell death in the model system of serum- and nerve growth factor (NGF)-free cultures of PC12 cells. Serum deprivation induced massive death of undifferentiated PC12 cells, which was inhibited by the addition of NGF, but not by the addition nicotine (100 microM). Even after PC12 cells had been differentiated by the treatment with NGF, serum and NGF deprivation induced rapid and massive death of these cells. The addition of nicotine (1-100 microM) to the deprivation system prevented such cell death almost completely. The protective effect of nicotine was abolished by hexamethonium or mecamylamine, inhibitors of nicotinic acetylcholine (nACh) receptors. Treatment with reserpine to deplete intracellular catecholamines did not influence the effect. The results suggest that the protective effect of nicotine against neuronal cell death is exerted through nACh receptors.     

Lumbar intervertebral disc herniation in children less than 16 years of age. Long-term follow-up study of surgically managed cases

STUDY DESIGN: In this retrospective study, the long-term clinical results of lumbar intervertebral disc herniation in children less than 16 years of age were reviewed. OBJECTIVES: To evaluate the effectiveness of surgical treatment including posterior discectomy, extraperitoneal anterolateral discectomy, and anterior interbody fusion for lumbar intervertebral disc herniation in children less than 16 years of age. SUMMARY OF BACKGROUND DATA: Although previous follow-up studies on surgically managed lumbar intervertebral disc herniation in children and adolescents generally reveal good outcomes, few reports have focused on the time course of clinical findings and the long-term results. METHODS: The outcome of subjective symptoms, clinical signs, and time-related change of the intervertebral disc space in 11 patients were evaluated with an average follow-up period of 9 years (range, 5-12 years). RESULTS: The posterior discectomy procedure relieved clinical symptoms quickly. In the case of central herniation with or without intervertebral instability, extraperitoneal anterolateral discectomy or anterior interbody fusion led to favorable long-term results. Clinical symptoms (lower back pain, leg pain) and neurologic disturbance disappeared within 3 months after surgery. Recovery of normal straight leg raising test results (tight hamstrings), however, required much more time than recovery of other symptoms. Narrowing of the intervertebral disc space progressed up to 3-6 months after discectomy, but then disc space widening occurred. CONCLUSIONS: Satisfactory long-term clinical results and early return to school life were obtained with each surgical procedure. It is important to aim toward an early return to school via surgical treatment.     

Surgical treatment of herniation of a lumbar intervertebral disk in young people (author's transl)

Among 2755 patients operated on for nerve-root compression there were 38 children and juveniles (aged 11-22 years). Average interval between onset of symptoms and operation was 14 1/2 months and often involved considerable diagnostic effort. 36 of the 38 patients were re-examined an average of 11 years after operation: 15 were free of symptoms, 18 had occasional mild symptoms, two had continuous mild pain and one had occasional severe pain. Re-operation was necessary in six. All patients are able to work. A connection between an accident and the herniation was demonstrated in only two instances.     

Extraligamentous lumbar intervertebral disk displacement

The preoperative assessment of sciatica secondary to a herniated intervertebral disk has been radically changed over recent years due to the development of percutaneous treatment techniques which now offer an alternative to surgery. After recalling the terminology used for the position of a herniated lumbar disk in relation to the posterior common vertebral ligament (subligamentous or transligamentous hernia) and to describe whether or not the hernia is detached from the original disk (excluded or non-excluded hernia), the authors review the current state of the art of imaging for each type of herniated lumbar intervertebral disk.     

Diffuse intervertebral disk calcification in primary amyloidosis

Circulating lymphocytes were incubated for 72 hours in either pure culture medium or a medium-urine mixture in the presence of phytohemagglutinin, concanavalin A or pokeweed mitogen, and assayed for blastogenesis and viability. The amount and osmolality of the urine were varied. Between 80 and 90 per cent of the cells remained viable during the entire study despite the culture mixture. If 50 percent of the culture was replaced by urine at an osmolality of 150, 300 or 500 mOsm, a severe but uniform depression of lymphocyte activity was seen. However, if only 25 percent or less of the medium was replaced by urine at 300 mOsm, the cells stimulated as well as they did in pure medium.     

Correlation study on infrared thermography and nerve root signs in lumbar intervertebral disk herniation patient: a short report

OBJECTIVE: To determine whether infrared skin thermography is an objective measurement reflecting the seriousness of nerve root irritation in lumbar disk herniation patients. DESIGN: Quantified nerve root signs by physical examination were collected from the patients along with the infrared skin temperature measurement on the lumbosacral region and posterior part of thighs. A correlation study was applied to observe the relation between the nerve root signs and the skin temperature before a successful conservative treatment (mainly spine manipulation), and between the alteration of nerve root signs and that of skin temperature after the treatment. SETTING: Hospitalized care. PATIENTS: Twenty-seven hospitalized samples with computed tomography or magnetic resonance approval were consecutively selected during the latter half of 1990. MAIN OUTCOME MEASURE: Changes in nerve root signs. RESULTS: The temperature difference between a troubled thigh and healthy one is significantly correlated to the score of the nerve root signs before the treatment; and the reduction of temperature difference between two thighs is also significantly correlated with decreasing score of nerve root signs after the treatment. The correlation between the temperature difference on the left and right sides of the lumbosacral region and the nerve root signs before the treatment is insignificant; and the variation of the temperature difference of the same region after the treatment is not correlated with the decreasing score of the nerve root signs. CONCLUSION: Infrared skin thermography of lower extremities might be an objective sign in signaling the soothing process of the nerve root irritation in lumbar disk herniation patients, which may help a doctor in checking the responses of the patient to treatment.     

Intraoperative ultrasound in lumbar intervertebral disk displacement

Intraoperative ultrasound of the spine has been used in neurosurgery (tumours) and traumatology (reposition of fractured vertebral bodies fragments). AIM: To describe initial experiences with this method and to document the opportunities and problems. METHOD: 24 nucleotomies were documented and evaluated. Sonography was performed using a 7.5 MHz sector probe and a typical surgical approach. RESULTS: In 21 of 24 cases, imaging of intraspinal structures was possible. The complete extraction of the herniated disk could be documented. In 3 cases the examination failed because the probe was too large to be pushed down between the spinous processes and the wound retractor to the operative site. CONCLUSIONS: Intraoperative sonography can be used easily as a routine method for exploration of the spinal canal. Technical innovations in the probes would make the method even more feasible.     

Facet joint asymmetry as a radiologic feature of lumbar intervertebral disc herniation in children and adolescents

STUDY DESIGN: This study compared the incidence of facet joint asymmetry between adult and juvenile patients with lumbar intervertebral disc herniation. OBJECTIVES: To determine the different distribution of the facet joint asymmetry between the adult and juvenile patients. SUMMARY OF BACKGROUND DATA: As early as 1967, it was suggested that asymmetry of the facet joints is correlated with the development of disc herniation. There have been numerous arguments for and against Farfan's hypothesis, however, most studies were carried out on adult patients, and this hypothesis has not been verified in juvenile patients. METHODS: The study group consisted of 29 levels of 25 patients aged 12-20 years (juvenile group) and 50 levels of 33 patients aged 30-49 years (adult group) who underwent posterior discectomy. The shape of facet joints, the facet joint angle, and the moment arm angle and length were measured for each facet joint using computed tomography. Facet joint asymmetry was defined as the difference in facet joint shape or a difference of more than 10 degrees in facet joint angles between the right and left sides. The incidence of facet joint asymmetry and the relationships among the facet joint asymmetry and the location, type of disc herniation, and disc degeneration were examined in juvenile and adult groups. RESULTS: The overall incidence of facet joint asymmetry was significantly higher in the juvenile group (12 levels, 41%) than in the adult group (four levels, 8%; P < 0.01). There were no significant relationships among the facet joint asymmetry, the location, type of disc herniation, and disc degeneration. CONCLUSIONS: This study revealed that the frequency of facet joint asymmetry in the juvenile group was five times higher than that in the adult group. This result indicates that facet joint asymmetry is a radiologic feature of lumbar intervertebral disc herniation in children and adolescents.     

Lumbar disk prolapse. Alcohol, tobacco and prognosis

The aim of the study was to examine whether smoking or the intake of different alcoholic beverages are associated with the outcome after first time lumbar disc surgery. One hundred and forty-eight patients consecutively operated upon for lumbar disk herniation over a one-year period were classified according to various social and demographic variables. Two and a half years later they were asked about their drinking and smoking habits and the outcome of the operation was assessed using a rating scale. Results showed that intake of wine, but not other alcoholic drinks, was associated with a good prognosis. Logistic regression analysis calculated that intake of wine was associated with a fourfold increase in success rate. This odds ratio was not significantly reduced by the following variables: Age, sex, smoking habits, employment status, social class, household income or marital status. In conclusion, intake of wine was associated with a good prognosis after lumbar discectomy.     

Prolapsed cervical intervertebral disk in professional drivers in Denmark 1981-1990

The aim of this study was to estimate the risk of being hospitalized due to prolapsed cervical interverteral disc among male professional drivers in Denmark. A cohort consisting of all economically active persons in Denmark, identified January 1981, gives information on the most important occupation during 1980. The cohort was followed for ten years. Additional data on occupational exposures were extracted from a national survey. Occupational groups such as bus and taxi-cab drivers were found to have an increased risk, of cervical prolapse as did the group of professional drivers as a whole.     

Radiological case of the month. Childhood intervertebral disk calcification

BACKGROUND: Cisplatin is an active drug in head and neck cancer. Paclitaxel seems a promising drug. This article reports a phase II assessment of the combination of the two. PATIENTS AND METHODS: Twenty-three patients were treated with paclitaxel 90 mg/m2 over three hours plus cisplatin 60 mg/m2 every other week. Sixteen patients had locoregional disease and seven had metastatic disease. None of the patients had previously been treated with chemotherapy. Nine patients had had radiotherapy to the target lesions. RESULTS: One patient was not evaluable for response. Partial responses were observed in 32% of evaluable patients. Toxicity included asthenia (56%), neutropenia, peripheral neuropathy, anemia and vomiting. CONCLUSIONS: The overall response rate observed in this study does not seem to justify the use of this chemotherapy regimen in the palliative setting.     

Body mass index and height in patients requiring surgery for lumbar intervertebral disc herniation

The immediate preoperative body mass index and standing body height of 1128 patients who underwent surgery for lumbar intervertebral disc herniation were compared in a cross-sectional study with the corresponding values obtained from a general population sample. The material was divided into sex- and age-specific subgroups. To delineate possible differences, the 99% confidence intervals for the anthropometric mean values were constructed instead of hypothesis testing. With the exception of the oldest age group, from 50 to 59 years, the patients who underwent surgery for a disc herniation were more obese and taller than the population on average in all other sex- and age-specific subgroups. The major contrast emerged in women aged 20-29 years, in whom the 99% confidence interval for the mean body mass index of the patients undergoing surgery on was 25.1-27.3 kg/m2 versus 22.3-23.1 kg/m2 in the general population. In patients aged 20-39 years the mean body mass index was increased also when the body height of the patients was less than the mean value of the general population samples. Both an increased body mass index and a tall stature seem to have a clear association with those severe lumbar intervertebral disc herniations that require operative treatment.     

Lumbar disc herniation: social and demographic factors determining duration of disease

Carcinoma of the oral cavity in patients less than thirty years of age is quite uncommon. Moreover, the usual tobacco and alcohol exposure is not found in these patients. We reviewed retrospectively the medical files of 7 patients with squamous cell carcinoma of the oral cavity treated between 1980 and 1993. Six patients were male. Mean age was 26 years. The primary site was staged T1 in 2 patients, T2 in 3 patients, T3 in 1 patient and T4 in 1 patient. The results of treatment suggest that there is no difference in control rate between this group and older patients. It is difficult to draw conclusions from most of published reports because studies often include patients up to fourty years of age and tumors of various anatomic sites. Young age and alcohol and tobacco exposure do not appear significant factors of prognosis.     

Progressive scoliosis with vertebral rotation after lumbar intervertebral disc herniation in a 10-year-old girl

A case report of a 10-year old girl with a herniated disc is presented. The most significant symptoms were progressive scoliosis with a flat back and paravertebral muscle spasm. An absent H reflex on the left and an increased latency of the somatosensory-evoked potentials of the left posterior tibial nerve were found. The computed tomographic scan of the lumbar spine showed a large central left-sided disc protrusion at the L5-S1 level. Our case presents the youngest patient with documented intervertebral disc herniation and the only one with severe scoliosis and vertebral rotation. The curve was not structural because it improved with surgery and an orthosis was not necessary.