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.     

Lumbar intervertebral disk herniation in children

A consecutive series of 16 children from 9 to 18 years old, with lumbar intervertebral disc herniation who were treated surgically in Department of Neurosurgery Medical Academy in Poznań, between 1978-1992, was analysed. The clinical symptoms, X-ray assessment, type of operation and outcome are reviewed. In our analysis characteristic features of disc herniation in children are: the onset of pain due to violent injury in relation to lifting, bilateral neurological symptoms and radiculography imaging central intervertebral disc herniation.     

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.     

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.     

Intraoperative and laparoscopic ultrasound

The instruments, techniques, clinical applications and results, advantages and limitations of intraoperative ultrasound (IOUS) and laparoscopic ultrasound (LUS) in general surgical oncology are presented based on our experiences and review of publications. IOUS provides remarkable benefits in acquisition of accurate diagnostic information, particularly in tumor staging and resectability, and thereby in intraoperative decision making during hepatobiliary, pancreatic, and endocrine surgery. In addition, various surgical procedures are guided or assisted by IOUS. A latest modality of IOUS is LUS, which can provide similar valuable information and compensate for the limitation of laparoscopy. LUS will demonstrate great promise as an adjunct to laparoscopic exploration or surgery.     

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.     

Foraminal and extraforaminal lumbar disk herniations

Thirteen patients with foraminal or extraforaminal lumbar disk herniation were treated during a 32-month period. Myelography and magnetic resonance imaging proved to be ineffective in identifying the lesion in most patients. High-resolution computed tomography demonstrated the lesions in all patients, and the findings were subsequently confirmed at surgery. Surgical treatment consisting of disk fragment removal and nerve root decompression was effective in relieving radicular pain.     

Aging and degeneration in the lumbar intervertebral disc

1. The maintenance of the nucleus pulposus matrix in the adult human disc is dependent on the functional integrity of the cartilage end plate cells. 2. Cartilage end plate senescence is followed by compensatory cartilaginous metaplasia of annulus fibrosus cells. 3. It is proposed that disc narrowing and collapse are related to metabolic failure of matrix production by end plate and annulus fibrosus cells. 4. Calcium pyrophosphate dihydrate crystal deposits, a visible manifestation of a metabolic abnormality, are found frequently in the annulus fibrosus and cartilage end plates of elderly patients with degenerative disc disease.     

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.