Disc herniation

G. D. Ticgonfilng, E. E. Transfeldt, I. A. McCulloch, L Macnab,and A. Nacbennon. Chymopapain versus conventional surgery for lumbw disc herniation. 10-Yenr results of treatment../. Bone Joint Surg- 73BMI (1991). 

H, Weber. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spin ft 131 (1983). 

K. P. Muralikuilan, A. Hamilton. W. G. Kemohan, R. A. B. Mollan. and L V. Adair. A prospective randomized trial of chemonucleolysis and conventional disc surgery in single level lumbar disc herniation. Sptne 77.381 (1992). 

Y. Takeuaka, M- Bevd, A. Kalian, and B. Amur- Experimental model of disc herniation in rats for study of flucleolytic drugs. Spine 72 556 (1967). 

A report on malpractice suits in the USA has shown that in 1990-96 claims against chiropractors have been constant (between 2.3 and 3.0 claims per 100 policy holders per year) (152). There were about four times more claims against primary care physicians. The percentage of claims paid varied between 46 and 57% for the chiropractors and 29 and 33% for the physicians. The three most frequent reasons for the claims against chiropractors were disc herniation, failure to diagnose, and bone fractures produced through treatment. 

Muramatsu K, Hachiya Y, Morita C. Postoperative magnetic resonance imaging of lumbar disc herniation comparison of microendoscopic discectomy and Love s method. Spine 2001 26(14) 1599-605. 

W. C. Watters, S. Mirkovic, and J. Boss. Treatment of the isolated lumbar intervertebral disc herniation microdisectomy versus chemonucleolysis. Spine 75 360 (1988). 

A. Toumade, Z. Patay, T. Tajahmady, J. P. Braun, S. Million, and G. Schmutz. Contribution of discography to the diagnosis and treatment of lumbar disc herniation. J. Neuroradiol. 78 1 (1991). 

Indications Chronic bi patterns, liver/kidney dual deficiency, qi and blood insufficiency. Chronic rheumatoid arthritis, osteoarthritis, rheumatic sciatica, lumbar strain, lumbar intervertebral disc herniation, pain in the midline and back during pregnancy, hemiplegia due to stroke, and the sequelae of poliomyelitis... 

Hatano E, Fujita T, Ueda Y, Okuda T, Katsuda S, Okada Y, Matsumoto T. Expression of ADAMTS-4 (aggrecanase-1) and possible involvement in regression of lumbar disc herniation. Spine 2006 31 1426-1432. 

Leinonen, V., Kankaanpaa, M., Luukkonen, M, Kansanen, M., Hanninen, O., Airaksinen, O., and Taimela, S. 2003. Lumbar paraspinal muscle function, perception of lumbar position, and postural control in disc herniation-related back pain. Spine 28 842-848. 

Koike, Y., UzuM, M., Kokubun, S., Sawai, T. Angiogenesis and inflammatory cell infiltration in lumbar disc herniation. Spine (Phila Pa 1976) 28,1928—1933 (2003)... 

Yorimitsu E., K. Chiba, Y. Toyama, and K. Hirabayashi. 2001. Long-term outcomes of standard discectomy for lumbar disc herniation A follow-up study of more than 10 years. Spine 26 652-657. 

Type I fractures are commonly seen in children. These children present with symptoms suggestive of disc herniation. Whilst other authors have sug-... 

Isolated anterior column compression fractures do not result in neurological injury. Neurological injury in this setting should raise the suspicion of associated disc herniation. With compressions greater than 50 degrees, the middle column acts as a fulcrum and can lead to posterior ligamentous injuries. 

Fig. 40.18. Lateral FD-dataset derived MPR of massive Irnnbar inter-vertebal disc herniation, transversal MPR parallel to the lower vertebral endplate. Minimal D-CSA and D-CSD levels were measured...

A posterolateral herniation is most common. In the lumbar region, the most common disc herniations occur at L5-S1 or L4-L5. These account for approximately 95% of all lumbar disc herniations. Most serious is the impingement of the cauda equina in the lower spinal canal or the spinal cord at a higher level leading to cauda equina syndrome. Bowel and/or bladder dysfunction, paresis, or paralysis may result... 

Hypertonicity or spasm of the piriformis muscle may cause irritation of the sciatic nerve, sometimes to the point of causing neuritis. Although the sciatic nerve most typically passes inferior to the piriformis, normal variants exist with its passage through or posterior to the piriformis muscle. The sciatic involvement often causes confusion between piriformis syndrome and a disc herniation. 

Magnetic resonance imaging (MRI) MRI is useful in identifying soft tissue injury or herniation of an intervertebral disc. It need not be performed for every suspected disc herniation unless the finding of such will change the treatment plan for the patient. 

Technical Standards J. Hankinson The Surgical Treatment of Syringomyelia. — F. Loew and W. Caspar Surgical Approach to Lumbar Disc Herniations. — B. Pertuiset, D. Fohanno, and O. Lyon-Caen Recurrent Instability of the Cervical Spine With Neurological Implications— Treatment by Anterior Spinal Fusion. 

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