Intervertebral disc herniation

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

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... 

It is indicated in spasticity due to neurological disorders e.g., multiple sclerosis, chronic myelopathy, degenerative diseases of the spinal cord, cerebrovascular accidents and cerebral palsy painful muscle spasm associated with static and functional disorders of the spine (cervical and lumbar syndromes) painful muscle spasm following surgery e.g., for herniated intervertebral disc or for osteoarthritis of the hip. 

S Spinal Surgery (Emphasis to Correct Herniated Intervertebral Discs) in the Rabbit... 

Extension traction on the intervertebral disc can result in anterior separation of the annulus fibrosis from the vertebral endplate and is associated with rupture of the anterior longitudinal ligament. With axial loading the disc material can herniated through the endplates in older children resulting in acute Schmorl s node lesions. 

The intervertebral disc in the paediatric spine has greater resistance to herniation. Therefore, there is a tendency to compression fracture with flexion and axial loading. Simple compression fractures are stable and heal satisfactorily. With severe axial loading, burst fractures can occur. The posterior vertebral line is a useful sign to assess this injury. There is retropulsion into the spinal canal vfliich can be satisfactorily assessed on CT. MR imaging is optimal for the effects of the retropulsion on cord and nerve roots. Compression and burst fractures are discussed in detailed in Sections 20.7.1.2 and 20.7.1.4. 

Any pathology that affects the spinal cord or its nerve roots can create low back pain. Common problems are herniation of an intervertebral disc, degenerative arthritis, congenital osseous changes, or neoplasm. When the nerve root becomes involved, as in a herniated disc, the symptoms may include pain and loss of function of the muscles of the extremity involved. 

R.T. was a 48-year-old man who came to the clinic with a report of numbness and "pins and needles" in his right forearm and hand. This had been present for several months. He gave a history of an automobile accident approximately 1 year previously. He had undergone an MRl 1 month previously that demonstrated a herniation ofthe intervertebral disc between C6-C7, with apparent impingement on the foramen. He had a history of a mild elevation of his blood pressure, which was controlled with verapamil. He had been scheduled for surgery for the cervical disc for the following week and requested that a trial of manipulation be performed in an attempt to prevent surgery. 

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. 

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