Influences of spinal decompression therapy and general traction therapy on the pain,disability, and straight leg raising of patients with intervertebral disc herniation

[Purpose] The purpose of this study was to identify how spinal decompression therapy and general traction therapy influence the pain, disability, and straight leg raise (SLR) ability of patients with intervertebral disc herniation. [Subjects] The subjects were 30 patients with chronic lumbar pain who were divided into a spinal decompression therapy group (SDTG, n=15), and a general traction therapy group (GTTG, n=15). [Methods] The SDTG used a spinal decompression device, and the GTTG used a lumbar traction device. Both groups received conservative physical therapy three times a week for four weeks. A visual analog scale (VAS) was used to measure the degree of pain the patients with chronic lumbar pain. The Oswestry Disability Index (ODI) was used to measure the degree of functional disability. A goniometer was used to measure the patients’ SLR ability. [Results] Both SDTG and GTTG showed statistically significant decreases in VAS and ODI scores and a statistically significant increase in SLR angle. A comparison of the two groups found no statistically significant differences. [Conclusion] Spinal decompression therapy and general traction therapy are effective at improving the pain, disability, and SLR of patients with intervertebral disc herniation. Thus, selective treatment may be required.Key words: Spinal decompression therapy, Pain, Straight leg raise     

Clinical diagnosis and treatment of a patient with low back pain using the patient response model: A case report

The medical management of low back pain (LBP) can be approached in a multitude of ways. Classification via subgrouping is increasingly common in orthopedic literature. Clinical diagnosis and treatment of LBP using the patient response model (PRM) can assist clinicians in hypothesizing the origin of pain and providing beneficial interventions unlike the widely used pathoanatomical model. This case report involved a 52-year-old female with sudden onset of right-sided LBP that radiated to the foot. These symptoms were accompanied by occasional paresthesias in bilateral lower extremities. Magnetic resonance imaging (MRI) confirmed disc bulges at levels T11-T12 and T12-L1. On the first of seven visits, she reported 9/10 on the Numeric Pain Rating Scale (NPRS), scored a 24/50 on the modified Oswestry disability index (mODI), and demonstrated lumbar flexion range of motion (ROM) of 10°. Using the PRM, the patient was classified as an extension responder and was instructed to perform 10 repetitions of standing lumbar extension every 2 waking hours. After 4 weeks of therapy, the patient reported a 1/10 pain localized to the low back, scored 20/50 on the mODI, and improved flexion ROM to 45°. Classification using the PRM yielded positive outcomes with this patient’s symptoms and daily function.     

穴位按摩联合早期功能锻炼对腰椎间盘突出症患者术后疼痛的影响

目的 探讨穴位按摩联合早期功能锻炼对腰椎间盘突出症患者术后疼痛的影响.方法 采取简单随机对照法将50例腰椎间盘突出症术后患者分成两组,对照组采用术后常规护理、心理指导、分散注意力、适时应用镇痛药的方法,试验组在对照组方法的基础上采用穴位按摩和早期功能锻炼对术后疼痛进行护理,每6h对所有入组患者进行疼痛评估1次.比较两组患者疼痛程度和应用止痛药物的差别.结果 术后0～6h,两组的疼痛指数差异无统计学意义(P＞0.05),而在术后6～48h,试验组的疼痛指数较对照组低,使用止痛药的级别和例数均较对照组低,差异有统计学意义(P＜0.05).结论 穴位按摩联合早期功能锻炼能有效减轻腰椎间盘突出症术后患者的疼痛,并可明显减少止痛药物的使用.     

Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study

The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and cognitive intervention and exercises. Sixty patients aged 25-60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment (n=5) or changed groups (n=2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after cognitive intervention and exercises. The mean difference between treatments after adjustment for gender was -7.3 (95% CI -17.3 to 2.7, p=0.15). The success rate was 50% in the fusion group and 48% in the cognitive intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over cognitive intervention and exercises.     

T2-3 Thoracic disc herniation with myelopathy

We report a case of thoracic disc herniation in a 53-year-old woman who presented to the Emergency Department (ED) with a 2-week history of acute lower back numbness and intermittent fecal incontinence. On examination, she had lower extremity hyperreflexia, an abnormal gait, and lower lumbar pain but lacked any radicular findings. A magnetic resonance imaging scan revealed a large focal paracentral herniated disc at the T2-3 level. The patient underwent successful T2-3 anterior discectomy with T2-3 rib autograft fusion. Nine months after surgery her weakness and gait had improved, but she continued to have recurrent intermittent fecal incontinence. Thoracic disc herniation is an uncommon, but treatable cause of spinal cord compression. Prompt recognition and early treatment are the keys to preventing permanent neurologic sequelae.     

三种功能障碍评估量表在麦肯基疗法治疗腰椎间盘突出症疗效评估中的应用

目的：探讨三种功能障碍评估量表在麦肯基疗法治疗腰椎间盘突出症疗效评估中的应用。方法：腰椎间盘突出症患者42例,均进行麦肯基疗法治疗。治疗前后采用简式 McGill疼痛问卷（SF-MPQ）、中文版Oswestry功能障碍指数（CODI）、汉译Roland-Morris功能障碍调查表（CRMDQ）进行评定。结果：治疗2周后,42例患者的SF-MPQ、CODI、CRMDQ评分均较治疗前明显下降（P＜0．01）。结论：麦肯基疗法可有效改善腰椎间盘突出症患者的疼痛和功能障碍;SF-M PQ、CODI及CRMDQ等功能障碍评估量表可有效地应用于评估腰椎间盘突出症患者疼痛及功能状态的临床工作中。     

瑞士球运动治疗对腰椎间盘突出症患者疼痛和肌力的影响

目的:探讨瑞士球运动康复治疗对腰椎间盘突出症患者临床疗效和腰椎稳定性的影响。方法:30例非急性期腰椎间盘突出症患者,按性别和就诊次序依次分成对照组和运动组。选用Roland-Morris问卷（RMQ）和视觉模拟疼痛评分（VAS）,在治疗前、2周后和4周后分别进行疼痛、腹、腰背肌力评定。运动组采用瑞士球运动治疗和牵引治疗。对照组采用牵引治疗。结果:与治疗前相比,对照组和运动组4周后 RMQ 和VAS评分显著降低（P<0.05,P<0.01）;与对照组相比,运动组2周后、4周后的RMQ和VAS评分显著降低（P<0.05,P<0.01）。与对照组相比,运动组2周后、4周后腹、腰背肌力增强（P<0.05,P<0.01）。结论：瑞士球运动治疗结合腰椎牵引能显著缓解腰椎间盘突出症患者腰腿痛症状,增强腹、腰背肌力和腰椎的稳定性。     

中医取穴干预联合Pilates运动操对腰椎间盘突出症患者腰椎功能与疼痛程度的影响

目的探讨中医取穴干预联合Pilates运动操对腰椎间盘突出症患者腰椎功能与疼痛程度的影响。方法选择我院2018年1月至2019年3月收治的腰椎间盘突出症患者70例,随机等分为对照组与观察组,对照组采用常规护理,观察组采用中医取穴干预联合Pilates运动操,比较两组患者腰椎Oswestry功能障碍程度及疼痛程度。结果观察组患者腰椎Oswestry功能障碍程度轻于对照组(P<0.05),疼痛程度轻于对照组(P<0.05)。结论中医取穴干预联合Pilates运动操在腰椎间盘突出症患者中的应用,能缓解腰椎功能障碍及疼痛不适。     

Computed tomographic evaluation of lumbar spinal structures during traction

In the previous studies, it is reported that traction diminishes the compressive load on intervertebral discs, reduces herniation, stretches lumbar spinal muscle and ligaments, decreases muscle spasm, and widens intervertebral foramina. The aim of this study was to evaluate the effects of horizontal motorized static traction on spinal anatomic structures (herniated area, spinal canal area, intervertebral disc heights, neural foraminal diameter, and m.psoas diameter) by quantitative measures in patients with lumbar disc herniation (LDH). At the same time the effect of traction in different localizations (median and posterolateral herniation) and at different levels (L4-L5 and L5-S1) was assessed. Thirty two patients with acute LDH participated in the study. A special traction system was used to apply horizontally-motorized static lumbar traction. Before and during traction a CT- scan was made to observe the changes in the area of spinal canal and herniated disc material, in the width of neural foramina, intervertebral disc heights, and in the thickness of psoas muscle. During traction, the area of protruded disc area, and the thickness of psoas muscle decreased 24.5% (p = 0.0001), and 5.7% (p = 0.0001), respectively. The area of the spinal canal and the width of the neural foramen increased 21.6% (p = 0.0001) and 26.7% (p = 0.0001), respectively. The anterior intervertebral disc height remained unchanged with traction however the posterior intervertebral disc height was significantly expanded. This study is the first to evaluated in detail and quantitatively the effect of motorized horizontal lumbar spinal traction on spinal structures and herniated area. According to detailed measures it was concluded that during traction of individuals with acute LDH there was a reduction of the size of the herniation, increased space within the spinal canal, widening of the neural foramina, and decreased thickness of the psoas muscle.     

麦肯基疗法联合腰部核心肌力训练治疗腰椎间盘突出症的疗效观察

目的:观察麦肯基疗法联合腰部核心肌力训练治疗腰椎间盘突出症(LDH)的临床疗效。方法:80例LDH患者随机分为对照组与观察组各40例,2组患者均给予常规康复治疗,包括牵引、超短波治疗等;观察组增加麦肯基疗法与腰部核心肌力训练,均接受4周治疗,并分别于治疗前后选用Oswestry下腰背功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)及临床疗效进行评定。结果:治疗4周后,2组患者ODI及VAS评分较治疗前均有降低(P<0.05),且观察组较对照组评分更低(P<0.05);治疗后2组临床疗效比较,观察组总有效率明显优于对照组(92.50%,77.50%,P<0.05)。结论:麦肯基疗法联合腰部核心肌力训练治疗腰椎间盘突出症有更好的疗效,治疗周期短且见效快,值得临床推广应用。     

Sciatic neuropathy secondary to a uterine fibroid: a case report

Lesions of the sciatic nerve outside the pelvis have been well described. Lesions within the pelvis, however, are far less common. We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling. She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. A subsequent magnetic resonance image of the lumbosacral spine revealed multilevel disc degeneration at L3-4 through L5-S1, without disc herniation or canal stenosis. A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen. The patient underwent a subtotal abdominal hysterectomy, with resolution of her right lower limb pain. This case illustrates the importance of considering intrapelvic causes of sciatic neuropathy. To our knowledge, this is the first reported case of sciatic neuropathy secondary to a uterine fibroid.     

Comparison of two mobilization techniques in management of chronic non-specific low back pain

AimThe aim of the study was to compare between the effects of Maitland's postero-anterior (PA glide) mobilization and Mulligan's sustained natural apophyseal glide (SNAG) on pain, mobility, muscle activation and functional disability in subjects with chronic, non-specific low back pain.MethodsThe study was a two arm repeated measure design with random allocation of subjects (n = 33). Subjects in group 1 received Maitland's PA glide mobilization and those in group 2 received Mulligan's SNAG. Along with the respective mobilization technique, individualized exercises were common for subjects in both the groups. Subjects in both groups received treatment for 4 days a week for 4 weeks. The outcome measures were numeric pain rating scale (NPRS) scores, lumbar flexion and extension range of motion, erector spinae muscle activity and Oswestry low back pain disability questionnaire score.ResultsThe outcome measure scores showed statistical significance in time effect on NPRS (p = 0.001); lumbar flexion and extension range of motion (p = 0.001); erector spinae muscle activity (0.001); Oswestry low back pain disability questionnaire score (p = 0.001); group effect on lumbar flexion (p = 0.03) and extension range of motion (p = 0.05); and interaction effect (time x group) on lumbar flexion (p = 0.003) and extension range of motion (p = 0.002); and, erector spinae muscle activity (p = 0.05) at the 3rd lumbar vertebral level.ConclusionThe addition of Maitland or Mulligan mobilization techniques of the spine does not show a difference in the improvement of symptoms associated with chronic non-specific low back pain.     

The Effects of Stretching with Lumbar Traction on VAS and Oswestry Scales of Patients with Lumbar 4–5 Herniated Intervertebral Disc

[Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4–5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4–5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4–5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4–5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4–5 HIVD patients.Key words: HIVD, Lumbar traction, Stretching     

Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation

OBJECTIVE: To describe the nonsurgical treatment of acute S1 radiculopathy from a large (12 x 12 x 13 mm) L5-S1 disk herniation. CLINICAL FEATURES: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. His symptoms began 5 days before the initial visit and progressed despite nonsteroidal anti-inflammatory drugs and analgesic medication. An absent left Achilles reflex, left S1 dermatome hypesthesia, and left gastrocnemius/soleus weakness was noted. Magnetic resonance imaging demonstrated a large L5-S1 disk herniation. INTERVENTION AND OUTCOME: Initial treatment of this patient included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy. Counseling was provided to reduce abnormal illness behavior risk. Later, flexion distraction and side-posture manipulation were provided to improve joint function. Sensory motor training, trunk stabilization exercises, and trigger point therapy were also used. He returned to modified work 27 days after symptom onset. A follow-up, comparative magnetic resonance imaging (MRI) study was unchanged. He was discharged as symptomatic (zero rating on both the Oswestry and numerical pain scales) after 50 days and 20 visits, although the left S1 reflex remained absent. Reassessment 169 days later revealed neither significant symptoms nor lifestyle restrictions. CONCLUSION: This case demonstrates the potential benefit of a chiropractic rehabilitation strategy by use of multimodal therapy for lumbar radiculopathy associated with disk herniation.     

The clinical effect of herbal magnetic corsets on lumbar disc herniation

OBJECTIVE: To determine the clinical effects of the treatment of lumbar disc herniation with herbal magnetic corsets. DESIGN: A randomized control trial. SETTING: The outpatient and inpatient departments of the Rehabilitation Center of the West China Hospital. PATIENTS: Sixty patients with clinically diagnosed lumbar disc herniation were included in the study. INTERVENTIONS: Both groups received lumbar traction, medium frequency electrotherapy and massage, whereas the experimental group wore herbal magnetic corsets in addition. MAIN OUTCOME MEASURES: Pain and lumbar function were assessed before treatment and at one week, two weeks and four weeks after intervention. RESULTS: Both groups reported improvements in pain and lumbar function after treatment (P 0.05 or P 0.001). However, the experimental group reported gradually increasing relief over time leading to a better curative effect than observed in the control group (P 0.05 for visual analogue scale or P 0.001 for lumbar function). CONCLUSION: Herbal magnetic corsets can facilitate the reduction of pain caused by lumbar disc herniation and can improve lumbar function. This is a safe and effective non-operative therapeutic option for treatment of lumbar disc herniation.     

腰椎间盘突出症患者治疗依从性的影响因素分析

目的通过问卷调查了解腰椎间盘突出患者治疗的依从性,分析其治疗依从性的影响因素,探讨提高患者治疗依从性的方法。方法参考有关文献及量表设计腰椎间盘突出症患者服药及功能锻炼依从性问卷调查表。对304例腰椎间盘突出症患者的治疗依从性及其影响因素进行分析。结果腰椎间盘突出症患者中服药高度依从患者占22.70%,低度依从患者占37.83%。功能锻炼高度依从患者占20.39%,低度依从患者占30.26%。年龄、学历、腰痛、下肢疼痛或麻木、肌力等级是影响患者服药依从性的重要因素(P<0.05)。年龄、学历、家庭月收入、腰痛、下肢疼痛或麻木、肌力等级、病因及发病机制解释、功能锻炼方法介绍是影响患者功能锻炼依从性的重要因素(P<0.05)。结论腰椎间盘突出症患者服药和功能锻炼依从性均较差,对低收入、文化程度较低的患者应强调功能锻炼必要性和有效性,而对收入较高、文化程度较高的患者应加强按医嘱服药的宣教。     

空心椎弓根螺钉置入结合小切口后路腰椎融合治疗腰椎间盘突出症

背景：经皮椎弓根螺钉技术的优点在于可有效减少置钉操作对椎旁肌的过度损伤,有利于患者术后的腰背肌功能恢复,其微创技术操作可避免传统开放手术创伤大,出血多等缺陷。可折断U形长尾空心椎弓根螺钉为中空设计,撑开效果良好,内固定后应力强度、压缩时间、弯曲刚度和扭转力学性能均得到临床验证。目的：观察可折断U形长尾空心椎弓根螺钉系统置入结合小切口后路腰椎椎体间融合治疗单节段腰椎间盘突出症的临床效果。方法：纳入2012年1至12月间因腰椎间盘突出症接受可折断U形长尾空心椎弓根螺钉系统置入结合小切口后路腰椎椎体间融合治疗的患者30例。术后随访12个月,通过患者腰腿疼目测类比评分、Oswestry功能障碍指数以及影像学指标评估临床治疗效果。结果与结论：患者术前目测类比评分及Oswestry功能障碍指数分别为（7.3±0.7）分和71.4±7.1;术后第3天分别为（2.9±0.7）分和29.8±3.6,与术前相比差异有显著性意义;至术后12个月时,低水平目测类比评分及Oswestry功能障碍指数未发生显著改变。术后短时间随访发现,病例术后1年椎间融合良好,无内固定失败或感染等并发症发生。提示可折断U形长尾空心椎弓根螺钉系统置入结合小切口后路腰椎椎体间融合治疗腰椎间盘突出症的临床效果良好,椎间融合率高,手术并发症发生率低,创伤小。     

Spontaneous regression of a large sequestered lumbar disc herniation: a case report and literature review

Lumbar disc herniation is a common disorder in adults that is accompanied by lower back and radicular pain. A 32-year-old man visited our clinic with 1-week history of persistent lower back pain and weakness in his right big toe. Magnetic resonance imaging (MRI) of his lumbar spine revealed herniated discs at L3/L4, L5/S1 and L4/L5, where a right-sided intraspinal mass lesion deep to the L4 vertebral body was causing compression of the nerve root. The patient underwent conservative treatment and reported no symptoms referrable to his back or leg 4 months later. Follow-up MRI showed no herniation of the nucleus pulposus at the L4/L5 level or lesion deep to the vertebral body of L4, whereas no changes had occurred to the status of the herniated L3/L4 and L5/S1 discs. The present case and a literature review show that a sequestered lumbar disc herniation can regress within a relatively short timeframe without surgery. The authors emphasise the utility of conservative therapy for patients who do not have a definitive surgical indication.