Two-level percutaneous endoscopic lumbar discectomy for highly migrated upper lumbar disc herniation: A case report

BACKGROUND The technique of percutaneous endoscopic lumbar discectomy(PELD)as a transforaminal approach has been used to treat highly migrated lower lumbar disc herniations.However,due to the different anatomic characteristics of the upper lumbar spine,conventional transforaminal PELD may fail to remove the highly migrated upper lumbar disc nucleus pulposus.Therefore,the purpose of this study was to describe a novel surgical technique,two-level PELD,for the treatment of highly migrated upper lumbar disc herniations and to report its related clinical outcomes.CASE SUMMARY A 60-year-old male presented with a complaint of pain at his lower back and right lower limb.The patient received 3 mo of conservative treatments but the symptoms were not alleviated.Physical examination revealed a positive femoral nerve stretch test and a negative straight leg raise test for the right leg,and preoperative visual analog scale(VAS)score for the lower back was 6 points and for the right leg was 8 points.Magnetic resonance imaging(MRI)demonstrated L2-L3 disc herniation on the right side and the herniated nucleus pulposus migrated to the upper margin of L2 vertebral body.According to physical examination and imaging findings,surgery was the primary consideration.Therefore,the patient underwent surgical treatment with two-level PELD.The pain symptom was relieved and the VAS score for back and thigh pain was one point postoperatively.The patient was asymptomatic and follow-up MRI scan 1 year after operation revealed no residual nucleus pulposus.CONCLUSION Two-level PELD as a transforaminal approach can be a safe and effective procedure for highly migrated upper lumbar disc herniation.     

Lumbar disc sequestration mimicking a tumor: Report of four cases and a literature review

BACKGROUNDDisc herniation refers to the displacement of disc material beyond its anatomical space. Disc sequestration is defined as migration of the herniated disc fragment into the epidural space, completely separating it from the parent disc. The fragment can move in upward, inferior, and lateral directions, which often causes low back pain and discomfort, abnormal sensation, and movement of lower limbs. The free disc fragments detached from the parent disc often mimic spinal tumors. Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors, such as lumbar soreness, pain, numbness and weakness of lower limbs, radiation pain of lower limbs, etc. It is usually necessary to diagnose the disease according to the doctor''s clinical experience, and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging (MRI) and contrast-enhanced MRI. However, pathological examination is the gold standard that distinguishes tumoral from non-tumoral status. We report four cases of disc herniation mimicking a tumor, and all the pathological results were intervertebral disc tissue.CASE SUMMARYThe first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year, with exacerbation over the last 2 wk. After admission, MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment, with enhancement on contrast-enhanced MRI suggesting neurilemmoma. The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years, with exacerbation over the last 3 mo. MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4–5 level, with obvious peripheral enhancement on contrast-enhanced MRI. Thus, neurilemmoma was suspected. The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk. MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4–5 level, with obvious rim enhancement on contrast-enhanced MRI. Thus, a spinal tumor was suspected. The fourth case was a 75-year-old man with right lower extremity pain for 2 wk, with exacerbation over the last week. MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion. There was no obvious enhancement on contrast-enhanced MRI, so a spinal tumor was suspected. All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5, 8, 8, and 6, respectively. All patients had an uneventful postoperative course and fully recovered within 3 mo.CONCLUSIONDisc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor. Examinations and tests should be improved preoperatively. Patients should undergo comprehensive preoperative evaluations, and the lesions should be removed surgically and confirmed by pathological diagnosis.     

椎间盘突出临近退变节段是否导致腰痛

背景:椎间盘突出症患者腰痛原因很难判断,一直以来,认为突出的椎间盘是椎间盘突出症患者腰痛及腿痛重要原因,椎间盘突出临近退变节段是否导致腰痛需进一步研究证实.目的:通过椎间盘造影判断突出临近退变节段是否是椎间盘突出症患者腰痛原因,并报告经椎间盘镜摘除椎间盘后残留腰痛在临近退变疼痛椎间盘经亚甲蓝注射治疗的效果.方法:20例同时具有腰痛和腿痛椎间盘突出症患者行椎间盘造影检查,这些患者腰椎MRI表现为有1个突出椎间盘外至少合并1个或1个以上的临近退变的椎间盘,全部患者均经椎间盘镜摘除椎间盘切除突出的椎间盘,5例临近退变椎间盘造影阳性患者在椎间盘镜切除后经椎间盘内注射亚甲蓝治疗.腰痛、腿痛采用目测类比评分评定.结果与结论:20例患者总共64个椎间盘行椎间盘造影,共11个椎间盘造影阳性,其中6个位于椎间盘突出临近退变节段,5个位于引起神经根性痛的椎间盘突出节段.全部病例腿痛行椎间盘镜切除突出椎间盘后明显缓解,腰痛有部分缓解,6例临近椎间盘造影阳性患者经椎间盘镜摘除椎间盘后腰痛明显,影响日常生活,其中5例行临近疼痛椎间盘亚甲蓝注射后腰痛缓解,1例患者拒绝亚甲蓝注射治疗仍有明显腰痛.结果显示椎间盘突出症患者腰痛可能来源于突出临近退变节段.     

椎间盘突出临近退变节段是否导致腰痛

背景：椎间盘突出症患者腰痛原因很难判断,一直以来,认为突出的椎间盘是椎间盘突出症患者腰痛及腿痛重要原因,椎间盘突出临近退变节段是否导致腰痛需进一步研究证实。目的：通过椎间盘造影判断突出临近退变节段是否是椎间盘突出症患者腰痛原因,并报告经椎间盘镜摘除椎间盘后残留腰痛在临近退变疼痛椎间盘经亚甲蓝注射治疗的效果。方法：20例同时具有腰痛和腿痛椎间盘突出症患者行椎间盘造影检查,这些患者腰椎MRI表现为有1个突出椎间盘外至少合并1个或1个以上的临近退变的椎间盘,全部患者均经椎间盘镜摘除椎间盘切除突出的椎间盘,5例临近退变椎间盘造影阳性患者在椎间盘镜切除后经椎间盘内注射亚甲蓝治疗。腰痛、腿痛采用目测类比评分评定。结果与结论：20例患者总共64个椎间盘行椎间盘造影,共11个椎间盘造影阳性,其中6个位于椎间盘突出临近退变节段,5个位于引起神经根性痛的椎间盘突出节段。全部病例腿痛行椎间盘镜切除突出椎间盘后明显缓解,腰痛有部分缓解,6例临近椎间盘造影阳性患者经椎间盘镜摘除椎间盘后腰痛明显,影响日常生活,其中5例行临近疼痛椎间盘亚甲蓝注射后腰痛缓解,1例患者拒绝亚甲蓝注射治疗仍有明显腰痛。结果显示椎间盘突出症患者腰痛可能来源于突出临近退变节段。     

腰椎间盘退变MRI:与Modic改变相关的影像学分析

背景:部分椎间盘源性下腰痛患者MRI可出现Modic改变,但Modic改变的相关因素及Modic改变与椎间盘退变之间因果关系目前尚不十分清楚。目的:分析存在腰椎间盘Modic改变的下腰痛患者性别、年龄分布特点及腰椎间盘发生Modic改变的相关因素。方法:回顾性分析634例(2536个椎间盘)存在腰椎间盘Modic改变患者的性别、年龄分布特点,并分析腰椎间盘Modic改变与椎间盘突出或膨出、Schmorl结节、椎体滑脱、椎间盘解剖水平及椎间盘退行性改变程度的相关性。结果与结论:634例患者中,女性患者ModicⅡ、Ⅲ型出现率均较男性高,而ModicⅠ型出现率小于男性患者(P<0.001);40岁以上患者较40岁以下患者Modic各型改变的出现率均高(P<0.001)。2536个腰椎间盘中,有椎体滑脱、出现Schmorl结节、有椎间盘突出或膨出者Modic各型改变的出现率均比无此类表现者高(P<0.001);L4/5、L5/S1水平(低位)Modic各型改变的出现率均比L2/3、L3/4水平(高位)高(P<0.001);椎间盘退行性改变越严重,Modic各型改变的出现率越高(P<0.001)。椎间盘退行性改变分级、Schmorl结节与Modic改变有显著相关性。结果说明,腰椎间盘Modic改变与患者性别、年龄、椎间盘有无突出或膨出、有无Schmorl结节、椎体有无滑脱、椎间盘解剖水平及椎间盘退行性改变分级均有相关性。其中,椎间盘退行性改变分级、Schmorl结节与腰椎间盘Modic改变间的相关性最高,且椎间盘退行性改变分级较Schmorl结节与之相关性更高。     

Lumbar extension exercises in conjunction with mechanical traction for the management of a patient with a lumbar herniated disc

ABSTRACT

Low back pain resulting from lumbar disc herniation is a common reason for referral for physical therapy. There is no evidence to support the management of lumbar disc herniation and derangement using mechanical traction combined with lumbar extension exercises. Therefore, the purpose of this case report was to describe and discuss the use of mechanical traction in conjunction with lumbar extension exercises for a patient with a lumbar herniated disc. The patient was a 49-year-old male referred to physical therapy with a medical diagnosis of a lumbar herniated disc at L5-S1 with compression of the L5 nerve root confirmed by MRI. The patient's chief complaint was pain over the left lumbosacral and central lumbar region with radiating pain into the left buttock accompanied by numbness and tingling in the left lower leg and foot. The patient was seen for a total of 14 visits. The first 5 days (2 weeks) of therapy consisted of lumbar extension exercises. For the following nine visits (over a 3-week period), mechanical traction was added as an adjunct to the extension exercises. Outcome measures included the Oswestry Disability Questionnaire, Back Pain Function Scale (BPFS), and the Numeric Pain Rating Scale (NPRS). Results from initial evaluation to discharge (Oswestry: 36% to 0%; BPFS: 33/60 to 57/60; NPRS: 7/10 to 0/10) demonstrated that the patient no longer experienced low back pain and improved in terms of functional status and pain-related disability. The patient no longer complained of numbness and tingling in the left lower extremity and the goals for the patient had been attained. The data from this case report suggests lumbar extension exercises in conjunction with mechanical traction facilitated the patient's improvement in pain and return to prior level of function.     

Clinical evaluation and treatment options for herniated lumbar disc

Degeneration of the intervertebral disc from a combination of factors can result in herniation, particularly at the L4-5 and L5-S1 levels. The presence of pain, radiculopathy and other symptoms depends on the site and degree of herniation. A detailed history and careful physical examination, supplemented if necessary by magnetic resonance imaging, can differentiate a herniated lumbar disc from low back strain and other possible causes of similar symptoms. Most patients recover within four weeks of symptom onset. Many treatment modalities have been suggested for lumbar disc herniation, but studies often provide conflicting results. Initial screening for serious pathology and monitoring for the development of significant complications (such as neurologic defects, cauda equina syndrome or refractory pain) are essential in the management of lumbar disc herniation.     

椎体终板形态与腰椎间盘突出关系的临床研究

背景:有研究报道,在间盘退变的过程中,可造成椎体终板的重塑.目前终板形态和椎间盘退变的关系仍不非常清楚.目的:观察分析椎体终板形态与腰椎间盘突出症的之间的关系.方法:纳入40例无腰椎疾病的正常人和62例腰椎间盘突出症患者,进行螺旋CT扫描,扫描范围从L4到S2,扫描条件:140 kV,345 mA,FOV160 mm,层厚1 mm,间距1.0.原始图像通过O2的三维重建图像工作站进行三维重建,W300,C80,ZOOM=1.5,Expand1.在平面重建术(CPR)基础上测量椎间盘最大前后,横径,圆形,面积和形状.结果与结论:终板形态和椎间盘突出症密切相关(P均＜0.01).终板面积和男性L4/5、男性和女性的L5/S1椎间盘突出关联差异无显著性意义(P＜0.05).提示椎体终板的边缘形状是腰椎的椎间盘突出症(L4/5、L5/S1)进展的重要因素之一.     

局部生物力学因素在L5/S1椎间盘突出症发病中的作用

背景：近年来,有关生物力学因素与腰背痛关系的报道大多集中在腰椎整体生物力学与腰背痛的研究上,而针对局部生物力学特点与单纯腰椎间盘突出的研究则较少。目的：探讨局部生物力学因素在L5/S1椎间盘突出症发病中的作用。方法：共纳入对象124例,包括椎间盘突出症组和对照组,62例/组。椎间盘突出症组为2008-06/2009-07于青岛大学医学院附属医院诊断明确并行手术治疗的L5/S1椎间盘突出症患者;对照组为健康体检人员。在腰椎正侧位X射线片上测量和观察各组L5椎体相对深度、腰骶移行椎、L5/S1椎间盘相对高度、腰骶角、骶骨水平角和骶骨垂直角的变化。结果与结论：与对照组比较,椎间盘突出症组L5椎体相对深度明显增加（P〈0.01）,椎间盘突出症组腰骶移行椎数目明显降低（P〈0.01）,说明相对位置较深的L5椎体及腰骶移形椎可能对L5/S1椎间盘具有保护作用,可降低L5/S1椎间盘突出症的发生率。椎间盘突出症组腰骶角和骶骨水平角明显减小（P〈0.01）;但L5/S1骶骨垂直角和椎间盘相对高度在椎间盘突出症组与对照组之间差别无显著性意义（P〉0.05）,可见,L5/S1椎间盘相对高度、腰骶角、骶骨水平角和骶骨垂直角与椎间盘突出的关系仍不明确,需进一步探讨。     

极外侧型腰椎间盘突出症磁共振分级与下腰痛评分的相关性

目的 探讨磁共振（MRI）分级与下腰痛评分的相关性及其在诊断极外侧型腰椎间盘突出症（ Far lateral lumbar disc herniation , FLLDH）中的价值。方法 回顾性分析2009年8月至2014年4月收治的经手术确诊的35例FLLDH患者的MRI表现,并选择同时期其他类型的腰椎间盘突出症（LDH）包括中央型、侧后型共35例作为对照组,根据其突出间盘大小及与神经根受累情况进行MRI分级,并分析MRI分级与各自下腰痛评分[采用日本骨科学会（JOA ）腰痛评分]的相关性。MRI分级评分越高表示突出间盘越大及神经根受累情况越严重;下腰痛评分越低表示功能障碍越明显。结果（1）MRI下,FLLDH与其他类型LDH分布节段差异有统计学意义（P〈 0.05） , FLLDH多见于L3-L4 , L4-L5节段,而L5-S1,无FLLDH分布。（ 2） FLLDH的MRI分级高于其他类型LDH（t=5.714,P〈0.01）,下腰痛评分低于其他类型LDH（t=4.406 ,P 〈0.01）,两组间差异均有统计学意义。（ 3 ） FLLDH的MRI分级与下腰痛评分呈负相关关系（r=-0.754 , P 〈0.05）。结论MRI的FLLDH分级评分与神经根受压引起的下腰痛虽然有一定的相关性,但在临床应用中还应注意其他影响因素。     

Schmerzen und Funktionsstörungen des Iliosakralgelenks bei Bandscheibenvorfällen der unteren Lendenwirbelsäule

Back and leg pain in patients with lumbar disc herniation can be caused by various mechanisms. In addition to nerve root compression, functional alterations in the sacroiliac joint, facet joint or the iliolumbar and sacrotuberal ligaments can produce "pseudoradicular" lower back syndrome. The following study attempts to show whether or not pain and functional alterations in the sacroiliac joint (SIJ) correlate with herniations revealed by computed tomography (CT). The study also attempts to determine the correlation between pain and functional changes of the SIJ and the size and level of the disc herniation. Fifty patients with monosegmental disc herniations revealed by CT who showed no signs of bone or soft tissue alterations were included in this study. The average duration of the patients' complaints of leg or back pain was 5.7 years. Ninety-six percent of these patients had received conservative treatment before admission to our hospital. All patients were compared to a control group consisting of 16 healthy subjects of comparable age. All patients underwent a comprehensive functional, neurologic and radiologic examination. The CTs were analyzed by a standardized three-dimensional method. All of the 50 patients had sciatica complaints and a disc herniation revealed by CT. In two cases hemiation of the L3-4 disc was demonstrated, in 14 cases L4-5 disc herniation and in 34 cases a L5-S1 disc herniation. In contrast to the control group of 15 healthy subjects, the patients showed a significant number of functional disorders upon examination. In 84% of all patients, movement of the SIJ was restricted. Painful palpation of the symphysis was demonstrated in 46% of all cases. Thirty-five percent of patients with herniation of L4-5 disc demonstrated SIJ tenderness as opposed to 65% of the patients with herniation of the L5-S1 disc. This SIJ tenderness did not correlate with motion of the SIJ. In addition, SIJ motion and frequency of sensory dysfunction showed no correlation with the size of the disc herniation. Paralysis and loss of reflexes showed a positive correlation with the increasing size of the disc herniation. SIJ tenderness decreased as the size of the herniation increased. Dysfunction of the ipsilateral SIJ is explained by increased muscular tone caused by irritation of the n. sinuvertebralis and its lumbar coupling. Frequency of SIJ tenderness is significantly higher in patients with herniations between L5 and S1. Since the SIJ is innervated by the r. dorsalis of the sacral roots, the increased tenderness can be explained by the change in neurovegetative innervation of the SIJ. Due to the high correlation between lumbar disc herniation and SIJ dysfunction, disc herniation should be considered as a possible cause of sacroiliac-joint syndrome.     

腰椎间盘突出髓核的自身免疫性

背景：引起椎间盘源性腰腿痛的发病机制很多,在椎间盘退变的发生和发展过程中血管内皮生长因子与T,B淋巴细胞的表达与突出类型、病程等是否具有相关性还未完全清楚。目的：观察不同类型腰椎间盘突出症患者腰椎间盘组织中T,B淋巴细胞及血管内皮生长因子的表达变化,分析其与患者症状、体征的相关性。方法：选取腰椎间盘突出症患者的腰椎间盘标本作为实验组,包括游离脱出型、突出型及膨出型;以腰椎骨折患者的正常椎间盘作为对照。采用苏木精-伊红染色法观察椎间盘标本中血管形成及周边淋巴细胞聚集情况,免疫组化法检测CD4,CD8,IgG,IgM及血管内皮生长因子的分布。结果与结论：①在突出髓核组织中有大量新生血管形成并可见血管内皮细胞,在其周围可见明显的淋巴细胞聚集。②实验组均有活化的CD4,CD8阳性T细胞、IgG,IgM阳性B细胞和血管内皮生长因子表达,其中脱出游离组和突出组的阳性细胞率高于膨出组（P〈0.05）,而对照组均无阳性表达。提示髓核组织暴露于自身免疫系统中可以激活T、B细胞,引起自身免疫反应,血管内皮生长因子参与了退变椎间盘新生血管的形成,并可能与T,B细胞引起的自身免疫反应对椎间盘突出腰腿痛机制有协同作用。     

神经肽Y/降钙素基因相关肽在腰椎间盘中的分布与共表达

背景：研究发现,神经肽Y与降钙素基因相关肽在交感神经节中有共存现象。目的：观察神经肽Y/降钙素基因相关肽在正常腰椎间盘的共分布及在突出腰椎间盘髓核组织中的共表达。方法：从10例尸体中收集完整的腰椎间盘,在另10例尸体中收集腰椎间盘髓核组织作为对照组。收集30例有症状的腰椎间盘突出症患者,其中L4/5或L5/S1需行腰椎间盘髓核摘除,取出髓核组织作为实验组。结果与结论：①正常椎间盘组织中神经肽Y/降钙素基因相关肽荧光双标染色阳性的神经纤维较多的分布于椎间盘纤维环外1/3,但在椎间盘内2/3及髓核中未见或少量分布。②髓核的共表达,神经肽Y/降钙素基因相关肽荧光双标染色神经纤维的阳性率实验组均高于对照组（P〈0.05）。提示在正常腰椎间盘组织中神经肽Y/降钙素基因相关肽分布于纤维环外1/3部分,在纤维环内2/3部分及髓核组织未分布,但在突出椎间盘髓核组织中有大量的神经肽Y/降钙素基因相关肽共表达。     

腰椎间盘突出物中白细胞介素-1含量与根性痛的相关性

目的探讨炎症因素在腰椎间盘突出症患者根性痛中的作用。方法用ELISA法测定了84例腰椎间盘突出症患者手术中取出的髓核组织中白细胞介素－1(IL－1)含量,将之与患者的根性疼痛程度进行相关性分析,同时还进行了患者突出组织大小与根性痛间的相关性分析,并将两者进行对照。结果(1)IL－1含量与患者根性疼痛程度成正相关;(2)患者根性痛与突出物大小间无明显相关性。结论炎症因素较压迫因素在腰椎间盘突出症患者根性痛中起了重要的作用。     

Herniated nucleus pulposus with radiculopathy in an adolescent: successful nonoperative treatment

The following report describes a 17-year old girl with a central herniated nucleus pulposus (HNP) at L4-5. The diagnosis of lumbar disk herniation was based on findings from magnetic resonance imaging (MRI). A decision to use conservative treatment was unanimously agreed upon by a team of orthopedists, a neurosurgeon, and an internist. This report follows the patient's course from the onset of pain through the completion of the nonoperative treatment and shows that HNP of a lumbar intervertebral disk with radiculopathy can be treated successfully with aggressive nonoperative care.     

Verlauf nicht operierter lumbaler Bandscheibenvorfälle

In Western industrial countries, low back pain is one of the most frequent causes of illness. Between the 4th and 5th decades of life approximately 80% of adults complain of low back pain, lasting for fairly long periods. About 10% of this population must undergo disc surgery once during life. Several authors have discribed good results for lumbar disc surgery in 55%-86% of their cases. Few control data are available, however, on patients with radiologically proven herniation of the disc regression, who were treated conservatively. Their observations indicate that regression of herniation of a lumbar disc is possible using conservative therapy exclusively. A study was therefore carried out on 43 patients with lumbar disc abnormalities, as demonstrated by spinal computed tomography (CT). Initially, 38 of them showed a herniation and 5 protrusion of the disc plus further neurological deficits and radicular pain syndromes. The subjects were followed up for over 20 months (mean) and monitored by CT in order to check the possibility that the CT findings, neurological deficits, and pain would regress a lengthy period of therapy. The results were the following: Initially, all patients complained of severe low back pain and sciatica, leading to subsequent treatment. At the time of follow-up, 15 of them still reported remittent or chronic low back pain, 9 remittent, and 16 chronic sciatic pain but of much less intensity. Before treatment, 40 patients had neurological deficits, whereas at the time of follow-up, only 24 patients still had deficits. In 2 patients the symptoms had not changed and in 2 others slight deterioration was observed. CT control examinations showed clear regression in the extent of disc herniation in 15 patients, in 18 a moderate decrease, and in 9 cases the CT findings had not changed. A favorable tendency towards regression was observed in disc herniations at the level of L5-S1 and in cases showing sequestration of the disc. Herniations of the disc at higher levels between L4-5 and L3-4 or a lateral herniation, reaching the intervertebral foramen, showed on unfavorable prognosis.     

双平板DSA引导下经皮穿刺臭氧消融术治疗腰椎间盘突出症的临床疗效观察（附37例报告）

目的：观察双平板DSA及其类CT功能在经皮穿刺臭氧消融术治疗腰椎间盘突出症中的应用及临床疗效。方法回顾性分析37例腰腿疼痛或麻木患者,平均年龄（49.38±13.05）岁,共44个病变椎间盘,经CT或MRI证实为腰椎间盘突出症,在双平板DSA设备透视引导下行经皮穿刺臭氧消融术,术中每个椎间盘内注射臭氧4～25 mL（平均13.82±3.62 mL）,盘外神经根周围注射臭氧0～15 mL（平均7.73±2.87 mL）,并于盘内外注射曲安奈德水针共5 mL。观察术前及术后1周、1个月、3个月、6个月、1年腰腿疼痛变化情况,同时观察术中术后并发症发生情况。结果37例患者中,34例于臭氧消融术后腰腿疼痛VAS评分明显下降,并且疼痛缓解时间大于1年,改良Macnab疗效评定总有效率91.89%;3例疼痛缓解不明显,其中1例出现椎间盘感染。结论双平板DSA引导下经皮穿刺臭氧消融术治疗腰椎间盘突出症,创伤小,并发症少,止痛效果确切。     

Regression of herniated nucleus pulposus: two patients with lumbar radiculopathy

Thirty percent to 95% of patients with lumbar radiculopathy secondary to a bulging or herniated disc improve to a pain-free and functional level with nonsurgical treatment. What happens to the herniated disc material as this improvement occurs is unclear. We present two patients with lumbar radiculopathy documented by physical examination and electrodiagnostic testing. Both patients had herniated disc material at the L5 to S1 level on computed tomography (CT) scans corresponding to the side and level of their lesion on physical examination and electrodiagnostic testing. In both instances, the radiculopathy resolved with conservative treatment. CT scans were repeated in three months on one patient and four months on the other. The scans showed major resolution of the herniated disc material in both patients. These two cases demonstrate that in some patients with proven radiculopathy secondary to herniated nucleus pulposus, the herniated disc material will no longer be visible on CT scan and is presumed to resorb as the symptoms abate.     

选择性责任节段减压并椎弓根螺钉系统置入内固定治疗腰椎退变性疾病

背景：腰椎退变性疾病的患者经保守治疗无效,感觉运动功能障碍、马尾综合征,疼痛难忍而影响：[作和生活的情况,需要通过手术的方法来治疗。 目的：分析腰椎退变性疾病的植入物置入内咧定治疗效果,深入了解腰椎退变性疾病患者的临床症状检食方法,吲顾腰椎退变性疾病采用植入物置入内固定治疗的相关文献。 方法：选取2010年12月29日至2011年1月27日在解放军第306医院骨科治疗的腰椎滑脱合并相邻节段和,或跳跃性节段退变性疾病的患者23例,存全麻下行后路腰椎管减压椎间融合器植入植骨融合椎弓根螺钉系统内周定,采用VAS、JOA和ODI评分对患者术前和术后进行评定,加用临床症状改善程度作为手术疗效的判定标准。并检索腰椎退变性疾病采用植入物置入内固定治疗的相关研究文献,对文献的实验方法和实验结果进行深入分析。     

年轻患者腰椎间盘Pfirrmann分级与椎间盘膨出及突出的相关性研究

目的通过磁共振成像,观察30岁以下腰痛患者腰椎间盘退行性改变的Pfirrmann分级特征以及相关的其他改变,并评价Pfirrmann分级与椎间盘膨出及突出的相关性。材料与方法回顾性分析83例30岁以下因腰痛行腰椎MRI检查的患者,其中男50例,女33例,平均年龄25岁。由2名影像科医师对MR图像进行分析,观察L1~S1椎间盘信号、椎间盘形态、纤维环撕裂、椎间盘膨出、椎间盘突出、椎体终板及许莫氏结节的改变。椎间盘退行性改变采用Pfirrmann分级。观察指标的相关性分析采用Pearson多元相关分析。结果纳入研究的椎间盘共415个,其中Pfirrmann分级Ⅰ~Ⅱ级退变322个(77.6%),Ⅲ级退变56个(13.5%),Ⅳ级退变33个(7.9%),Ⅴ级退变4个(1.0%);103个椎间盘出现膨出或突出;椎间盘膨出以L4~5椎间盘最多(42.2%),且多合并Ⅲ级退变(51.1%);椎间盘突出以L5~S1椎间盘最多(51.7%),且多合并Ⅳ级退变(46.6%);17例患者出现椎间盘后方高信号区(HIZ),且均位于L4~5、L5~S1椎间盘水平;3例患者出现终板退变。多元相关分析结果显示PfirrmannⅢ级退变与椎间盘膨出有明显相关性(r=0.972;P=0.006),与椎间盘突出无明显相关性(r=0.639;P=0.245);PfirrmannⅣ级退变与椎间盘突出(r=0.999,P=0.000)及HIZ(r=0.919,P=0.028)有明显相关性,与椎间盘膨出无明显相关性(r=0.769,P=0.128)。HIZ与椎间盘膨出(r=0.919,P=0.027)及突出(r=0.935,P=0.020)均有相关性。结论腰椎MRI成像能够清晰显示年轻患者椎间盘早期退行性改变的不同病理阶段;PfirrmannⅢ退变与PfirrmannⅣ级退变分别与椎间盘膨出和椎间盘突出有相关性;年轻患者应及早发现椎间盘早期退变,以对临床评价提供更有价值信息。