Adolescent lumbar disc herniation: a case report

Lumbar spine disc herniations in children are a relatively rare condition reported to occur in less than 3% of those presenting with low back pain. Unlike the adult, the etiology and clinical picture often provides few clues to making the diagnosis. Although conservative management is the treatment of choice, surgical intervention may be required in some cases. The role of spinal manipulation in these cases may be of limited value. A case report is presented that illustrates the difficulty in making the diagnosis and conservatively managing lumbar disc herniations in children.     

Intraradicular lumbar disc herniation: report of two cases and review of the literature

Intraradicular lumbar disc herniation is very rare. The exact mechanism of the dural tear by a herniated disc is not known. Diagnosis of intraradicular lumbar disc herniation is difficult, so that it is rarely suspected preoperatively. This pathological entity may be a factor in the failure of lumbar disc surgery. We present the seventeenth and eighteenth cases of intraradicular lumbar disc herniation. We emphasise its importance and review the literature on intraradicular disc herniation.     

Atypical lumbar disc herniation: a case report.

BACKGROUND CONTEXT: This is a case report of a right posterolateral L5-S1 disc herniation that migrated to the left cephalad level to impinge on the left L5 nerve root as it exited the dura. The resultant free fragment migration is a rare variation of a posterolateral disc disruption. PURPOSE: The purpose is to report a rare variation of lumbar disc herniation not previously reported in the literature. STUDY DESIGN/SETTING: Case report. PATIENT SAMPLE: A 60-year-old white woman. OUTCOME MEASURES: Resolution of the patient's left lower extremity symptoms.METHODS: Not applicable. RESULTS: The patient experienced resolution of most of her left lower extremity symptoms after a slightly modified microscopically assisted lumbar hemilaminectomy, discectomy and nerve root decompression. CONCLUSIONS: This is a rare right to left migration of a sequestrated disc herniation, which was effectively treated with surgery.     

Osteopoikilosis mimicking lumbar disc herniation: a case report

It is important for the chiropractor to be able to determine the nature of the pathology discovered on plain film radiography, and to suggest appropriate follow-up investigations, deemed to be clinically appropriate. This case demonstrates the value of plain-film radiography in diagnosing a rare sclerosing bone dysplasia, which in 10–15% of affected individuals is associated with articular pain and swelling. However, the demonstration of the lesions on CT is unusual, in so far as plain-film radiography is the gold standard by which to diagnose this condition.     

Postoperative intraradicular lumbar disc herniation: A case report

An unusual case is presented in which a fragment of herniated lumbar disc was found within the sheath of the right S-1 nerve root. Diagnosis of intradural and intraradicular lumbar disc herniation is difficult, so that it is rarely suspected preoperatively. Surgical treatment results in a satisfactory clinical outcome.     

Adolescent apophyseal ring fracture simulating lumbar disc herniation: a case report

Lumbar disc herniation in adolescents is a rare condition. It is commonly associated with fracture of the vertebral ring apophysis. The diagnosis is most clearly established by CT scan. The differential diagnosis is important and should include spine and spinal cord tumours, discitis and neuropathy. A case is presented to illustrate the pathophysiology, clinical and radiological diagnosis and to discuss the differential diagnosis.     

Adolescent lumbar disc herniation in a Tae Kwon Do martial artist: a case report

Lumbar disc herniations are rare in children. The etiology and clinical picture may be different in children than in adults. Conservative management is the treatment of choice. Tae Kwon Do is a Korean martial art which is notorious for its high fast kicks. Tae Kwon Do will be an official Olympic sport in the year 2000. Low back pain is occasionally reported by Tae Kwon Do athletes but there are no reported cases in the literature on disc herniation in a Tae Kwon Do athlete. A case report is presented to illustrate clinical presentation, diagnosis, radiological assessment and conservative management of lumbar disc herniation in children.     

Spontaneous regression of a large lumbar disc herniation: report of an illustrative case.

A case of spontaneous regression of a large herniated disc at the lumbar level is presented. The disc regression correlated with clinical improvement and was documented on serial MRI studies. Although the phenomenon of spontaneous disappearance of decrease in size of herniated disc fragments is well known, the exact mechanism underlying this process remains unclear. This report discusses three possible explanations for disc regression: retraction into the intervertebral space, dehydration/shrinkage, and resorption due to inflammatory reaction.     

单穴电针治愈儿童腰椎间盘突出症1例报告

患儿,女性,11岁,在校学生,从事业余舞蹈练习4年余,发病前曾有反复多次的腰部扭伤史。2006年9月14日复因“跳舞时扭伤致双侧腰腿痛,站立行走困难2周”而就诊。双侧腰腿痛剧烈(VAS疼痛测量尺评分10分),且腿痛重于腰痛,疼痛无明显时间规律性,卧床可稍缓,咳嗽、喷嚏时则加重。患儿身高158cm,体重40kg,发育正常,全身情况好。专科检查见:跛行,减痛步态,由家长搀扶蹒跚步入诊室,腰椎左侧弯,胸腰段后凸畸形,双侧椎旁肌紧张,腰背部皮肤外观正常;腰椎前屈30°,后伸20°,左右侧屈及旋转活动时疼痛加重;屈颈试验阳性,挺腹试验阳性,直腿抬高试验:左侧30…     

Alkaptonuria with lumbar disc herniation: a report of two cases

STUDY DESIGN: Two cases of lumbar disc herniation with alkaptonuria are presented. OBJECTIVES: To present a probable clinical course of lumbar disc herniation with alkaptonuria, a rare metabolic disease. SUMMARY OF BACKGROUND DATA: Although lumbar disc disease is a common clinical occurrence in alkaptonuria, lumbar disc surgery is needed rarely in this disease. A patient with alkaptonuria without ochronotic signs is also rarely seen. METHODS: The cause, clinical presentation, diagnostic techniques and treatment of alkaptonuria with lumbar disc disease are reviewed. RESULTS: The symptoms of the patients disappeared after surgery, and there were no symptoms on follow-up. CONCLUSION: Alkaptonuria frequently occurs in association with lumbar disc disease. In patients with no other signs of alkaptonuria or ochronosis, early detection of the disease is important to treat involvement of other systems (e.g., cardiovascular and urinary).     

Discography-induced acute lumbar disc herniation: a report of five cases

The reported complication rate of provocative lumbar discography is low, ranging from 0-2.5%. We report five cases of acute lumbar disc herniation precipitated by discography, a previously unreported complication. The cases reported comprise of four men and one woman with ages ranging from 23-45 years. All developed an acute exacerbation of radicular leg pain following multilevel provocative lumbar discography. One patient developed an acute foot drop. Comparison of lumbar MRI scans before and after discography demonstrated either a new herniated disc fragment or an increase in size of a preexisting herniation in all cases. On review of each discogram study and pre-discogram MRI an annular tear or small disc herniation was noted in all cases. In each case the patients' symptoms failed to resolve necessitating surgical intervention in all cases. In conclusion, annular deficiency is an obvious predisposing factor to discogram related disc herniation. New onset or a persistent exacerbation of radicular symptoms following provocative discography merits further investigation.     

Intradural lumbar disc herniation: report of two cases

Intradural lumbar disc herniation (ILDH) is a rare pathology. The pathogenesis of ILDH is not known with certainty. Adhesions between the ventral wall of the dura and the posterior longitudinal ligament (PLL) could act as a preconditioning factor. Diagnosis of ILDH is difficult and seldom suspected preoperatively. Prompt surgery is necessary because the neurologic prognosis appears to be closely linked to preoperative duration of neurologic symptoms. Despite preoperatively significant neurological deficits, the prognosis following surgery is good. We report on two new cases of ILDH of high lumbar locations L1–2 and L2–3 with difficult differential diagnoses, and the possible pathogenic factors are discussed. Received: 25 June 1998 / Accepted: 15 April 1999     

Intra-radicular lumbar disc herniation: report of two cases

STUDY DESIGN: A case report. OBJECTIVES: To report two cases of intra-radicular disc herniation. SETTING: Kocatepe University Faculty of Medicine, Department of Neurosurgery, Afyon, Turkey, Vakif Gureba Training Hospital, Department of Neurosurgery, Istanbul, Turkey and Yeditepe University Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey. METHODS: Two cases with intra-radicular disc herniation at L2-3 level in one, and at L5-S1 level in the other were presented. Both patients were admitted with complaints of severe leg pain and motor weakness. In both cases, intra-radicular disc herniation was diagnosed during surgery. RESULTS: The patients had uneventful recovery. They had no complaints or neurological deficits 6 and 3 months after surgery, respectively. CONCLUSIONS: The possibility of an intradural disc herniation should be kept in mind for the success of the management of lumbar disc herniation. In some patients who did not benefit from surgery, intra-radicular or intradural disc herniations may be the cause of failure.     

单节段腰椎间盘突出症单纯髓核摘除术后10年以上随诊观察

目的:观察单纯髓核摘除术治疗单节段腰椎间盘突出症的远期疗效及影像学改变。方法:1990～1998年我院经单纯髓核摘除术治疗腰椎间盘突出症患者210例,对其中术后10年以上来门诊随访且资料完整的35例单节段腰椎间盘突出症患者进行回顾性分析,其中全椎板切除髓核摘除术10例,开窗减压髓核摘除术25例。随访内容包括:询问病史、骨科查体、摄腰椎正侧位及过伸过屈位X线片、行腰椎MRI检查及ODI评分,并对结果进行统计学分析。结果:随访时5例无腰腿疼痛症状,26例偶有腰痛及下肢酸痛,4例有明显腰腿痛。X线检查手术节段椎间隙变窄22例,占62.9%,手术节段残存活动度5.0°±3.2°,均未显示脊柱不稳定,依据U-CLA标准8例(22.9%)手术节段头侧相邻节段存在退变。MRI检查6例患者原手术节段可见椎间盘突出(占17.1%),其中4例有明显腰腿痛症状;依据改良Pfirrmann椎间盘退变分级,头侧椎间盘1～5级27例,6级及以上8例;12例手术节段存在终板信号改变,占34.3%,其中ModicⅠ型4例,Ⅱ型8例。随访时手术节段椎间隙狭窄与无狭窄患者的ODI评分有显著性差异(P<0.05)。两种术式患者ODI、相邻节段退变发生率和手术节段活动度均无统计学差异(P>0.05)。结论:单节段腰椎间盘突出症单纯髓核摘除术后10年以上手术节段能保留一定活动度,无脊柱不稳发生,但手术椎间隙变窄、相邻节段退变发生率较高,其与腰部功能障碍相关。