Clinical aspects, surgical treatment and prognosis of lumbar intervertebral disk displacement in childhood

This paper reports on 11 girls and 3 boys aged from 12 to 16 who, having suffered prolapses of lumbar discs, underwent surgery and were followed up between 18 and 87 months postoperatively. These 14 patients represent 0.25% of those who have undergone disc surgery in the authors' clinic over the last 11 years. Clinical peculiarities are pointed out and, in the light of the positive results (13 patients completely free of complaints) the prognosis is deemed to be very favourable; surgical treatment is therefore recommended of conservative therapy fails.     

Significance of nuclear magnetic resonance tomography for the diagnosis of degenerative diseases of the lumbar spine

The authors report on the diagnosis value of magnetic resonance imaging (MRI) in diseases of the lumbar spine, assessed on the basis of 960 cases treated at Düsseldorf University Orthopedic clinic since 1982. Diseases can be differentiated by changes in shape (vertebral collapse due to tumors, spondylitides, disk prolapse etc.) as well as by structural and pathomorphologic changes (disk degeneration, upper plate reactions etc.). Seventy-four patients were examined for upper plate reactions, which were detected in particular with the partial saturation and the short-time inversion recovery sequences. On the basis of prospective studies the authors comment on the value of MRI as compared to computerized tomography for diagnosing disk prolapses and disk sequestra. It can be shown that the sensitivity and specificity of MRI are very good.     

Significance of nuclear magnetic tomography in the diagnosis of lumbar disk displacements

In a prospective study we determined the validity of MRI (Magnetic Resonance Imaging) in lumbar disc herniations. MRI and CT were compared in 34 patients who underwent operation and 8 patients who underwent discography and intradiscal injection. By this study we determined the validity of CT and MRI being more than 90%.     

Value of myelography and computer tomography in problem cases of lumbar intervertebral disk diagnosis

The accuracy of myelographic and computerized tomographic findings in lumbar layer diagnostic techniques is examined in a total of 133 patients suffering from root compression syndrome. The comparatively high percentage of accurate results 94% (myelogr.) and 90% (ct) in 93 cases where the findings were operatively substantiated,--sinks when the problem cases are considered apart. In 22% of our patients, one method alone was not sufficient for satisfactory preoperative diagnosis. The value of myelography and ct in the diagnosis of problem cases in herniated lumbar disk disease is different. Because of specific advantages (Tab. 1) in the representation of the spinal canal the techniques have their own position. When clinical and computertomographical results are clear and corresponding, myelography-as an invasive diagnostic technique--is unnecessary. In problem cases, however, both methods should be used to complement one another.     

Effect of meteorologic parameters on acute admission of patients with lumbar intervertebral disk displacement

The correlation between local meteorological parameters and acute admittance to hospital of patients with lumbar disk prolapses was investigated. The study shows a significant correlation between drop of temperature and increase of humidity for male on the day of admittance and for female on changes from the day before to the day of admittance. This seems to be in contrast with other investigators, who couldn't find a correlation between local meteorological parameters and pain. The reasons for this are discussed.     

盘内注射胶原酶治疗上段腰椎间盘突出症

目的:探讨盘内注射胶原酶的方法治疗上段腰椎间盘突出症的可行性、疗效及安全性。方法:28例单纯上段腰椎间盘突出症患者,男16例,女12例;年龄21～62岁,平均44.5岁。病程3个月～10年。椎间盘突出4～9mm,平均4.9mm。采用椎旁进针盘内注射或突出物内注射胶原酶的方法进行治疗,随访观察有效率、突出椎间盘溶解、椎间隙感染等并发症发生情况。结果:所有患者随访1～6个月,依据Macnab评价标准进行疗效评价,优9例,良12例,可4例,无效3例。突出椎间盘溶解0～6mm,平均3.5mm。17例进行了重复注射,其中9例患者进行了3次注射。13例注射后短期内症状加重,对症处理后缓解。结论:盘内注射胶原酶的方法治疗上段腰椎间盘突出症效果理想、安全可行。     

Pedicle origin and intervertebral compartment in the lumbar and upper sacral spine

Summary The osseous boundaries of the intervertebral compartment are described. Measurements of the pedicles demonstrate that their configuration determines the shape of the intervertebral compartment. The pedicles originate in the upper lumbar spine (L 1 and L 2) in a vertical direction from the posterior aspects of the vertebral bodies. In the caudal lumbar spine (L 4 and L 5) the origin of the pedicles is more oblique and thereby moves much more laterally and ventrally. As a consequence the horizontal extension of the pedicles is increasing in the lower lumbar spine. In the upper lumbar region the intervertebral compartment corresponds more to a foramen, in the lower lumbar spine more to a canal. The resulting clinical relevance for the length of the intervertebral compartment and the nerve root course is discussed.     

Assessment of magnetic resonance imaging in the diagnosis of lumbar spine foraminal stenosis--a surgeon's perspective

STUDY DESIGN: A 2-part cadaveric study. OBJECTIVES: Part 1: To assess the reliability of a semiquantitative classification system for grading lumbar spine foraminal stenosis and the variability in magnetic resonance imaging (MRI) examinations carried out in different institutions. Part 2: to assess the difference between the foraminal measurements carried out on MRI images and on cadaveric specimens. SUMMARY OF BACKGROUND DATA: There are limited data to suggest that MRI examinations are sensitive or specific for the diagnosis of lumbar spine foraminal stenosis. The effect of the variability in techniques, used by different imaging centers, is not well understood. METHODS: Three fresh, frozen human lumbar spines were examined with 3 different clinical MRI systems. Eight spine surgeons used the MRI images to grade the foramina, on the basis of a previously suggested semiquantitative classification. In addition, the dimensions of all foramina were measured using software available on each of the MRI systems. The dimensions of the specimens' foramina were then measured in situ, graded, and compared with the MRI measurements. RESULTS AND CONCLUSIONS: There was poor intraobserver agreement using the semiquantitative grading system. The parameters associated with the grade of stenosis assigned to the foramen were as follows: (1) the observer doing the grading, (2) the place it was imaged, and (3) the location of the foramen. There was poor correlation between measurements of the foramina carried out on MRI and the specimens.     

MRI对腰椎间盘突出症的诊断价值

目的 探讨ＭＲＩ对于腰椎间盘突出病理分型的诊断价值。方法 比较２４２例腰椎间盘突出症例的ＭＲＩ检查结果与手术所见。结果 手术证实２４２名患者中包含型椎间盘突出１２９例,非包含型１１３例。轴位ＭＲＩ区分含民非包含型椎间透突出的敏感性、特异性和准确性分别为７７．９％、７２．１％和７４．８％,矢状位为８０．５％、７６．０％和７８．１％。结论 根据ＭＲＩ检查结果区分包含型与非包含型椎间盘突出并不可靠。     

MRI在诊断腰间盘脱出症中的应用及价值

自１９８７年７月到１９９１年１２月共收治１１４例腰间盘脱出症，手术治疗１１０例，其中ＭＲＩ检查确诊为腰间盘脱出症为８０例。ＭＲＩ检查与手术结果符合率占９７．５％．文章就．ＭＲＩ检查优于ＣＴ及ＭＲＩ图象区别腰间盘变性与腰间盘脱出作了阐述。     

经皮内窥镜下射频消融术治疗腰椎间盘突出症

目的:探讨经皮内窥镜下射频消融术治疗腰椎间盘突出症的安全性和疗效。方法:58例确诊为单纯性腰椎间盘突出症患者(其中L4/5突出44例,L5/S1突出13例,L3/4突出1例),在C型臂X光机透视监视下,采用经皮穿刺技术将同轴椎间盘内窥镜置入椎间盘内,摘除部分髓核后,在直视下采用ELLMAN射频机的双极可弯曲电极行髓核组织消融,完全去除镜下所见髓核组织。结果:采用MacNab标准评定,58例患者随访1~8个月,显效36例(62%),有效16例(28%),无效6例(10%),有效率为90%。所有病例均无严重并发症发生。结论:经皮内窥镜下射频消融术治疗单纯性腰椎间盘突出症安全、有效。     

Diagnosis of osteoid osteoma with special reference to angiography, scintigraphy, computerized tomography and magnetic resonance imaging

Clinical results from 50 patients with an osteoid-osteoma, show that night pain is considered one of the most important symptoms (90%). 88% responded to salicylic acid. The diagnosis can often be made from normal X-rays. Diagnostic problems are especially common in cases of rare, atypical localisations (spine, sacrum, clavicula, talus, calcaneus and the proximal part of the femur). The scintigraphy represents an unspecific but sensitive method of diagnosis in the early stages. The osteoid-osteoma is visible as a "hot spot" or, in the subperiosteal type, as a diffuse accumulation. Angiography is of great importance for preoperative localisation and differential diagnosis. Computer tomography is particularly valuable for localisation in the region of the spine. Magnetic resonance is an excellent method of examination. The three dimensional imaging allows an exact localisation, especially in atypical and difficult localisations. This will be the preferred method of the future, not least because there is no exposure to radiation.