Postoperative infection of lumbar intervertebral disk space.

Sixteen cases of postoperative intervertebral disk space infection are reviewed. Most occurred after diskectomy, but one followed an unsuccessful attempt at a spinal anesthetic and two followed diskography. Treatment varied from aggressive surgery, either by a posterior, lateral, or anterior approach, to drain the infected disk space or spaces, to more conservative immobilization. Antibiotics were used in all cases. Needle biopsy is valuable in establishing diagnosis and identifying the organism and its antibiotic sensitivities. In some cases fusion occurred spontaneously from the infection; in others, fusion was a result of surgical fusion preceding or following the infection.     

非单纯椎间盘突出后路内窥镜手术中难点问题及对策

目的 探讨后路显微内窥镜手术中的难点问题及时策。方法 回顾分析377例后路非单纯椎间盘突出症患者内窥镜手术中的难点及处理方法。结果 377例患者中随访238例，时间4～38个月。按Macnab疗效评价标准，优189例，良27例，可15例，差7例，优良率90．8％。结论 该手术难点问题可以在镜下处理。具有切口小，组织剥离少，出血少、对脊柱生理结构破坏干扰小，恢复快的优点。     

人工椎间盘及髓核假体的生物力学

背景:全椎间盘或髓核假体是否符合人的椎间盘的解剖特点、生物力学是目前关注的焦点。目的:综述目前存在的人工椎间盘及髓核假体的类型及其生物力学特征。方法:由第一作者用计算机检索万方数据库、中国期刊全文数据库和PubMed数据库,检索时间:1989/2011,检索词分别为"椎间盘、髓核、人工假体、生物力学"和"intervertebral diac,nucleus pulposus,artificial prosthesis,biomechanics",语言分别设定为中文和英文。纳入与人工椎间盘及髓核假体的材料类型及其生物力学特性相关的研究,排除重复性研究。共检索到72篇文章,按纳入和排除标准对文献进行筛选,共纳入26篇文章进行分析。结果与结论:目前应用于人工椎间盘的材料有钴铬合金、钛合金、不锈钢、陶瓷和超高分子量聚乙烯等。应用不同材料制备的人工椎间盘假体校多,其中Bryan假体在临床中最常用,体外实验、三维有限元分析及临床研究均证实其具有良好的生物力学特性,置换成功率高。目前存在的人工髓核假体有预制型和原位聚合型,由于其手术损伤小,是目前研究的热点,但仍很难达到人体髓核的生物力学功能。发掘新型材料和设计个性化假体是将来的发展方向。     

Disorders of micturition following intervertebral disk operations. Neurologic diagnosis and therapy

Urodynamic investigation was carried out in 33 patients (14 male, 19 female) who presented with micturition disorders after prolapsed disc operation. The predominant symptom was urinary incontinence in 16 cases and urinary retention or residual urine in 17 cases; faecal incontinence was encountered in 15 patients. The main nerve supply for detrusor and sphincter muscles stems from the S-3 segment. Of 25 patients with unilateral or bilateral loss of sensation in the S-3 dermatome, 21 patients demonstrated detrusor areflexia, 11 of those with urinary incontinence, 10 with urinary retention and 13 with faecal incontinence. 4 patients showed normoreflexia of the detrusor, although three of them had urinary incontinence, one urinary retention and two faecal incontinence. The success of medication or electrostimulation is demonstrated in 17 patients on follow-up over a period of 12 months postoperatively. Medication alone was successful only when no peripheral nerve lesion was present. Out of 9 patients with a nerve lesion located at S-1/S-3, transurethral electrostimulation according to Katona was successful in two cases, whilst functional electrostimulation successful in another two cases.     

髓核细胞移植抑制椎间盘退变

背景：近年来,椎间盘细胞移植和椎间盘移植修复椎间盘退变研究取得较大的进展。目的：探讨髓核细胞的体外培养方法以及髓核细胞移植在抑制椎间盘退变研究中的作用。方法：通过数据库检索的方式探讨髓核细胞移植抑制椎间盘退变的研究。髓核细胞的主要功能是产生胶原和蛋白聚糖,改进髓核细胞的培养方法,使培养后的髓核细胞数量增多,合成和分泌细胞外基质增加,通过髓核细胞移植来修复退变的椎间盘。结果与结论：通过三维小球聚集培养、微载体旋转立体培养等方法可以使髓核细胞数量增多,肝细胞生长因子对髓核细胞增殖产生促进作用。髓核细胞移植可以恢复退变椎间盘高度,促进退变椎间盘内蛋白多糖和Ⅱ型胶原的生物合成和分泌。随着对椎间盘退变研究的不断深入,髓核细胞移植对退变椎间盘可能是一种重要的治疗手段。     

B超诊断腰椎间盘脱出症

腰椎间盘脱出症 ,是以腰腿痛为主要症状的常见病多发病。据有关资料统计 ,本病占整个下腰痛的1 0 %～ 1 2 .5% [1] ,又由于能够引起腰腿痛的病症有 2 0多种 ,所以本症的诊断与鉴别诊断非常重要。 1 994年以来 ,我院采用Ｂ超诊断腰椎间盘脱出症 31例 ,取得初步经验 ,现报告如下。资料与方法1 1 .一般资料经Ｂ超初诊 31例腰椎间盘脱出症 ,系本院 1 994年至 1 997年门诊及住院患者。男 2 2例 ,女 9例 ;年龄2 1～ 50岁 ,平均 35岁 ;腰痛 6例 ;伴左侧腿痛 1 3例 ,右侧 8例 ,双侧 4例。病程半年到 3年。1 2 .检查方法采用ＧＥ产、ＲＴＦＩＮＯ、…     

Neuroradiologic treatment possibilities of intervertebral disk displacement]

A CT assisted method for automated percutaneous lumbar discectomy (APLD) is described. With this technique and introduction of a "pull and push" method as well extruded and sequestrated herniated lumbar discs as cervical herniated discs can be treated. The CT assisted discectomy was performed in 70 patients. The success rate was 86% in the lumbar region and 93% for cervical herniated discs. We believe that this percutaneous technique will increase the importance of interventional neuroradiology for this common disease.     

Nomenclature and standard reporting terminology of intervertebral disk herniation

Spine pathology is ubiquitous and is encountered by nearly all medical specialties. The anatomy of the spine is complex, but the language used to describe pathology may be even more complex. Many of the common references differ in their nomenclature used to report intervertebral disk herniation. This article summarizes and relates the standard recommendations for reporting terminology in regard to herniation of the intervertebral disk. This standard reporting terminology may be used with CT or MR imaging and is useful to report the location and size of the disk herniation. Recommendations are to report abnormalities in zones on axial images and in levels on the sagittal and coronal images. The diagnostician must also be aware of the various pitfalls associated with disk herniation to avoid the scenario of surgical intervention at the incorrect spinal level.     

Biomechanics of the lumbar intervertebral disk: a review

This article reviews the literature on the biomechanics of the lumbar intervertebral disk according to: 1) disk structure and properties, 2) biomechanical principles and their application to the disk, 3) biomechanics and intradiskal pressures as they relate to posture, work, and exercise, and 4) prophylactic measures.     

Modeling of the heat distribution in the intervertebral disk

The heat transfer equation was used to model the heat distribution in an intervertebral disk during ultrasound (US) exposure. The influence of thermal and acoustic parameters was studied to get a quantitative understanding of the heat transfer in the system. Heating of collagen to 65 degrees C or above will lead to denaturation and is believed to stabilize and contract the outer part of the disk in a herniated disk. In our model, the US intensity was approximated by a Gaussian distribution and nonlinear propagation was excluded. The effect of self-heating and cooling of the transducer was also studied. The simulations were performed using the finite element method. From this model, it can be concluded that it is possible to heat parts of the disk to treatment temperature using a focused 5-mm diameter US probe. The physical constraints on the piezocrystal set the limit of the size of the treatment volume.     

经CT引导采用胶原酶溶核术治疗腰椎间盘突出症的护理

腰椎间盘突出症是指由于生理性退变、长期慢性劳损或外伤,导致腰椎间盘纤维环发生破裂,髓核外移后突,刺激和／一或压迫神经根或脊髓,出现以根性坐骨神经痛为主要症状的腰腿痛。以往腰椎间盘突出症患者大都采用手术切除突出椎间盘的方法根治。随着介入疗法的应用,一种新的微创手术——CT引导下胶原酶溶核术,在治疗腰椎间盘突出症中取得了很好的疗效。南京大学医学院附属鼓楼医院镇痛科于2003年4月-2004年4月对93例腰椎间盘突出症患者采用胶原酶溶核术,治愈及好转率达91．6％,现将护理体会介绍如下。     

椎间盘组织工程支架材料的研究进展

学术背景:椎间盘组织工程是目前医学领域的研究热点之一,但是研究的成果却不多,其中一个关键问题就是支架材料这个瓶颈。目的:介绍近年来应用于椎间盘组织工程的支架材料。检索策略:以网络数据库为主,查询Pubmed,Elsiver,Springerlink,Highwire等数据库1994/2007关于椎间盘组织工程支架材料方面的文献,检索关键词为"intervertebral disk,tissue engineering,scaffold"限定文献语言种类为"English";检索CNKI,数据库2000/2007的相关文献为补充,限定文献语种种类为中文,检索关键词为"椎间盘,组织工程,支架材料";同时手工翻阅相关书籍。纳入标准:内容与应用于椎间盘组织工程的支架材料相关。排除标准:重复性研究。文献评价:共收集到58篇文献,对资料进行初审,40篇符合纳入标准,进一步查找全文,纳入其中25篇进行归纳总结。资料综合:目前常用的材料按其来源可分为人工合成材料、天然材料及复合材料3大类;按其形状又可分为凝胶状、海绵状和纤维网状3大类。详细介绍了壳聚糖、脂肪族聚酯均聚物、藻酸盐、胶原、小肠黏膜下层、纤维蛋白胶、明胶、磷酸钙等材料的优缺点及应用现状结论:目前应用于椎间盘组织工程的支架材料不少,但缺少一种理想的支架材料,研制和开发应用于椎间盘组织工程的支架材料仍是椎间盘组织工程的研究的热点和难点之一。     

Thoracic intervertebral disk herniation: a commonly missed diagnosis

In the emergency department and the physician's office, it is often difficult to distinguish benign causes of back pain from more serious ones. The diagnosis of thoracic intervertebral disk herniation is often missed because of its complex and variable presentation. In order to further investigate this condition, 78 patient charts were reviewed in the largest single study of thoracic disk herniation in the world's literature. Injury was associated with disk herniation in approximately half of patients, much higher than reported in previous studies. Back pain was the most common presenting symptom (73% of cases) and weakness was the most common physical finding (42% of cases). Eighty-five percent of patients had either historical or physical findings consistent with neuropathy; 26% of patients had multiple thoracic disk herniations. These findings will aid physicians in the diagnosis of this potentially serious condition.     

Sonographic characterization of the lumbar intervertebral disk with anatomic correlation and histopathologic findings.

OBJECTIVE: The purpose of this study was to describe the normal anatomy and abnormalities of the lumbar intervertebral disk with sonography in cadaveric specimens and to correlate the sonographic findings with pathologic findings. METHODS: Sonographic imaging with both 4.5- and 10-MHz linear array transducers was performed on 35 lumbar intervertebral disks in 13 human cadaveric spines. The cadaveric specimens were sectioned for anatomic and histopathologic evaluation. Findings on anatomic sections were correlated with the findings on corresponding sonographic images with respect to the sonographic appearance of disk components in 30 intervertebral disks. RESULTS: High-resolution sonography with a 10-MHz frequency transducer enabled distinction of the nucleus pulposus from the annulus fibrosus and assessment of the echogenic characteristics of these structures. Sonography showed numerous fine linear echoes in the outer portion of the intervertebral disk in 26 (87%) of 30 specimens, which corresponded to the normal concentric arrangement of the fibers in the periphery of the annulus fibrosus. Amorphous areas of low echogenicity in the inner portion of the annulus fibrosus (n = 14, 47%) correlated with degenerative changes of the disk on corresponding microscopic sections. The nucleus pulposus appeared relatively isoechoic (n = 5, 17%) or hyperechoic (n = 4, 13%) to the annulus fibrosus. In degenerative disks (n = 21, 70%), the nucleus pulposus showed decreased echogenicity, and differentiation between the nucleus pulposus and annulus fibrosus was difficult. CONCLUSIONS: High-resolution sonography is a simple imaging method that can show the normal lumbar intervertebral disk and degenerative changes in appropriate subjects. High-resolution sonography proves superior to conventional sonography for evaluation of the lumbar intervertebral disk.     

手法点穴治疗腰椎间盘突出症68例疗效分析

腰椎间盘突出症是腰腿痛最常见原因之一。是椎间盘纤维环破裂、髓核突出压迫神经根所致的腰腿痛综合征。我院自 1994年至 2 0 0 0年采用手法点穴配合斜扳法治疗腰椎间盘突出症 68例 ,收效显著 ,现报告如下。资料与方法1 1 一般资料本组 68例 ,其中男 5 2例 ,女 16例 ;年龄最小 2 2岁 ,最大 64岁 ;发病 3个月以内的 2 8例 ,4个月至 1年者 3 2例 ,1年以上者 8例。 68例病人均经过ＣＴ检查以后确诊 ,来院住院治疗的病人。其中Ｌ4～Ｌ5突出者40例Ｌ5～Ｓ1者 2 8例。1 2 治疗方法1 2 1 手法点穴法　以突出部位夹脊穴为主 ,医者在压痛明显部位进…     

MR imaging and osseous spinal intervention and intervertebral disk intervention

Percutaneous spine intervention, a wide range of invasive spine procedures performed through a puncture hole or through a small incision not requiring soft tissue closure and with few or no skin sutures or staples, is rapidly emerging as an effective alternative to open surgery. This article describes many of the minimally invasive osseous, intervertebral disk, and spinal nerve interventions currently being performed, including both well-established procedures and procedures developed recently. A general introduction to these types of procedures is provided, along with the characteristic pre- and postprocedural MR imaging appearance related to these techniques. The article also discusses reported and theoretical complications that may arise and their respective MR imaging appearances.