Lumbar disc excision in children and adolescents

Fifty patients, all of whom were sixteen years old or younger, underwent discectomy for a herniated lumbar disc at the Mayo Clinic between 1950 and 1976. Ninety-four per cent of the patients had had excellent or good initial relief of symptoms after the initial operation. Subsequently, however, twenty-eight of the thirty-seven patients who initially had undergone disc excision only required additional treatment for low-back pain or sciatica. Twelve of them required a second operation, consisting of nine discectomies (six with a concomitant spine fusion), two spine fusions alone, and one re-fusion. Of the thirty-seven patients who initially had had disc excision alone, three had a recurrent disc protrusion and five had a disc protrusion at another level. Of sixteen patients who had had multiple subtotal hemilaminectomies at the initial operation, either for involvement of multiple discs or for exploration, seven required reoperation. In the twelve patients who had had both a disc excision and a lumbar spine fusion as the initial operation, there were no recurrent disc protrusions and only one patient had a protrusion at another level. Follow-up on all patients ranged from five to thirty years (average, nineteen years). Ninety per cent of the patients stated that the condition of the back had little or no effect on their current way of life, despite the presence of continuing back complaints in some. However, we rated the results of the initial discectomy at follow-up as excellent or good in 73.5 per cent and poor in 26.5 per cent of the patients.     

青少年腰椎间盘突出症

为了解青少年腰椎间盘突出症的病因、临床表现及治疗与成人腰椎间盘突出症的区别，总结了３１例２０岁以下青少年手术后远期随访结果。随访平均８年，优良率９３％。作者认为，外伤是造成青少年腰椎间盘突出症的主要原因。临床上较少出现感觉、运动及腱反射异常等神经根损害的表现。治疗上不应过份强调保守治疗，手术治疗可获得满意疗效。     

Lumbar disc herniation in children

The symptoms, signs, and radiographic findings of lumbar disc herniation with apophyseal fracture are compared with those of lumbar disc herniation without fracture. Disc herniation with apophyseal fracture characteristically displayed central herniation, postoperative bony ridge formation, and end plate irregularity.     

Lumbar disc protrusion in children

Forty-three cases of surgically treated lumbar disc protrusion in patients 21 years or younger are analyzed. The results were generally good. Ten percent of the patients required reoperation within 3 years. No major complications were experienced. Follow-up observation ranged from 4 to 30 years. Disc protrusion should be considered in the differential diagnosis of children with back and sciatic pain, and early myelography should be carried out in the refractory case. The symptoms, signs, myelograms, and surgical findings are usually similar to those of the adult patient with a disc protrusion.     

经皮穿刺切吸治疗青少年腰椎间盘突出症

目的　探讨青少年腰椎间盘突出症的临床表现和治疗。方法　 7例青少年腰椎间盘突出症均行经皮穿刺切吸治疗 ,并分析临床表现和治疗方法。结果　随访全部病例 ,平均随访 2 .8年 ,症状体征均消失。结论　临床表现特点为症状轻 ,体征重 ;治疗上不要过分强调保守治疗 ,经皮穿刺切吸是重要的治疗方法之一。     

Intervertebral lumbar disc prolapse in children and adolescents

The radiographs and records of 58 cases of lumbar disc prolapse in children and adolescents were reviewed, and 28 cases were followed up after an average of 6.8 years. Trauma was not a significant aetiological factor, but there was a high incidence of back pain in relatives of affected patients. The clinical picture is similar to that in the adult except for a relative paucity of neurological signs. This review of patients treated by surgical or conservative methods suggests that good results may be obtained in patients with a short history who are offered surgery early. Preoperative radiculography is considered to be essential because of the inaccuracy in localising the level of disc prolapse by clinical signs. The result of treatment in patients with long histories is usually disappointing.     

14例青少年腰椎间盘突出症的临床特点及治疗分析

[目的]探讨青少年腰椎间盘突出症的临床特点、治疗方法与效果.[方法]14例青少年腰椎间盘突出症均行手术治疗,其中开窗9例,扩大开窗5例,对其进行回顾性分析.[结果]11例得到随访,平均随访时间21个月,优良率为90.9%.[结论]创伤、体育活动、艺术体操训练和畸形是造成青少年腰椎间盘突出症的主要原因;X线检查无特异性,但体征明显是其临床特点,先严格保守治疗,无效者采取手术治疗,近期效果良好.     

青少年腰椎间盘突出症的手术治疗

目的：探讨青少年腰椎间盘突出症的手术治疗方法及效果。方法：对14例经保守治疗无效或临床症状特别严重的青少年腰椎间盘突出症患者进行单侧或双侧椎板开窗减压腰椎间盘髓核摘除术，观察治疗效果。结果：全部病例获得随访，随访时间2个月-11年，平均4年2个月，11例术后症状完全消失，恢复正常工作与生活，无复发；2例术后症状基本消失，但仍有轻微腰部不适，劳累后出现腰痛，短暂休息后症状消失，不影响正常工作；1例术后症状明显减轻，体征大部分消失，但未能恢复正常体力活动。结论：青少年腰椎间盘突出患者突出物较大且神经损害症状较重，保守治疗不能取得满意疗效时应尽早采用单侧或双侧椎板开窗手术，手术治疗效果满意。     

Lumbar disc arthroplasty

Degenerative disc disease is the leading cause of pain and disability in adults in North America, and spinal fusion is the standard treatment. Despite this, it has been discussed among surgeons that (1) spinal fusion deserves reexamination in terms of its long-term consequences and benefits and (2) modern clinical research and development in disc arthroplasty strongly supports its emergence as an alternative. The ability to relieve pain by maintaining motion may be a critical factor in obtaining not only greater pain relief but in preventing adjacent segment degeneration. Early research in arthroplasty devices was promising but cut short. New knowledge in the functional anatomy and biomechanics of the spine has made possible the development of modern arthroplasty devices (eg, Charite Artificial Disc, ProDisc, Maverick device, FlexiCore device) of different constructions and materials (metal-on-plastic, metal-on-metal) and various ranges of motion/mobility that provide a basis for a classification of spinal mode and an assistance in implant selection. Current research also is confronting the critical obstacles of wear and tear and axial compression. Several devices currently are in clinical trials. A detailed review of their characteristics shows the exciting progress of a new treatment era of total disc replacement in spine-lumbar disc arthroplasty.     

青少年腰椎间盘突出症的病因及治疗

目的 :探讨青少年腰椎间盘突出症的病因和治疗。方法 :12例青少年腰椎间盘突出症均手术治疗 ,开窗术 9例 ,扩大开窗 3例 ,分析其病因 ,临床表现及治疗方法。结果 :随访全部病例 ,平均随访时间 1 5年 ,优良率达 92 3 %。结论 :外伤和畸形是造成青少年腰椎间盘突出症的主要原因 ;X线检查不易诊断和定位 ,体征明显是其临床特征。治疗上在严格保守治疗无效的情况下 ,手术治疗也是重要的治疗方法。     

Lumbar disc prosthesis

Summary Twenty-two patients with 29 lumbar disc prosthesis have been reviewed clinically and radiologically with a minimum of 12 months follow-up. The first operation in France with the SB Charity model was carried out in January 1989 with the help of the German authors Schellnäck and Büttner. The surgical technique consists of an anterior extraperitoneal approach with the patient in a supine and hyperlordotic position and must be very precise. The indications are very rare. At the moment, we only consider the prosthesis as an alternative to an arthrodesis in young patients with good-quality bone. We limit the indication to cases where fusion in situ is to be avoided: degenerative disease with collapsed disc, failed backs and instability at a maximum of one or two levels. The immediate results are encouraging, and no loosening of the prosthesis or osteolysis at the boneprosthesis interface has been noticed in patients with 2 or more years follow-up. The segmental mobility still remains in bending and flexion/extension and is demonstrated by dynamic X-rays. Because we do not know the long-term results of implantation of the prosthesis, it must continue to be a rare procedure and the patient must be informed that in case of failure, fusion by a posterior or anterior approach may be necessary and is always possible.     

Lumbar disc herniation in teenagers

Summary We report 48 patients operated on for lumbar disc herniation in the second decade of life (aged 13–20 years) in our Neurosurgical Division. To analyze the clinical and diagnostic features and surgical outcome of the disease in teenagers and to point out any differences from adults, we made a detailed study of over 900 juvenile cases and compared them with 11000 adult cases reported in the literature. Low-back pain proved to be less frequent among youngsters both as a first symptom and at diagnosis, while sensorimotor deficits have the same frequency in the two age groups. Herniation occurs more often at L4–L5 and is more frequently median among teenagers. The long-term surgical results in children and adolescents are better than in adults.     

腰椎间盘损伤

腰椎间盘损伤陈雄生贾连顺腰椎间盘损伤与下腰痛和腰椎退变关系密切,但由于早期诊断困难,临床上容易被忽视。１．腰椎间盘损伤的病理解剖：腰椎间盘损伤后可发生一系列病理变化。Ｋｐ等〔１〕将猪腰椎间盘前方纤维环作部分切除,建立损伤模型。３个月后观察到如下病理变...     

Lumbar disc arthroplasty.

BACKGROUND CONTEXT: Painful lumbar disc degeneration is one of the most common ailments treated by spine surgeons. Currently, early disc disease and herniation are often treated with microdiscectomy. Late disc degeneration is usually treated with arthrodesis. With the advent of new technology and techniques in lumbar disc arthroplasty, interest in preserving spinal motion at degenerated motion segments has increased. The goals of lumbar disc arthroplasty are to provide long-term pain relief at the degenerated disc level, to restore disc height to protect neural elements and to preserve motion to prevent posterior facet arthropathy and adjacent segment disease. PURPOSE: The purpose of this review is to examine the anatomy and biomechanics of the lumbar motion segment to determine the features that successful disc arthroplasty prosthesis must possess. In addition, the early clinical results of three prostheses currently being used in humans are reviewed. STUDY DESIGN/SETTING: Review of the literature. METHODS: A systematic review of Medline for articles related to lumbar disc arthroplasty was conducted up to and including journal articles published in August 2003. In addition, the abstracts from the annual meetings of the North American Spine Society and Scoliosis Research Society from 1998 to 2003 were searched. The literature was then reviewed and summarized. RESULTS/CONCLUSIONS: Short-term results of lumbar disc arthroplasty as measured by pain relief and disability are good in some studies. Implants are relatively safe in the short term, and with newer designs complications are usually related to the surgical approach rather than early implant failure. Recovery times appear to be shorter than arthrodesis. Despite the relatively good early clinical results of these devices, questions remain about the long-term efficacy in pain relief and maintenance of motion, the results of randomized comparative trials with fusion and the life span of the devices. In addition, late sequelae and revision options are unknown. Current indications for lumbar disc arthroplasty are in the setting of a Food and Drug Administration trial in young, nonosteoporotic patients with one or two level symptomatic disc degeneration without severe facet arthropathy, segmental instability or neural element compression requiring a posterior decompression.     

Lumbar disc herniation]

Back pain is common (80-90% population), conservative treatment is usually successful. Lumbar disc herniation and sciatica are fairly common but are far less frequent than is idiopathic low back pain. Sciatica is usually due to lumbar disc herniation; the outcome is usually favorable. Surgery for lumbar disc herniation and sciatica is indicated if acute bladder and bowel impairment is present (cauda equine syndrome) or if sciatic pain is incapacitating and persistent for more than 6 to 12 weeks. Confirmation of the clinical level of disc herniation must be made by imaging (CT or MRI). With proper patient selection, surgery for lumbar disc herniation and sciatica can be expected to lead to excellent results in the majority of patients.