Spontaneous resorption of intradural lumbar disc fragments.

BACKGROUND CONTEXT: Intradural disc herniation is relatively rare complication of the spinal degenerative process that occurs most frequently in the lumbar part of the spine. Both myelographic and magnetic resonance features of this entity have been described, and the mechanism of intradural herniation has already been proposed and generally accepted. In this article, we present a case of spontaneous resorption of an intradural, fragmented intervertebral disc. Spontaneous resorption of intradural disc fragments has not been previously reported. PURPOSE: To discuss a possible mechanism of spontaneous resorption of the subdural disc fragments. STUDY DESIGN: Case report and literature review. METHODS: Radiological follow-up of a 46-year-old man with the intradural herniation of disc fragments. CONCLUSION: The reaction generated by the meninges might lead to the complete resorption of intrathecally localized disc fragments.     

Spontaneous resorption in recurrent intradural lumbar disc herniation. Case report

The authors report a case of spontaneous resorption of intradural disc material in a patient with recurrent intradural lumbar disc herniation and review magnetic resonance (MR) imaging and histopathological findings. Intradural lumbar disc herniation is rare, and most patients with this condition require surgical intervention due to severe leg pain and vesicorectal disturbance. In the present case, however, the recurrent intradural herniated mass had completely disappeared by 9 months after onset. Histological examination of intradural herniated disc tissue demonstrated infiltrated macrophages and angiogenesis within the herniated tissue, and Gd-enhanced MR images showed rim enhancement not only at the initial presentation, but also at recurrence. The authors conclude that when rim enhancement is present on Gd-enhanced MR images, there is a possibility of spontaneous resorption even though the herniated mass may be located within the intradural space. Moreover, when radiculopathy is controllable and cauda equina syndrome is absent, conservative therapy can be selected.     

Intradural migration of sequestrated disc fragment during decompression of cauda equina

We report the case of a man who underwent urgent surgery to relieve compression of the cauda equina caused by a large L4/5 disc protrusion. A post-operative but not pre-operative MRI scan showed appearances suggestive of intradural migration of a disc fragment, confirmed at re-operation. We believe that this event happened during the first operation and not before it.     

伴有“自溶”现象的腰椎椎间盘突出症的治疗探讨

目的 探讨对伴有“自溶”现象的腰椎椎间盘突出症的治疗策略。 方法 回顾2006年1月~2011年12月本院收治的腰椎椎间盘突出症患者34例,所有患者比较首次发病与入院前腰椎MRI检查发现均有突出椎间盘缩小的影像学表现。对其中15例行腰后路减压椎间植骨内固定术或髓核摘除术;19例采用卧床休息、腰围固定以及脱水、消炎镇痛等非手术治疗。采用Oswestry功能障碍指数（Oswestry disability index, ODI）、疼痛视觉模拟量表（visual analogue scale, VAS）评分及影像学检查评价治疗效果。 结果 手术组15例,手术切口均一期愈合,随访2~16个月,平均12.3个月。术前ODI为42.8±4.25,末次随访时为12.5±1.26,与术前比较差异有统计学意义（P＜0.01）。VAS评分术前为7.13±1.24分,末次随访时为1.45±0.86分, 与术前比较差异有统计学意义（P＜0.01）。非手术治疗组19例,治疗前ODI为27.9±3.61,末次随访时为10.5±6.4,治疗6个月后复查腰椎MRI平扫提示突出椎间盘完全消失者4例,部分消失者9例,无明显变化者6例。 结论 对于伴有“自溶”现象的腰椎椎间盘突出症患者应根据影像学及临床表现采用相应的治疗方法,可获得较满意的临床疗效。     

颈椎间盘突出组织重吸收1例报告

Guinto等[1]于1984年首次报告了腰椎间盘突出组织重吸收的现象后,相关的临床案例及实验室研究报告日益增多.但关于颈椎间盘突出组织重吸收现象的报告仍然少见.2011年4月我们收治1例伴脊髓受压症状的颈椎间盘突出症患者,经非手术治疗,并MRI随访,发现椎间盘突出组织大部分重吸收,临床症状基本消失,报告如下.患者男,36岁.颈肩部疼痛伴左上肢麻木间断发作10个月,加重15d,偶有"踩棉感",于2011年4月8日来我院就诊.无外伤史.查体:颈肩部肌肉僵硬,C3/4～C6/7棘突间及棘突旁压痛明显,左侧臂丛神经牵拉试验(+),双上肢肌力5级,C6平面感觉减退,双侧Hoffman征(+).颈椎正侧位X线片可见颈椎曲度变浅,颈椎退行性改变.2011年4月9日颈椎MRI显示C5/6椎间盘髓核向后突出,同水平脊髓明显受压,脊髓信号未见明显改变(图1).结合患者症状、体征及MRI,诊断为颈椎间盘突出症.患者拒绝手术治疗,亦无颈托外固定及其他系统保守治疗,仅休息、慢跑及做扩胸运动等,避免剧烈运动,加强颈部保护,避免颈部过度屈曲及后伸.     

Dorsally sequestrated thoracic disc herniation--case report

A 53-year-old male presented with a rare dorsally sequestrated thoracic disc herniation manifesting as acute low back pain and weakness. He had no history of trauma. Magnetic resonance (MR) imaging demonstrated a mass at T10-11 intervertebral level connected with the T-10 disc. Axial MR imaging showed the mass had surrounded and compressed the dural sac from the lateral and dorsal sites. MR imaging with gadolinium-diethylenetriaminepenta-acetic acid showed slight rim enhancement of the lesion. Computed tomography detected no abnormal calcification. The diagnosis was thoracic disc herniation. Laminectomy resulted in rapid and satisfactory recovery. The histological diagnosis was thoracic disc herniation. MR imaging was very effective for the diagnosis based on the connection between the mass and the disc space. The differential diagnosis includes metastatic epidural tumor, epidural hematoma, and epidural abscess.     

炎症在腰椎间盘退变、突出、吸收发病机制中的作用

腰椎间盘退变、突出是下腰痛的主要原因,炎症与腰椎间盘退变及下腰痛密切相关.病理性退变的椎间盘细胞出现炎症介质异常表达,炎症介质诱导激活基质金属蛋白酶,加剧椎间盘退变.纤维环破裂、髓核组织暴露于硬膜外,激发急性创伤炎症反应,合成、分泌大量炎症介质,引起神经根炎,导致坐骨神经痛,同时炎症反应促使腰椎间盘突出组织吸收.该文就近年来有关炎症与腰椎间盘病变关系的研究进展作一综述.     

细胞自噬对腰椎间盘突出后重吸收的意义

细胞自噬作为细胞的一种自我保护性机制,可通过降解自身衰老物质而维持细胞稳定,且可被高度诱导,自噬对细胞的降解能力会随年龄的增加而减弱。腰椎间盘突出后的重吸收现象是临床保守治疗腰椎间盘突出症患者有效的机制之一,退行性病变是腰椎间盘突出的主要原因之一,细胞自噬又广泛参与了腰椎间盘的退行性病变,并延缓了退行性病变的发生,同时细胞自噬可潜在性诱导重吸收现象的发生。细胞自噬的研究对椎间盘退行性病变以及腰椎间盘突出后的重吸收现象意义重大,对临床保守治疗腰椎间盘突出症患者具有指导意义,因此应重视细胞自噬在重吸收现象中的研究。     

Clinical studies of isolated disc resorption in the lumbar spine

Low lumbar pain with radiation into the leg is a common symptom pattern caused by a number of pathological processes. Isolated disc resorption is one such entity which can be readily identified and is amenable to surgical treatment. This study consisted of two groups of patients. Group I were 50 patients suffering from isolated disc resorption at L5--S1 with ill-defined low backache extending into the buttocks and down one or both legs, but not into the feet. Clinical signs of nerve root dysfunction were found in 16 per cent of patients. Radiographic changes with loss of disc height, facet over-riding and intrusion into the nerve root canal and intervertebral foramen were common and frequently associated with sclerosis of the vertebral end-plate. Group II were a series of 45 patients with isolated disc resorption independently reviewed an average of 45 months after surgical decompression of the S1 (98 per cent) or lower lumbar nerve roots. Based on objective grading by the clinician and subjective assessment by the patient complete success was achieved in 62 per cent of the patients and partial success in 24 per cent. Provided there is full appreciation of the pathological anatomy, strict diagnostic criteria and meticulous surgery, decompression of the nerve root canal is a useful surgical procedure in severely disabled patients suffering from isolated disc resorption.     

The treatment of lumbar disc herniation: simple fragment excision versus disc space curettage.

The purpose of this study was to determine whether there was any difference in the clinical outcome between groups of patients treated with lumbar discectomy and vertebral endplate curettage as compared with disc fragment excision without endplate curettage. Eighty-three patients requiring lumbar disc excision for herniated nucleus pulposus were evaluated retrospectively at minimum 2-year follow-up. Forty-three patients had undergone fragment excision and disc space curettage at one center, whereas 40 patients underwent fragment excision without curettage at two other centers. There was no increased rate of reherniation or reoperation in the excision-only group. Vertebral endplate curettage carries a risk of annular penetration and damage to the great vessels. This study shows that this potentially dangerous step of the operation is unwarranted. In addition, patients who underwent endplate curettage had a higher incidence of low-back pain on follow-up.     

Uninstrumented posterolateral lumbar fusion for single level isolated disc resorption and/or degenerative disc disease

The limited soft-tissue envelope technique for an uninstrumented single-level posterolateral lumbar fusion has been studied in a group of 23 patients. It resulted in a solid fusion in 21 of 23 (91%) patients. Overall, 18 of 23 (78%) patients had a satisfactory outcome to this fusion technique, which can be performed in any community-based hospital.     

Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome

Posterior epidural migration of free disc fragments is rare, and posterior migration of the free fragments causing cauda equina syndrome is exceptionally rare. This report describes a 53-year-old man with disc fragment extrusion at the levels of L3-4 and a 54-year-old man with disc fragment extrusion at L5-S1 intervertebral space. The patients responded well to the operative therapy with complete relief of the symptoms. The pathological examination confirmed that the specimen was a degenerated intervertebral disc. Early surgery should be the first choice of therapy in patients with large posteriorly migrated sequestered disc fragments, to prevent severe neurological deficits such as cauda equina and conus medullaris syndromes.     

Posterior epidural migration of an extruded free fragment from a lumbar disc herniation

The majority of symptomatic lumbar disc herniations are located in a posterolateral position with resultant nerve root compression. Although caudal, rostral and lateral migrations of disc fragments are common, posterior epidural migration of an extruded free fragment from a lumbar disc herniation is a rare occurrence and sometimes may cause a dural sac compression with cauda equina syndrome. This retrospective case report describes a 63-year-old man with intractable lower back pain and cauda equina syndrome. Emergency magnetic resonance imaging (MRI) revealed a posterior epidural soft tissue compressing the dural sac. The lesion was hypointense on T1-weighted images, hyperintense on T2-weighted images and showed rim enhancement after intravenous injection of gadolinium. A laminectomy at L3 was performed and the extruded disc fragment was removed with dural sac decompression. Postoperatively the patient's radicular symptoms completely resolved. At the 2-year follow-up visit, the patient had recovered full motor, sensory and urinary functions. MRI is the modality of choice in the evaluation of an extruded free disc fragment and a cauda equina compression. In such cases a wide decompressive laminectomy is recommended. Received: 13 November 2000; Accepted: 4 December 2000     

大鼠破裂型椎间盘突出模型的建立及突出物重吸收机制的研究

目的:设计一种新的腰椎间盘突出重吸收模型.方法:取20只体重(300±20) g的3月龄远交群(SD)雄性大鼠,依据随机数字表随机分成实验组和对照组.实验组经手术切除尾椎椎间盘,埋植在硬膜外;动物30 d后处死,取埋植髓核组织,进行HE染色,流式细胞仪以及免疫组化检测.对照组,将线团埋植在背部肌肉内,30 d后处死作实验对照.结果:实验组30 d后的TNF-ɑ、VEGF免疫组化染色呈阳性.实验组的Th、B细胞数量与对照组比较差异有统计学意义.结论:大鼠破裂型椎间盘突出模型能够很好的揭示破裂型椎间盘突出后的重吸收过程,为进一步研究椎间盘突出后的重吸收提供一种新的动物模型.