椎间盘内加压注射疗法治疗腰椎间盘突出症

[目的]探讨椎间盘内加压注射疗法对有手术指征的腰椎间盘突出症的治疗效果。[方法]对58例有手术指征的腰椎间盘突出症进行椎间盘造影及加压注射,造影剂和生理盐水的注入压力最好不要超过3kg/cm2(1kg/cm2=7350mmHg)。[结果]最终随访JOAscore平均改善率为73.3%,手术回避率为79.3%。有明显疗效的32例(占55.2%)。[结论]椎间盘内加压注射疗法对保守疗法无效而且有手术指征的腰椎间盘突出症也有明显疗效。     

CT椎间盘造影诊断腰椎间盘突出症

７３例临床疑诊为腰椎间盘突出症的患者作了脊髓造影和ＣＴ椎间盘造影检查。手术治疗５３例，其中突出４５例５１个间隙。两种方法的阳性率分别为７０％和９２％。ＣＴ椎间盘造影影像能清晰显示突出物的大小、部位，硬膜囊神经根受压、造影剂充填、关节突退变情况。当其它辅助检查仍不能明确定性和定位诊断时，ＣＴ椎间盘造影可帮助确诊，尤其对Ｌ＿５－Ｓ＿１椎间盘突出意义更大。     

CT椎间盘造影诊断超外型腰椎间盘突出症：（附4例临床报告）

文献报道~([1-6])超外型腰椎间盘突出症突出物位于椎间孔或更外侧的部位,主要压迫同间隙的神经根,如L4～5突出压迫L4神经根,L5～S1突出压迫L5神经根。作者于1989年进行了73例CT椎间盘造影研究,发现4例超外型突出,现报告如下并复习文献。 临床资料 例1:男,47岁,干部。腰痛10年,左下肢疼痛4个月。查:L3～4左侧椎旁压痛,放射痛阴性。直腿抬高左70°,右80°。左股神经牵拉试验阳性,左趾背伸力稍弱。左大腿前侧及小腿外侧痛觉减弱。余未见异常。脊髓造影和CTM发现L4-5左旁侧型突出。L3-4未见异常。CT椎间盘造影发现L4-5左旁侧型突出,L3-4…     

腰椎间盘造影及其临床意义：附68例83个椎间盘分析

１９９３～１９９４两年间腰椎间盘造影计６８例８３个椎间盘，造影椎间盘以Ｌ４－５和Ｌ５－Ｓ１为主（９５．２％）取后外侧穿刺方法，造影后无明显不良反应，部分病例有腰痛等自限性表现。造影像按Ａｄａｍｓ法归纳了５０在，椎间盘突出表现为撕裂型，破裂型，突出位置在外侧，后外侧占７８％，做手术治疗４０例，术中探查与影像诊断符合率为８５％，椎间盘造影术主要用作椎间盘突出的检查和诊断，能显著椎间盘突病变细节和突出的     

CT结合椎间盘造影(CTD)及其临床意义

目的明确CTD的适应证及在椎间盘源性疾病诊治的临床意义。方法对已作CT或和MR、椎管造影等检查未能明确诊断的腰椎间盘突出症、疑为椎间盘源性下腰痛及椎间盘突出症诊断明确为选择介入方法的患者作CTD检查,并根据检查结果选择不同的介入治疗方法治疗。结果术后随访6月～5年,椎间盘突出症介入的优良率为91.3%;椎间盘源性下腰痛的优良率为75%。结论CTD对椎间盘源性腰痛的诊断、腰椎间盘突出症的诊断及介入治疗方法的选择具有重要的临床意义。     

小关节内侧缘阻滞联合臭氧注射治疗腰椎间盘突出症的疗效观察

目的探讨小关节内侧缘阻滞联合臭氧注射与单纯小关节内侧缘阻滞治疗腰椎间盘突出症的治疗效果。方法临床CT(或MRI)检查证实为后外侧型和椎间孔型腰椎间盘突出症123例,随机分为小关节内侧缘阻滞联合臭氧注射治疗组(A组)61例和单纯小关节内侧缘阻滞治疗组(B组)62例;所有患者分别随访1、3、6个月。结果术后1个月,A组有效率90.2%;B组有效率70.9%;两组比较差异有统计学意义(P0.05);术后3个月和6个月,A组和B组疗效比较差异有统计学意义(P0.05)。结论小关节内侧缘阻滞联合臭氧注射治疗腰椎间盘突出症是一种安全、有效的治疗方法,与单纯小关节内侧缘阻滞术相比疗效更好。     

椎间盘内电热疗法

Saal等于2000年2月首次报道了椎间盘内电热疗法治疗椎间盘源性下腰痛的初步临床结果，引起了国际脊柱外科界的广泛重视。椎间盘内电热疗法是一种针对椎间盘源性疼痛的微小创伤性的新方法。文献中使用的名称尚未统一，主要有椎间盘内电热疗法（intradiscalelectrothermaltherapy）、椎间盘内电热凝结术（intradiscalelectrothermalcoagulation）、椎间盘内电热法纤维环成形术（intradiscalelectrothermalannuloplasty），但使用的缩写均为IDET。由于其作用机理尚未完全清楚，故我们暂使用“椎间盘内电热疗法”这一名称。IDET在20世纪90年…     

椎间盘造影与脊髓造影用于腰椎间盘突出症的对比分析

椎间盘造影与脊髓造影用于腰椎间盘突出症的对比分析方国华，欧阳甲自Ｌｉｎｄｂｌｏｍｌ１９４８年首次报道椎间盘造影的临床应用以来，对其诊断价值仍有争论。有些国外学者比较推崇这种方法，认为它是一种较为可靠的椎间盘病理诊断方法。国内５０～６０年代有几位作者进...     

胶原酶盘内注射治疗腰椎间盘突出症

我院自 1999年以来使用胶原酶盘内注射治疗腰椎间盘出症 32例 ,近期疗效满意 ,现报道如下。1　临床资料1.1　一般资料　本组 32例 ,男 2 3例 ,女 9例 ,年龄 2 7～ 6 5岁。病程 1月～ 2年。全部病例均有典型的腰腿疼痛症状 ,均经 CT扫描或 MRI检查或腰椎管造影确诊。其中 L3,4椎间盘突出 2例 ,L4,5椎间盘突出 18例 ,L5S1 椎间盘突出 8例 ,L4,5、L5S1 椎间盘突出 4例。1.2　治疗方法　术前 30 min推注地塞米松 2 0 mg防止过敏反应。术中取俯卧位 ,腹部垫一软枕以撑开椎间隙。棘突旁开 10 cm与躯干矢状面呈 30°～ 40°夹角进针 ;如为 L5…     

Epidural abscess and cauda equina syndrome after percutaneous intradiscal therapy in degenerative lumbar disc disease

Background context

Percutaneous intradiscal therapies are gaining popularity as a regenerative treatment option for spinal disc degeneration. The risks, benefits, and possible complications associated with such procedures have been poorly defined. As these procedures are performed with increasing frequency, the likelihood that clinicians will be faced with significant complications also increases.

Purpose

The purpose of this study is to describe a significant complication of a percutaneous intradiscal bone marrow and adipose tissue transplantation for symptomatic lumbar disc degeneration.

Study design

The study design is a case report.

Methods

Two weeks after an injection of adipose cells, bone marrow aspirate and plasma into his L3–L4 and L5–S1 lumbar discs, a 64-year-old patient presented to the emergency room with cauda equina syndrome, fever, and back pain. Magnetic resonance imaging diagnosed L3–L4 disc extrusion, discitis with osteomyelitis, and epidural abscess, resulting in emergency decompressive surgery. An epidural abscess was drained, extruded disc material was removed, and cultures obtained. Five days later, once afebrile on antibiotics, he underwent a definitive interbody arthrodesis and stabilization.

Results

Cauda equina syndrome resolved, osteomyelitis (methicillin-resistant Staphylococcus epidermidis) was treated, and instrumented arthrodesis stabilized the involved segment.

Conclusions

Complications associated with the intradiscal injection of agents, such as stem cells, fibrin glue, adipose tissue, or bone marrow, have been poorly defined. Given the nature of the degenerating disc, serious adverse events, including discitis, osteomyelitis, and extrusion of disc contents, may occur.     

Mechanical analysis of the lumbar vertebrae in a three-dimensional finite element method model in which intradiscal pressure in the nucleus pulposus was used to establish the model

We established a three-dimensional finite element method (FEM) model of the 4th and 5th vertebrae, using computed tomography (CT) images (2-mm slice thickness) of a healthy 29-year-old man. Because of the lack of specific data regarding the material characteristics of the nucleus pulposus of intervertebral discs, we used intradiscal pressure in the nucleus pulposus to establish the model. We referred to data from Nachemson and from Sato et al. regarding intradiscal pressure and to the methods of Shirazi-Adl for data for other material characteristics (see text for these references). The mid-position model bears a load of 294 N in the vertical direction, while the models of the flexed and extended positions bear loads of 15 N-m. In addition, a degenerative disc model without intradiscal pressure was created for the standing model. The use of these models allowed the investigation of von Mises stress on the vertebral endplates and the annulus fibrosus. We also examined von Mises stress on the facet joint in normal and degenerative disc models. There was increased von Mises stress on the vertebral endplate in the anterior, center portions. von Mises stress on the annulus fibrosus increased in the posterior portion, the entrance to the neural foramen, and the exit of the neural foramen. von Mises stress was greater during flexion in the posterior portion; in particular, increasing to about 1.6 times the level seen with other postures. No changes were observed in von Mises stress on the vertebral endplates or annulus fibrosus in the degenerative disc model, but von Mises stress on the facet joints was about 2.5 times that seen in the normal disc model. Received: June 28, 2001 / Accepted: October 27, 2001     

应用椎间盘造影判断腰椎间盘突出症腰痛的来源

[目的]应用椎间盘造影术探讨腰椎间盘突出症患者临床腰痛来源.[方法]137例椎间盘突出症患者根据造影术前MRI表现将椎间盘分为:正常、突出和退变.患者腰痛和腿痛的严重程度应用疼痛视觉模拟评分(VAS评分)判定,分为三组:(1)腰痛为主组;(2)腿痛为主组;(3)腰腿痛并重组.对所有退变的腰椎间盘及至少1个作对照的正常椎间盘进行椎间盘造影检查,如造影过程中诱发一致性腰痛,即认为椎间盘造影阳性.[结果]137例患者总共427个椎间盘行造影检查,其中104个造影阳性.椎间盘造影阳性患者腰痛与腿痛VAS评分无明显差异(P＞0.05),而阴性者腿痛评分高于腰痛评分(P＜0.05).腰痛为主组,腿痛为主组,腰腿痛并重组其造影阳性率分别为79.2%,18.6%,71. 7%.MRI表现为正常、突出和退变的椎间盘其造影阳性率分别是1.4%、48.3%、21.6%(P＜0.05).[结论]盘源性腰痛可能是腰痛明显的椎间盘突出症患者腰痛的主要原因,这种腰痛主要来源于椎间盘突出节段和或邻近退变节段.     

Intradiscal pressure after intradiscal injection of hypertonic saline: an experimental study

Although chemonucleolysis with chymopapain is a long-established treatment for lumbar intervertebral disc herniation, serious complications have been reported. Accordingly, alternative substances for chemonucleolysis have been sought. The main beneficial effect of chemonucleolysis derives from the decrease in intradiscal pressure. Several previous studies have investigated the relationship between physiological saline injection and disc mechanics in cadaveric specimens [2, 5, 16]. However, no previous study has assessed the intradiscal pressure after intradiscal injection of “hypertonic saline” in living animals. The present study compared the changes in intradiscal pressure after intradiscal injection of hypertonic saline with those after chymopapain injection. The lumbar intervertebral discs of 26 living rabbits were examined: 10% hypertonic saline was injected in ten rabbits, and chymopapain (10 pikokatal units) was injected intradiscally in another ten, with the remaining six being used as controls. The intradiscal pressure was measured at 1, 4, and 12 weeks after injection. The intradiscal pressure of the hypertonic saline-injected group at 4 weeks was significantly lower than that of the control group, but by 12 weeks it had recovered. On the other hand, that of the chymopapain-injected group remained significantly lower than that of the control group at 12 weeks. The results of this study found that hypertonic saline injected into the intervertebral discs temporarily decreased the intradiscal pressure. Received: 26 July 1999 Revised: 26 November 1999 Accepted: 22 December     

腰椎间盘间孔突出症

腰椎间盘间孔突出症在腰椎间盘突出症中并非少见，诊断主要依据以下四点：（１）腿部症状严重；（２）典型神经障碍；（３）椎间手术后证实；（４）ＣＴ检查。本文详细讨论了该病的论断的技巧和效果。     

经皮激光汽化减压术对造影结果不同的腰椎间盘突出症的疗效对比

目的对比经皮激光汽化减压术（PercutaneousLaserDiscDecompression,PLDD）对两种椎间盘造影结果的腰椎间盘突出症的疗效,结合文献探讨椎间盘造影及PLDD的临床应用。方法自2010-01—2013-05行PLDD治疗的单节段腰椎间盘突出症患者58例进行回顾性分析,术前造影阴性的16例为A组,阳性者42例为B组;激光烧灼总能量控制在300～600J,汽化减压并反复抽吸;对2组患者术前、术后即刻和随访时的临床表现、直腿抬高角度及JOA评分进行比较。结果A组与B组在术前、术后即刻和随访时直腿抬高角度及JOA评分均无显著差别。结论椎间盘造影阴性并不能完全排除椎间盘源性腰腿痛;椎间盘造影结果不同的两组腰椎间盘突出症患者在PLDD的中期疗效上无显著差异。     

腰椎间盘突出症的量化手术适应证

回顾103例手术证实的腰椎间盘突出症,将诊断依据标准化计分,试图找到比较适用而标准的手术适应证,从分档的疗效评定结果可以看出:计分大于15分者有明显的手术指征;计分9至15分者有手术指征,但应谨慎;而计分小于9分者,应慎之又慎,为手术的相对禁忌证.