模特征对伴单侧坐骨神经痛的腰椎间盘突出症的诊断价值

目的：介绍与验证一种反映腰椎间盘突出伴单侧坐骨神经痛的体征——模特征。方法：选取72例经腰椎MRI证实有腰椎间盘突出（L4，532例，L5／S1 40例）并伴单侧坐骨神经痛的患者，男49例，女23例，年龄32～68岁，平均50．7岁。每例患者人院当日由两位医师间隔2h分别检查，患者背对检查者，嘱其取最能缓解坐骨神经痛的站立姿势，若患者出现患侧屈髋屈膝、骨盆倾向患侧的姿势，记为“模特征阳性”，否则记为“模特征阴性”。同时行直腿抬高试验（SLR），阳性患者记录诱发下肢放射痛的最小角度。结果：70例患者两检查者结果完全相同，其中阳性60例，阴性10例，敏感性为85．7％；仅2例患者两检查者结果不一致，重复性97．2％。SLR均为阳性。结论：模特征是诊断伴单侧坐骨神经痛腰椎间盘突出症的简单、敏感的临床体征。     

显微内窥镜下椎间盘切除术及其与胶原酶溶核术联合治疗腰椎间盘突出症的疗效比较

目的:比较显微内窥镜下椎间盘除术(MED)及MED与胶原酶溶核术(CCNL)联合应用治疗腰椎间盘突出症的临床疗效。方法:120例腰椎间盘突出症患者中,60例单纯行MED治疗(MED组),另60例在行MED的基础上向椎间盘内注射胶原酶600U(MED CCNL组)。术后观察并分析两组的疗效及并发症。结果:两组均顺利完成手术,未发生并发症。术后全部病例随访6～48个月,按照MacNab标准评定,MED组有效率为83.3%,MED CCNL组为95%,后者明显高于前者(P<0.05)。结论:MED与CCNL联合治疗腰椎间盘突出症较单纯MED治疗具有更好的疗效。     

经皮穿刺颈椎髓核成形术治疗多间隙颈椎间盘突出症

目的:探讨经皮穿刺颈椎髓核成形术(percutaneous cervical nucleoplasty,PCN)治疗多间隙颈椎间盘突出症的临床疗效及其对颈椎稳定性的影响。方法:对我院2003年7月～2005年6月因颈椎间盘突出症住院行PCN治疗的64例患者进行回顾性研究,根据手术间隙分为两组:单间隙组(A组)34例,多间隙组(B组)30例。临床效果评价采用JOA评分标准(17分制并计算改善率),颈椎稳定性评价采用Katsumi标准。比较两组的临床效果及颈椎稳定性。结果:随访6～24个月,A组平均14.1±3.7个月,B组平均13.9±3.8个月,A组术前JOA评分为9.19±2.64分,术后为14.37±1.42分,改善率为66.3%;B组术前JOA评分为8.89±2.31分,术后为14.33±1.28分,改善率为67.1%,与术前比较均有显著性差异(P<0.001),两组患者的JOA评分改善率无显著性差异(P>0.05)。两组患者术后颈椎稳定性与术前比较均无显著性差异(P>0.05)。结论:PCN治疗多间隙颈椎间盘突出症效果优良,对颈椎稳定性影响小,不会造成颈椎失稳。     

腰椎间盘突出症合并椎管狭窄23 例治疗分析

目的探讨经后路椎间盘镜手术治疗合并腰椎管狭窄症的椎间盘突出症的临床应用。方法采用后路椎间盘镜进行单侧开窗减压术。通过术前标记腰椎正侧位片定位，于定位棘突间隙后正中偏患侧作长约1.5 cm小切口，逐级扩张后置入工作通道管，钻除部分椎板，置入内窥镜，于电视监视器下显露椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织，彻底解除其对硬脊膜、神经根的压迫。结果本组共治疗合并腰椎管狭窄症的腰椎间盘突出症23例，平均随访7个月，按Prolo标准评定，治愈20例，有效2例，无效1例。结论本术式在严格掌握适应证前提下对合并腰椎管狭窄症的腰椎间盘突出症患者效果明显。     

腰椎间盘突出症合并左髂总动脉瘤破裂1例

1 病例资料 患者,女,60岁.因腰痛6个月加重伴右下肢麻痛10余天入院.入院时查体:心肺及腹部未发现明显异常,脊柱无明显侧弯及后突畸形, L4～5右侧压痛,臀部压痛,伴右下肢小腿外侧窜痛,直腿抬高试验阳性(40°),膝跟腱反射右侧减弱,跷踇肌力右侧三级.CT示:L4～5椎间盘突出,Hb 118 g/L.入院诊断.L4～5椎间盘突出症.     

Outcome of surgery for a symptomatic herniated thoracic disc in relation to preoperative characteristics of the disc

Summary   Background. This report presents general information on herniated thoracic discs, their clinical manifestations as well as surgical treatment, and examines the differences in the surgical outcome based on disc characteristics. Methods. This study includes 33 thoracic discectomies in 29 patients with a ventrally situated herniated thoracic disc reaching to the thoracic cord. Using preoperative computed tomography scanning and magnetic resonance imaging, the direction of the disc was classified as either central or lateral, and disc consistency classified as either soft or hard. Clinical outcome was assessed according to the Japanese Orthopedic Association (JOA) Score for thoracic myelopathy. The score was obtained by analysing motor, sensory and bladder function. Recovery rate was assessed, comparing preoperative and postoperative status based on disc characteristics. The correlations between outcome, symptom duration and recovery rate were also investigated. Findings. Clinical outcome according to the JOA Score showed significant postoperative improvement, increasing from 7.0 ± 3.1 points to 8.2 ± 2.7 points postoperatively (p < 0.01). The mean recovery rate was 12.4 ± 56.9%, and 16 patients (55.2%) showed improvement. In the soft disc group, there was improvement in all categories, but the hard disc group showed no improvement. The central disc group showed improvement in sensory function, but the lateral disc group showed little improvement. Regression analysis revealed a statistically significant correlation between the preoperative and postoperative score, symptom duration and recovery rate. Conclusions. Clinical outcome after surgery of a herniated thoracic disc proved successful, especially when the disc was considered to have a soft consistency. In order to decide the optimal surgical strategy and prospective surgical outcome, disc characteristics, including consistency and direction of prolapse should be considered preoperatively.     

Is there any relationship between proinflammatory mediator levels in disc material and myelopathy with cervical disc herniation and spondylosis? A non-randomized,prospective clinical study

The proinflammatory mediator (PIM) levels were assessed in surgically removed samples of herniated cervical intervertebral discs. The objective of this study was to investigate if there is a correlation between the levels of PIMs in disc material and myelopathy associated with cervical intervertebral disc herniation and spondylosis. The role of proinflammatory mediators in the degeneration of intervertebral disc and the inflammatory effects of disc herniations on radicular pain has been previously published. However, the possible relationship between PIMs and myelopathy related to cervical disc herniation and spondylosis has not been investigated before. Thirty-two patients undergoing surgery for cervical disc herniation and spondylosis were investigated. Surgically obtained disc materials, stored at 70 degrees C, were classified into two groups: cervical disc herniation alone or with myelopathy. Biochemical preparation and solid phase enzyme amplified sensitivity immunoassay (ELISIA) analysis of the samples were performed to assess the concentration of mediators in the samples. Very similar values of interleukin-6 were found in both groups whereas the concentrations of mediators were significantly higher in myelopathy group. This study has demonstrated that PIMs are involved in cervical intervertebral disc degeneration with higher concentrations in the samples associated with myelopathy.     

颈椎前路减压人工颈椎间盘置换术与融合术治疗单节段颈椎间盘突出症的短期疗效比较

背景：颈前路椎间盘切除植骨融合术（ACDF）能够为有症状的颈椎病患者提供较好的治疗效果,但颈椎融合可导致相邻节段椎间盘内部应力增加,加速邻近节段椎间盘的退变。颈椎人工椎间盘置换术（ACDR）作为最具代表性的颈椎前路非融合技术,为颈椎间盘突出症的治疗提供了另外一种外科手段。目的：比较ACDR和ACDF治疗单节段颈椎间盘突出症的临床效果。方法：2009年1月至2012年2月,61例单节段颈椎间盘突出症患者接受Discover人工颈椎间盘置换手术（置换组,26例）或ACDF手术（融合组,35例）。分别在术前,术后1周,术后3、6、12及24个月对患者进行疼痛视觉模拟评分（VAS）、日本矫形外科协会（JOA）评分及影像学评估,同时记录患者并发症及二次手术情况。结果：最终,52例患者（融合组29例,置换组23例）获得平均15.3个月（12-24个月）随访。两组患者术后各随访时间点的颈痛、上肢痛VAS和JOA评分,较术前均有改善（P〈0.05）,但两组间无显著统计学差异（P〉0.05）。置换组术后手术节段及邻近节段屈伸活动度与术前比较无统计学差异（P〉0.05）。融合组融合成功率为90.5%。置换组中2例患者术后6个月时假体有〈3 mm的前移,l例术后发生脑脊液漏。融合组中1例患者发生邻椎病并接受二次手术治疗。结论：单节段Discover人工颈椎间盘置换术和ACDF均可明显缓解颈椎间盘突出症患者的症状。间盘置换还能减少手术邻近节段代偿活动度的增加,有望预防相邻节段退变的发生。     

Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica

Background contextGadolinium-enhanced magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar disc surgery. However, correlation between enhancement and clinical findings is debated, and limited data are available regarding the reliability of enhancement findings.PurposeTo evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica.Study designProspective observational evaluation of patients who were enrolled in a randomized trial with 1-year follow-up.Patients samplePatients with 6- to 12-week sciatica, who participated in a multicentre randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after 1 year.Outcome measuresPatients were assessed by means of the Roland Disability Questionnaire (RDQ) for sciatica, visual analog scale (VAS) for leg pain, and patient-reported perceived recovery at 1 year. Kappa coefficients were used to assess interobserver reliability.MethodsIn total, 204 patients underwent Gd-MRI at baseline and after 1 year. Magnetic resonance imaging findings were correlated to the outcome measures using the Mann-Whitney U test for continuous data and Fisher exact tests for categorical data.ResultsPoor-to-moderate agreement was observed regarding Gd enhancement of the herniated disc and compressed nerve root (kappa<0.41), which was in contrast with excellent interobserver agreement of the disc level of the herniated disc and compressed nerve root (kappa>0.95). Of the 59 patients with an enhancing herniated disc at 1 year, 86% reported recovery compared with 100% of the 12 patients with nonenhancing herniated discs (p=.34). Of the 12 patients with enhancement of the most affected nerve root at 1 year, 83% reported recovery compared with 85% of the 192 patients with no enhancement (p=.69). Patients with and without enhancing herniated discs or nerve roots at 1 year reported comparable outcomes on RDQ and VAS-leg pain.ConclusionsReliability of Gd-MRI findings was poor-to-moderate and no correlation was observed between enhancement and clinical findings at 1-year follow-up.     

Case report: The operation for the lumbar disk herniation just after cesarean delivery in the third trimester of pregnancy

INTRODUCTION

Low back pain is common during pregnancy. However, the incidence of symptomatic lumbar disc herniation during pregnancy is very rare. We report a case of lumbar disc herniation underwent discectomy just after cesarean delivery in the third trimester of pregnancy.

PRESENTATION OF CASE

A 33-year-old woman presented at 32 weeks gestation. She had a low back pain and the left-sided leg pain below the knee. At 34 weeks gestation, she had severe weakness of the left extension halluces longus, left ankle dorsiflexion. MRI showed a large disc herniation at L4/5 expanded to the spinal canal more. The cesarean delivery was performed in the supine position. The patient was then turned to a prone position, and a left L4/5 discectomy was performed. But the day after surgery, she had a severe low back pain and the right leg pain below the knee. MRI showed a disc herniation at L4/5 on the right side of the spinal canal. At 6 days after the first surgery, a right L4/5 discectomy was performed. In the immediate postoperative period, the patient experienced complete relief of the right leg pain.

DISCUSSION

It is necessary to cooperate with a pediatrician, an obstetrician, and an anethesiologists. For obtaining the best outcome on mother and child, it is important to discuss in advance to be able to respond quickly for changeable situation.

CONCLUSION

It is necessary to conduct the operation under pregnancy in consideration of the great influence on mother and child.