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。     

一期后、前路手术治疗发育性颈椎管狭窄症合并巨大椎间盘突出

目的：评价一期后、前路手术治疗发育性颈椎管狭窄合并巨大椎间盘突出的特点及疗效。方法：回顾分析2002年2月至2006年1月接受该术式的21例患者的临床资料,对手术前后临床表现、JOA评分、MRI影像变化以及术后神经功能改善率及并发症进行总结分析。结果：术后未发生神经系统症状加重、感染及内固定失效等并发症。获得1年以上随访者21例,平均随访时间为29.2个月,术后3个月、12个月时神经功能改善率分别为：58%、66%;16例获得2年以上随访者神经功能改善率为71%。结论：一期后、前路手术治疗发育性颈椎管狭窄合并巨大椎间盘突出可缩短治疗周期,相对节省治疗费用,同时解除了硬膜囊前、后方的压迫,减压彻底,疗效满意。     

臭氧结合胶原酶治疗腰椎间盘突出症的临床应用

目的研究臭氧髓核氧化术结合胶原酶溶解术治疗腰椎间盘突出症的临床疗效。方法对183例腰椎间盘突出症患者进行臭氧结合胶原酶盘内、外注射治疗。术后随访6~12个月,按照Macnab评定标准进行疗效评定。结果183例患者,优144例,良18例,可16例,差5例;优良率为88.5%,有效率为97.3%;本组患者无1例并发症出现。结论臭氧髓核氧化术结合胶原酶溶解术治疗腰椎间盘突出症集合了两者的优点,因此疗效更好,同时安全、费用低,是腰椎间盘突出症首选的微创治疗方法。     

Contrast on T2-weighted images of the lumbar spine using fast spin-echo and gated conventional spin-echo sequences

A prospective study in 31 patients was designed to compare contrast quantitatively using axial conventional, gated spin-echo T2-weighted (T2W) (SE) (asymmetrical echo TE 30 and 80 ms) and axial dual-echo fast spin-echo (FSE) sequences (TE_eff20 and 120 ms) to image lumbar discs, nerve roots, and cerebrospinal fluid CSF. We used two quantitative measures, percent (%) contrast and contrast-to-noise ratio (CNR), to compare the sequences. The FSE sequence had greater % contrast and CNR on the first and second echo images for both disc and nerve root detection using these scan parameters. An axial FSE sequence, therefore, provided contrast characteristics similar to those of gated axial T2W SE sequence in the lumbar spine, with a 60% saving in acquisition time. The FSE sequence is now our standard axial T2W study for the lumbar spine.     

Disc herniation in the lumbar spine during growth: Long-term results of operative treatment in 18 patients

We studied 18 patients who had undergone surgery for herniated lumbar discs between the ages of 11 and 17 years. The inclusion criteria for girls was an age of 15 years or below and for boys 17 or below at surgery. The mean follow-up time was 10 years and the clinical outcome was good. Age at surgery and length of the follow-up had no effect on the result. The radiological disc height at follow-up did not correlate with the follow-up time or age of the patient at operation. MRI scans at follow-up from ten patients operated at less than 15 years of age revealed multilevel disc degeneration but favourable clinical results.     

Experimental model of chronic tonsillar herniation associated with early stage syringomyelia

This report describes an experimental model of chronic tonsillar herniation and its effects on the spinal cord. In ten rats, a small piece of chemically induced mammary cancer was transplanted to the supraoccipital bone. In all cases, the transplanted cancers grew into the posterior fossa, destroying the supraoccipital bone and compressing the cerebellum extradurally. In six of the ten rats, tonsillar herniation was observed at 8–14 weeks after transplantation. Transdural infiltration of the tumor cells was not apparent in any animal. In those rats with tonsillar herniation (n=6), the spinal cord from the C5 to the T8 segments showed enlargement of the central canal without exception. Histological examination revealed the following changes: stretching and thinning of the ependymal cells; swelling of the astrocytic processes; and extracellular edema, predominantly in the dorsal gray matter, but also in the ventral inner portion of the dorsal column. In the control group (n=4) and those rats without tonsillar herniation (n=4), such histological changes of the spinal cord were not observed. Although the lesions can not be regarded as representing mature syringomyelia, they most likely constitute an earlier evolutionary stage.     

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目的　探讨腹腔镜食道裂孔疝修补术的可行性及安全性。方法　回顾性分析 2 0 0 1年 3月至 2 0 0 3年12月天津南开医院行腹腔镜食道裂孔疝修补术 11例病人的临床资料。结果　 10例行裂孔疝修补后同时行胃底折叠术 ,其中 7例行Nissen胃底折叠术 ,3例行Toupet胃底折叠术 ,1例仅行裂孔修补术。术后症状完全缓解。食道下段压力由 (8 6± 2 4 )mmHg(1mmHg =0 133kPa)提高到 (18 2 0± 3 4 3)mmHg(P <0 0 1) ,2 4hpH值监测评分由 5 3 4± 39 7降低到 8 0 4± 2 12 (P <0 0 1) ,较手术前有明显改善 ,并达到正常范围。无手术并发症 ,无中转开腹及死亡病例。结论　对于食道裂孔疝 ,腹腔镜食道裂孔疝修补术是一种安全、有效的治疗方法     

A new technique for the treatment of lumbar far lateral disc herniation: technical note and preliminary results

A newly designed technique for a minimally invasive approach to the laterally herniated disc is presented. Fifteen patients suffering from far lateral disc herniation (extraforaminal) were operated according to this technique. Through a small skin incision (1.5 cm), the paraspinal muscles are spread by dilators, until a working channel of 9 mm inner diameter and 11 mm outer diameter can be placed. The next steps are done through this channel using the surgical microscope. No bone resections are necessary and the facet joints are left untouched. However, partial resection of the intertransverse ligament may be necessary. The mean follow-up period for these 15 patients was 11.5 months, and they were evaluated by using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The average surgical time was 43 min. The ODI improved from 30.6 (preoperative) to 14.3 (postoperative). The VAS of leg pain improved from 7 (preoperative) to 3.6 (postoperative), which represented a statistically significant improvement at the significance level of (P<0.01). No intra-operative or early postoperative complications occurred. However, one recurrence did occur, which was treated by the same technique. This technique combines the advantages of three-dimensional visual control (operating microscope) with the minimal surgical trauma of endoscopic techniques, while avoiding some of the shortcomings of both the microsurgical and endoscopic techniques.     

Modic changes following lumbar disc herniation

Only a small proportion (20%) of patients with LBP can be diagnosed based on a patho-anatomical entity. Therefore, the identification of relevant subgroups, preferably on a patoanatomical basis, is strongly needed. Modic changes have been described by several authors as being closely linked with LBP. The aims of this study were to describe the prevalence of Modic changes, their development as well as their association to LBP, previous disc contour, and surgery in patients with previous severe sciatica. This is a longitudinal cohort study where the patients were recruited from an RCT comparing two active conservative treatments, the 181 patients, who at baseline had radicular pain in or below the knee; all underwent a physical examination and MRI. MRI’s, pain history and physical examination of 166 patients were obtained at follow-up 14 months later. The prevalence of Modic changes type 1 increased from 9% at baseline to 29% at follow-up. At that time, a strong association between Modic changes and non-specific LBP was noted. Apparently, Modic changes type 1 was more strongly associated with non-specific lumbar pain than Modic changes type 2. The development of new Modic changes was closely related to the level of a previous disc herniation. A lumbar disc herniation is a strong risk factor for developing Modic changes (especially type 1) during the following year. Furthermore, Modic changes are strongly associated with LBP.     

Early neuromuscular customized training after surgery for lumbar disc herniation: a prospective controlled study

A prospective and controlled study of training after surgery for lumbar disc herniation (LDH). The objective was to determine the effect of early neuromuscular customized training after LDH surgery. No consensus exists on the type and timing of physical rehabilitation after LDH surgery. Patients aged 15–50 years, disc prolapse at L4–L5 or L5–S1. Before surgery, at 6 weeks, 4, and 12 months postoperatively, the following evaluations were performed: low back pain and leg pain estimated on a visual analog scale, disability according to the Roland–Morris questionnaire (RMQ) and disability rating index (DRI). Clinical examination, including the SLR test, was performed using a single blind method. Consumption of analgesics was registered. Twenty-five patients started neuromuscular customized training 2 weeks after surgery (early training group=ETG). Thirty-one patients formed a control group (CG) and started traditional training after 6 weeks. There was no significant difference in pain and disability between the two training groups before surgery. Median preoperative leg pain was 63 mm in ETG and 70 mm in the CG. Preoperative median disability according to RMQ was 14 in the ETG and 14.5 in the CG. Disability according to DRI (33/56 patients) was 5.3 in the ETG vs. 4.6 in the CG. At 6 weeks, 4 months, and 12 months, pain was significantly reduced in both groups, to the same extent. Disability scores were lower in the ETG at all follow-ups, and after 12 months, the difference was significant (RMQ P=.034, DRI P=.015). The results of the present study show early neuromuscular customized training to have a superior effect on disability, with a significant difference compared to traditional training at a follow-up 12 months after surgery. No adverse effects of the early training were seen. A prospective, randomized study with a larger patient sample is warranted to ultimately demonstrate that early training as described is beneficial for patients undergoing LDH surgery.