Vertebral ʼCornerʼ Defect Associated with Lumbar Disk Herniation Shown by Magnetic Resonance Imaging

Abstract Background With advances in techniques and instruments, percutaneous endoscopic transforaminal lumbar diskectomy (PETLD) is now widely used for lumbar disk herniation. Although the indication for PETLD is expanding, the technique still has limitations. To overcome them, we performed the epidural catheter-assisted PETLD described here. Methods A 49-year-old woman had severe radiating pain in a left L5 dermatomal distribution. Magnetic resonance imaging (MRI) revealed left paramedial disk herniation at L4–L5 and a small downward-migrated disk fragment. We performed epidural catheter-assisted PETLD. Mechanical outward pushing and normal saline injection through the epidural catheter were performed for removal of hidden disk remnants. In the second case, a 26-year-old man presented with severe radiating pain in the L5–S1 dermatoms on both sides. MRI revealed massive disk herniation at L4–L5. A unilateral approach was used, and the ruptured disk could be moved using an epidural catheter. Results The patients' pain improved immediately after the procedures. With this method, neural decompression can be performed more easily and effectively. Conclusions Epidural catheter-assisted PETLD has several advantages and can overcome the limitations of conventional PETLD.

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The Dose-Response Relationship Between Cumulative Lifting Load and Lumbar Disk Degeneration Based on Magnetic Resonance Imaging Findings

Physical Therapy ◽

10.2522/ptj.20130095 ◽

2014 ◽

Vol 94 (11) ◽

pp. 1582-1593 ◽

Cited By ~ 7

Author(s):

Yu-Ju Hung ◽

Tiffany T-F. Shih ◽

Bang-Bin Chen ◽

Yaw-Huei Hwang ◽

Li-Ping Ma ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Dose Response ◽

Response Relationship ◽

Resonance Imaging ◽

Dose Response Relationship ◽

Compression Load ◽

Lumbar Disk ◽

Lumbar Disk Degeneration ◽

Disk Height

BackgroundLumbar disk degeneration (LDD) has been related to heavy physical loading. However, the quantification of the exposure has been controversial, and the dose-response relationship with the LDD has not been established.ObjectiveThe purpose of this study was to investigate the dose-response relationship between lifetime cumulative lifting load and LDD.DesignThis was a cross-sectional study.MethodsEvery participant received assessments with a questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disk dehydration, annulus tear, disk height narrowing, bulging, protrusion, extrusion, sequestration, degenerative and spondylolytic spondylolisthesis, foramina narrowing, and nerve root compression on each lumbar disk level. The compression load was predicted using a biomechanical software system.ResultsA total of 553 participants were recruited in this study and categorized into tertiles by cumulative lifting load (ie, <4.0 × 105, 4.0 × 105 to 8.9 × 106, and ≥8.9 × 106 Nh). The risk of LDD increased with cumulative lifting load. The best dose-response relationships were found at the L5–S1 disk level, in which high cumulative lifting load was associated with elevated odds ratios of 2.5 (95% confidence interval [95% CI]=1.5, 4.1) for dehydration and 4.1 (95% CI=1.9, 10.1) for disk height narrowing compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 2.1 (95% CI=1.3, 3.3) for bulging compared with low lifting load. The tests for trend were significant.LimitationsThere is no “gold standard” assessment tool for measuring the lumbar compression load.ConclusionsThe results suggest a dose-response relationship between cumulative lifting load and LDD.

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