Double-blind evaluation of intradiscal chymopapain for herniated lumbar discs

1976 ◽  
Vol 45 (6) ◽  
pp. 622-627 ◽  
Author(s):  
P. Robert Schwetschenau ◽  
Archimedes Ramirez ◽  
James Johnston ◽  
Elnora Barnes ◽  
Albert N. Martins
Keyword(s):  
Conservative Treatment ◽  
Lumbar Disc ◽  
Intractable Pain ◽  
Double Blind ◽  
Content Type ◽  
Early Results ◽  
Significant Difference ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ The authors report 66 patients with signs, symptoms, and a myelographic abnormality of herniated lumbar disc, who were not responsive to conservative treatment. The discs were injected at random with either chymopapain or a placebo. Neither patient nor surgeon knew which agent was used until after the results had been tabulated. Unless early laminectomy was necessary for intractable pain, all patients were followed for 2 months or more. There was no statistically significant difference in incidence or quality of improvement between the two groups: chymopapain was successful in 58% while placebo was successful in 49% (p = 0.15). Early results from this study indicate that most, if not all, of the putative effectiveness of chemonucleolysis probably derives from a placebo effect.

Efficacy of chymopapain chemonucleolysis

1985 ◽  
Vol 62 (5) ◽  
pp. 662-666 ◽  
Author(s):  
Manucher J. Javid
Keyword(s):  
Marked Improvement ◽  
Lumbar Disc ◽  
Slight Improvement ◽  
Content Type ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ A 9- to 12-year follow-up review was conducted in 105 of 124 patients who were treated with chymopapain chemonucleolysis for herniated lumbar disc. The data were obtained from responses to a questionnaire. Seventy-nine patients (75.2%) reported marked improvement, six (5.7%) had slight improvement, and 20 (19.0%) had no improvement. Of the 87 patients not receiving workman's compensation, 70 patients (80.5%) had marked improvement; four (4.6%) had slight improvement; and 13 (14.9%) had no improvement. Of the 18 compensation cases, nine patients (50.0%) had marked improvement; two patients (11.1%) had slight improvement; and seven patients (38.9%) had no improvement. These results are comparable to those reported for surgical discectomy, and confirm that chymopapain chemonucleolysis is an alternative to surgery.

A comparison of the gamma knife model C and the Automatic Positioning System with Leksell model B

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 25-28 ◽  
Author(s):  
Daniela Tlachacova ◽  
Michal Schmitt ◽  
Josef Novotny ◽  
Josef Novotny ◽  
Mustafa Majali ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Gamma Knife ◽  
Positioning System ◽  
Content Type ◽  
Ocular Lesions ◽  
Significant Difference ◽  
Model C ◽  
Automatic Positioning ◽  
Fine Print

Object. The authors sought to compare the quality of treatment planning, radiation protection, and the time taken for treatment in the Leksell gamma knife model B with that using the model C Automatic Positioning System (APS). Methods. Data were obtained in 463 patients treated with the B model and 518 patients treated with the C model. Data were analyzed in patients in whom the following diagnoses had been made: vestibular schwannoma, pituitary adenoma, meningioma, solitary metastasis, and other benign and malignant solitary tumors. Patients with arteriovenous malformations, ocular lesions, and functional diagnoses were excluded from this study. Conclusions. With the C model there was a better conformity for most treated targets, such as vestibular schwannomas (p = 0.005) and meningiomas (p = 0.015). The level of radiation exposures to personnel was significantly decreased when using the model C (p < 0.001). There was no significant difference in radiation exposure of extracranial structures for the same number of shots in patients treated by both models. The mean time saved using the C model with the APS was 41 minutes per treatment. It would seem that the gamma knife model C permits better dose conformity, shorter treatment times, and less radiation exposure to personnel.

Extraosseous extradural tuberculous granuloma simulating a herniated lumbar disc

1971 ◽  
Vol 35 (4) ◽  
pp. 488-490 ◽  
Author(s):  
S. Balaparameswara Rao ◽  
I. Dinakar ◽  
K. Sreenivasa Rao
Keyword(s):  
Cerebrospinal Fluid ◽  
Granulation Tissue ◽  
Lumbar Disc ◽  
Disc Prolapse ◽  
Content Type ◽  
X Ray ◽  
Herniated Lumbar Disc ◽  
Tuberculous Granuloma ◽  
Fine Print

✓ A 25-year-old man with left-sided sciatica, in whom the cerebrospinal fluid and x-ray films of the spine were normal, was diagnosed as having a L5-S1 disc prolapse. At surgery extradural, extraosseous granulation tissue was removed, which histologically proved to be a tuberculous granuloma.

Syndrome of the incidental herniated lumbar disc

1983 ◽  
Vol 59 (1) ◽  
pp. 137-141 ◽  
Author(s):  
James E. Wilberger ◽  
Dachling Pang
Keyword(s):  
Clinical Features ◽  
Lumbar Disc Herniation ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Appropriate Treatment ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ Lumbar myelographic defects consistent with herniated disc were found in 108 asymptomatic patients undergoing myelography for other reasons. Within 3 years, 64% of these patients developed symptoms of lumbosacral radiculopathy. The clinical features of these patients comprise a syndrome significantly different from that typically associated with classical lumbar disc herniation: the syndrome described here carries a much higher incidence of silent root compression with minimal pain. Incidental lumbar myelographic defects are not necessarily benign findings, and patients in whom they are encountered deserve close clinical follow-up review and appropriate treatment if the defects become symptomatic.

Intraradicular herniated lumbar disc

1984 ◽  
Vol 60 (4) ◽  
pp. 858-860 ◽  
Author(s):  
José Barberá ◽  
José Gonzalez-Darder ◽  
Fernando García-Vazquez
Keyword(s):  
Nerve Root ◽  
Unusual Case ◽  
Lumbar Disc ◽  
Content Type ◽  
Pathogenic Factors ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ An unusual case is presented in which a fragment of herniated lumbar disc was found within the sheath of the S-1 nerve root. The possible pathogenic factors are discussed.

Nimodipine treatment in poor-grade aneurysm patients

1988 ◽  
Vol 68 (4) ◽  
pp. 505-517 ◽  
Author(s):  
Kenneth C. Petruk ◽  
Michael West ◽  
Gerard Mohr ◽  
Bryce K. A. Weir ◽  
Brien G. Benoit ◽  
...  
Keyword(s):  
Outcome Analysis ◽  
Double Blind ◽  
Content Type ◽  
Poor Grade ◽  
Good Outcome ◽  
Significant Difference ◽  
Delayed Neurological Deterioration ◽  
Repeat Angiography ◽  
Grade 3 ◽  
Fine Print

✓ A multicenter, randomized placebo-controlled double-blind trial of nimodipine in poor-grade aneurysm patients was carried out in 17 Canadian hospitals. Of 188 patients enrolled in the trial, 32 were excluded for protocol violations and two were excluded due to statistical considerations, leaving 154 patients for valid outcome analysis. Nimodipine treatment was associated with a significantly better outcome (p < 0.001): 21 (29.2%) of 72 nimodipine-treated patients had a good outcome at 3 months after subarachnoid hemorrhage (SAH) compared to eight (9.8%) of 82 placebo-treated patients. Delayed ischemic deficits from vasospasm alone were significantly less frequent in the nimodipine group (p < 0.05) with permanent deficits occurring in five nimodipine-treated patients (6.9%) and in 22 placebo-treated patients (26.8%). Improvement in the good outcome rate and reduction in delayed ischemic deficits from vasospasm alone occurred in both Grade 3 and 4 patients, with no difference between nimodipine- and placebo-treated patients being found in Grade 5 patients. Repeat angiography after Day 4 was carried out in 124 patients. There was no significant difference in the incidence of moderate or severe diffuse spasm, which was seen in 64.3% of nimodipine-treated patients and 66.2% of placebo-treated patients. The authors conclude that nimodipine treatment in poor-grade patients with SAH results in an increase in the number of good outcomes and a reduction in the incidence of delayed neurological deterioration due to vasospasm. This effect occurs by a mechanism other than prevention of large-vessel spasm as visualized on angiography.

Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study

1989 ◽  
Vol 70 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Juha Öhman ◽  
Olli Heiskanen
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Anterior Part ◽  
Controlled Trial ◽  
Randomized Study ◽  
Prospective Randomized Study ◽  
Double Blind ◽  
Content Type ◽  
Acute Surgery ◽  
Significant Difference ◽  
Fine Print

✓ A total of 216 patients with a ruptured aneurysm of the anterior part of the circle of Willis were enrolled into this prospective randomized study of timing of the operation after aneurysmal subarachnoid hemorrhage (SAH). Only patients in clinical Grades I to III (according to the classification of Hunt and Hess) who were admitted and randomly assigned to a treatment group within 72 hours after the SAH were included in the trial. The patients were randomly assigned to one of three operation groups: acute surgery (AS: 0 to 3 days after the SAH; day of SAH = Day 0), intermediate surgery (IS: 4 to 7 days after the SAH), or late surgery (LS: 8 days to an indefinite time after the SAH). Three patients (4.3%) in the IS group and six patients (8.6%) in the LS group died before surgery was undertaken. At 3 months post-SAH, 65 patients (91.5%) from the AS group were classified as independent compared to 55 (78.6%) from the IS group and 56 (80.0%) from the LS group. The management mortality rate in the AS group was 5.6% compared to 12.9% in the LS group. Of the 216 patients enrolled in the timing study, 159 were randomly assigned to an independent double-blind placebo-controlled trial of nimodipine in Grade I to III patients. A total of 79 patients received nimodipine and 80 placebo. When the nimodipine group and the no-nimodipine group (the 80 placebo-treated patients plus the 52 patients who were not entered into the nimodipine trial) were analyzed separately, a significant difference was seen in the outcome of the no-nimodipine group (dependent AS vs. dependent IS, p = 0.01). Nimodipine treatment was associated with a significant reduction of delayed ischemic deterioration (all operation groups combined, nimodipine vs. no nimodipine p = 0.01; LS with nimodipine vs. LS with no nimodipine, p = 0.03).

Disappearing cervical disc

1997 ◽  
Vol 86 (2) ◽  
pp. 289-290 ◽  
Author(s):  
Richard M. Westmark ◽  
Kaye D. Westmark ◽  
Volker K. H. Sonntag
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Lumbar Disc ◽  
Spontaneous Resolution ◽  
Herniated Disc ◽  
Cervical Disc ◽  
Resonance Imaging ◽  
Content Type ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ The authors report the case of a 48-year-old woman who experienced spontaneous resolution of a large herniated disc at C6–7. Spontaneous resolution of a herniated lumbar disc was first documented by computerized tomography. This case is another example of a rare spontaneous resolution of a cervical disc herniation documented by magnetic resonance imaging.

Intervertebral bone implants following excision of protruded lumbar discs

1975 ◽  
Vol 42 (4) ◽  
pp. 401-405 ◽  
Author(s):  
Lee A. Christoferson ◽  
Bradford Selland
Keyword(s):  
Conservative Treatment ◽  
Intervertebral Disc ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Disc Protrusion ◽  
Content Type ◽  
Back Surgery ◽  
Fine Print

✓ The authors describe a technique whereby a portion of the lamina removed during exposure of an intervertebral lumbar disc protrusion is implanted in the intervertebral disc space following disc excision. An analysis of 456 consecutive cases operated on by this technique and followed from 1 to 10 years is presented. Of the 418 patients followed, 92% indicated they were able to return to their normal activities and were satisfied with the result. Thirty percent of the patients indicated they had required some conservative treatment for recurrent episodes of back or leg pain. Ten patients had subsequent back surgery; only one implant has dislocated.

A comparison of the gamma knife model C and the Automatic Positioning System with Leksell model B

2005 ◽  
Vol 102 ◽  
pp. 25-28 ◽  
Author(s):  
Daniela Tlachacova ◽  
Michal Schmitt ◽  
Josef Novotny ◽  
Josef Novotny ◽  
Mustafa Majali ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Gamma Knife ◽  
Positioning System ◽  
Content Type ◽  
Ocular Lesions ◽  
Significant Difference ◽  
Model C ◽  
Automatic Positioning ◽  
Fine Print

Object.The authors sought to compare the quality of treatment planning, radiation protection, and the time taken for treatment in the Leksell gamma knife model B with that using the model C Automatic Positioning System (APS).Methods.Data were obtained in 463 patients treated with the B model and 518 patients treated with the C model. Data were analyzed in patients in whom the following diagnoses had been made: vestibular schwannoma, pituitary adenoma, meningioma, solitary metastasis, and other benign and malignant solitary tumors. Patients with arteriovenous malformations, ocular lesions, and functional diagnoses were excluded from this study.Conclusions.With the C model there was a better conformity for most treated targets, such as vestibular schwannomas (p = 0.005) and meningiomas (p = 0.015). The level of radiation exposures to personnel was significantly decreased when using the model C (p < 0.001). There was no significant difference in radiation exposure of extracranial structures for the same number of shots in patients treated by both models. The mean time saved using the C model with the APS was 41 minutes per treatment. It would seem that the gamma knife model C permits better dose conformity, shorter treatment times, and less radiation exposure to personnel.

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