Absence of limitation of straight leg raising in proved lumbar disc lesion

1980 ◽  
Vol 52 (6) ◽  
pp. 852-853 ◽  
Author(s):  
B. Ramamurthi
Keyword(s):  
Lumbar Disc ◽  
Full Range ◽  
Clinical Signs ◽  
The Other ◽  
Nerve Roots ◽  
Disc Protrusion ◽  
Content Type ◽  
Straight Leg Raising ◽  
Important Sign ◽  
Fine Print

✓ The absence of the classical clinical sign of limitation of straight leg raising is reported in one patient and summarized in 14 others who had all the other clinical signs of disc protrusion and in whom the disc lesion was proved by myelography and at surgery. It is postulated that the absence of this important sign may be explained by the daily habits of patients who stoop and bend to perform their household duties. Such posture leads to an elongation of the nerve roots, which permits a full range of straight leg raising. It is worth remembering that this sign may be absent in some patients with a disc lesion.

Lumbar disc protrusion in children

1981 ◽  
Vol 54 (4) ◽  
pp. 480-483 ◽  
Author(s):  
Robert G. Fisher ◽  
Richard L. Saunders
Keyword(s):  
Differential Diagnosis ◽  
Adult Patient ◽  
Lumbar Disc ◽  
Disc Protrusion ◽  
Content Type ◽  
Sciatic Pain ◽  
Major Complications ◽  
Refractory Case ◽  
Fine Print

✓ Forty-three cases of surgically treated lumbar disc protrusion in patients 21 years or younger are analyzed. The results were generally good. Ten percent of the patients required reoperation within 3 years. No major complications were experienced. Follow-up observation ranged from 4 to 30 years. Disc protrusion should be considered in the differential diagnosis of children with back and sciatic pain, and early myelography should be carried out in the refractory case. The symptoms, signs, myelograms, and surgical findings are usually similar to those of the adult patient with a disc protrusion.

Changes in nerve root motion and intraradicular blood flow during intraoperative femoral nerve stretch test

2003 ◽  
Vol 99 (3) ◽  
pp. 298-305 ◽  
Author(s):  
Shigeru Kobayashi ◽  
Yoshihiko Suzuki ◽  
Takahiro Asai ◽  
Hidezo Yoshizawa
Keyword(s):  
Blood Flow ◽  
Disc Herniation ◽  
Standard Error ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Femoral Nerve ◽  
Nerve Roots ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. It is not known whether changes in intraradicular blood flow (IRBF) occur during the femoral nerve stretch test (FNST) in patients with lumbar disc herniation. An FNST was conducted in patients with lumbar disc herniation to observe the changes in IRBF, and results were then compared with clinical features. Methods. The study was composed of four patients with L3–4 disc herniation who underwent microdiscectomy. Patients were placed prone immediately before surgery, so that their knee flexed on the operating table with the hip joint kept in hyperextension, and the FNST was performed to confirm at which region pain developed in the anterolateral thigh. During the operation, the hernia-affected nerve roots were visualized under a microscope. The needle sensor of a laser Doppler flowmeter was then inserted into each nerve root immediately above the hernia, and the change in IRBF was measured during the intraoperative FNST. After removal of the herniated disc, a similar procedure was repeated and IRBF was measured again. The intraoperative FNST showed that the hernia compressed the nerve roots and there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, IRBF decreased by 92.8 to 100% (mean 96.9 ± 3.7% [± standard error of the mean]) relative to the blood flow before the test. This study demonstrated that the blood flow in the nerve root is reduced when the nerve root is compressed in vivo. Conclusions. The intraoperative FNST showed that the hernia compressd the nerve roots and there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, IRBF decreased by 92.8 to 100% (96.9 ± 3.7% [mean ± standard error of the mean]).

Primary epidural Ewing's sarcoma presenting as a lumbar disc protrusion

1979 ◽  
Vol 51 (1) ◽  
pp. 120-123 ◽  
Author(s):  
Lawrence H. Fink ◽  
Michael W. Meriwether
Keyword(s):  
Epidural Space ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Lumbar Disc ◽  
Pertinent Literature ◽  
Disc Protrusion ◽  
Content Type ◽  
Primary Neoplasms ◽  
Spinal Epidural ◽  
Fine Print

✓ Primary neoplasms of the spinal epidural space are uncommon. One of the rarest of these is a soft tissue sarcoma indistinguishable from Ewing's sarcoma of the bone. Only 39 such cases have been reported previously, of which only three arose within the epidural space. The authors report an additional case, which presented in an atypical manner, and review the pertinent literature.

Surgical treatment of 63 cases of conjoined nerve roots

1982 ◽  
Vol 56 (1) ◽  
pp. 114-117 ◽  
Author(s):  
James G. White ◽  
Timothy A. Strait ◽  
Joseph R. Binkley ◽  
Samuel E. Hunter
Keyword(s):  
Surgical Treatment ◽  
Lumbar Disc ◽  
Disc Disease ◽  
Nerve Roots ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Operative Results ◽  
Conjoined Nerve Roots ◽  
Conjoined Nerve Root ◽  
Fine Print

✓ The operative results of 63 cases of lumbar disc disease with surgically confirmed conjoined nerve roots are reviewed. The first 55 patients were treated by standard hemilaminectomy and discectomy, with only 30% reporting a good result. Of the last eight patients treated by hemilaminectomy, pediculectomy, and discectomy, seven patients returned to work. The rationale for and the technique of pediculectomy are discussed in detail. Clinical, radiological, and surgical clues indicating the presence of the conjoined nerve root anomaly are reviewed.

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.

Percutaneous treatment of gas-containing lumbar disc herniation

1999 ◽  
Vol 91 (1) ◽  
pp. 133-136 ◽  
Author(s):  
Andrea Righini ◽  
Silvia Lucchi ◽  
Paolo Reganati ◽  
Mario Zavanone ◽  
Agostino Bettinelli
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Percutaneous Treatment ◽  
Needle Aspiration ◽  
Nerve Root Compression ◽  
Nerve Roots ◽  
Content Type ◽  
Tomography Scanning ◽  
Fine Print

✓ A limited number of cases have been reported in which gas-containing lumbar disc herniation caused compression of nerve roots. The authors describe two patients in whom computerized tomography scanning revealed a large intraspinal gas collection that appeared to be causing nerve root compression and that was successfully evacuated by percutaneous needle aspiration.

Significance of a persistent positive straight leg raising test after lumbar disc surgery

1999 ◽  
Vol 91 (1) ◽  
pp. 50-53 ◽  
Author(s):  
Bo Jönsson ◽  
Björn Strömqvist
Keyword(s):  
Lumbar Disc ◽  
Reoperation Rate ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Straight Leg Raising ◽  
Grade Scale ◽  
Repeated Surgery ◽  
A Prospective Study ◽  
Fine Print

Object. Results of the straight leg raising (SLR) test provide the clinician with valuable information regarding possible causes of a patient's pain. In a previous study the results have also demonstrated a correlation between the outcome of the test and the severity of pain, as well as the prognostic value of the test; patients for whom the SLR test is persistently positive postoperatively appear to have a poorer short-term outcome. In a prospective study of 200 consecutive patients who underwent surgery for disc herniation, the authors evaluated the frequency of repeated surgery and outcome of surgery in patients with a persistent postoperative positive SLR test. Methods. The preoperative radiological evaluation included myelography, computerized tomography scanning, and/or magnetic resonance imaging. Preoperatively as well as 4, 12, and 24 months postoperatively, each patient was interviewed and examined using a standard protocol in which common symptoms and signs were described. The result of the SLR test was also classified into one of four categories: positive 0 to 30°; positive 30 to 60°, positive greater than 60°, or negative, and the surgical results were evaluated using a four-grade scale. Preoperatively, the SLR test was positive in 86% of patients. At 4 months postoperatively, 22% still had a positive SLR test. For the patients whose SLR test was positive 4 months postoperatively, the long-term outcome at all three follow-up examinations was inferior; this difference was statistically significant. Conclusions. During the 2-year period, the reoperation rate was 18% (eight of 44) in patients with a positive postoperative SLR test compared with 4.5% (seven of 156) in patients whose postoperative SLR test was negative. A postoperative positive SLR test thus correlates to an unfavorable surgical outcome.

Innervation of caudal denervated ventral roots and their target muscles by the rostral spinal motoneurons after implanting a nerve autograft in spinal cord—injured adult marmosets

2001 ◽  
Vol 94 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Song Liu ◽  
Nozar Aghakhani ◽  
Nazaire Boisset ◽  
Gérard Said ◽  
Marc Tadie
Keyword(s):  
Spinal Cord ◽  
Clinical Signs ◽  
Control Group ◽  
Nerve Roots ◽  
Content Type ◽  
Axonal Regrowth ◽  
Cord Injury ◽  
Ventral Roots ◽  
Nerve Autograft ◽  
Fine Print

Object. The authors conducted a study to determine the effects of using a nerve autograft (NAG) to promote and guide axonal regrowth from the rostral spinal cord to the caudal lumbar ventral nerve roots to restore hindlimb motor function in adult marmosets after lower thoracic cord injury. Methods. Nine animals underwent a left-sided hemisection of the spinal cord at T-12 via left-sided T9—L3 hemilaminectomy, with section of all ipsilateral lumbrosacral ventral nerve roots. In the experimental group (five animals), an NAG obtained from the right peroneal nerve was anastomosed with the sectioned and electrophysiologically selected lumbar ventral roots (left L-3 and L-4) controlling the left quadriceps muscle and then implanted into the left ventrolateral T-10 cord. In the control group (four animals), the sectioned/selected lumbar ventral roots were only ligated. After surgery, all marmosets immediately suffered from complete paralysis of their left hindlimb. Five months later, some clinical signs of reinnervation such as tension and resistance began to appear in the paralyzed quadriceps of all experimental animals that received autografts. Nine months postoperatively, three of the five experimental marmosets could maintain their lesioned hindlimb in hip flexion. Muscle action potentials and motor evoked potentials were recorded from the target quadriceps in all experimental marmosets, but these potentials were absent in the control animals. Horseradish peroxidase retrograde labeling from the distal sectioned/reconnected lumbar ventral roots traced 234 ± 178 labeled neurons in the ipsilateral T8–10 ventral horn, mainly close to the NAG tip. Histological analysis showed numerous regenerating axons in this denervated/reconnected nerve root pathway, as well as newly formed motor endplates in the denervated/reinnervated quadriceps. No axonal regeneration was detected in the control animals. Conclusions. These data indicate that the rostral spinal neurons can regrow into the caudal ventral roots through an NAG, thereby innervating the target muscle in adult marmosets after spinal cord injury.

Microsurgical reoperation following lumbar disc surgery

1989 ◽  
Vol 70 (3) ◽  
pp. 397-404 ◽  
Author(s):  
Uwe Ebeling ◽  
H. Kalbarcyk ◽  
H. J. Reulen
Keyword(s):  
Lumbar Disc ◽  
Time Interval ◽  
Epidural Fibrosis ◽  
Lumbar Intervertebral Disc ◽  
Disc Protrusion ◽  
Content Type ◽  
Disc Surgery ◽  
True Recurrence ◽  
Working Capability ◽  
Fine Print

✓ Ninety-two patients who underwent microsurgical reoperation for persistent or new complaints following initial lumbar intervertebral disc surgery were evaluated retrospectively. Sixty percent of all pain relapses occurred within 1 year following the first operation; thereafter, the probability of a relapse declined steadily and was as low as 0.1% per year between 5 and 20 years. The results of microsurgical reoperation in terms of pain relief and working capability were considered “excellent” in 22% of patients, “good” in 30%, and “satisfactory” in 29%. Thus, 81% of the patients could be considered as treated successfully and in 19% the result was not successful. The most common intraoperative findings were: a true recurrence at the same level in 43% of cases, a new herniation at another level in 15%, and a small recurrent fragment embedded in epidural fibrosis in 23%. Five percent of patients had severe epidural fibrosis as the only pathology. In 15%, reoperation was performed within 1 month to treat persisting pain, and either a missed disc fragment, an inadequately decompressed lateral recess, or an unrecognized second-level disc protrusion was found. The clinical outcome is affected predominantly by the intraoperative pathology and the time interval between the first and second operation. An excellent or good outcome was usually achieved in patients with a recurrence of pain after 1 year resulting from a true recurrent disc or a new herniation at another level. In contrast, very unfavorable results were noted with most reoperations performed during the 1st year when extensive epidural fibrosis (or fibrosis with a small recurrence) was present.

Posterior approach for cervical intramedullary arteriovenous malformation with diffuse-type nidus

1999 ◽  
Vol 91 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Alaa El-Naggar ◽  
Michiharu Morino ◽  
Akimasa Nishio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Poor Prognosis ◽  
Posterior Approach ◽  
The Other ◽  
Anterior Spinal Artery ◽  
Neural Element ◽  
Feeding Artery ◽  
Diffuse Type ◽  
Content Type ◽  
Fine Print

✓ The treatment of spinal intramedullary arteriovenous malformations (AVMs) with a diffuse-type nidus that contains a neural element poses different challenges compared with a glomus-type nidus. The surgical elimination of such lesions involves the risk of spinal cord ischemia that results from coagulation of the feeding artery that, at the same time, supplies cord parenchyma. However, based on evaluation of the risks involved in performing embolization, together with the frequent occurrence of reperfusion, which necessitates frequent reembolization, the authors consider surgery to be a one-stage solution to a disease that otherwise has a very poor prognosis. Magnetic resonance (MR) imaging revealed diffuse-type intramedullary AVMs in the cervical spinal cords of three patients who subsequently underwent surgery via the posterior approach. The AVM was supplied by the anterior spinal artery in one case and by both the anterior and posterior spinal arteries in the other two cases. In all three cases, a posterior median myelotomy was performed up to the vicinity of the anterior median fissure that divided the spinal cord together with the nidus, and the feeding artery was coagulated and severed at its origin from the anterior spinal artery. In the two cases in which the posterior spinal artery fed the AVM, the feeding artery was coagulated on the dorsal surface of the spinal cord. Neurological outcome improved in one patient and deteriorated slightly to mildly in the other two patients. Postoperative angiography demonstrated complete disappearance of the AVM in all cases. Because of the extremely poor prognosis of patients with spinal intramedullary AVMs, this surgical technique for the treatment of diffuse-type AVMs provides acceptable operative outcome. Surgical intervention should be considered when managing a patient with a diffuse-type intramedullary AVM in the cervical spinal cord.

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