Correlation of radiological features to failure of lumbar intervertebral disc chemonucleolysis

1986 ◽  
Vol 64 (5) ◽  
pp. 736-742 ◽  
Author(s):  
O. Wayne Houser ◽  
Burton M. Onofrio ◽  
Glenn S. Forbes ◽  
H. L. Baker
Keyword(s):  
Lumbar Disc ◽  
Disc Prolapse ◽  
Spinal Alignment ◽  
Lumbar Intervertebral Disc ◽  
Content Type ◽  
Persistent Symptoms ◽  
Radiological Features ◽  
Lumbar Disc Prolapse ◽  
Rate Of Failure

✓ Chemonucleolysis was performed in 103 patients for lumbar disc prolapse. Multiple (two) interspaces were injected in only seven patients. Radiographically, all patients had myelographic or computerized tomography evidence of disc prolapse. Eighty-seven of 100 patients who were available for follow-up review had improved. Ten of 13 patients with persistent symptoms required a laminectomy. Altered spinal alignment was evident in five of the 13 patients with persistent symptoms: retrolisthesis in three and myelographic disc defect on the convex aspect of the scoliosis in two. Review of radiographic studies was carried out in an attempt to establish guidelines for patient selection so as to decrease the rate of failure in chymopapain treatment.

scholarly journals Functional outcome of patients undergoing lumbar discectomy

2018 ◽  
Vol 4 (3) ◽  
pp. 514
Author(s):  
Harpreet Singh ◽  
Parth B. Bhavsar ◽  
Ankit Singh ◽  
Saurin Patel
Keyword(s):  
Functional Outcome ◽  
Lumbar Disc ◽  
Subjective Evaluation ◽  
Lumbar Discectomy ◽  
Intervertebral Disc Herniation ◽  
Disc Prolapse ◽  
Duration Of Symptoms ◽  
Lumbar Disc Prolapse ◽  
Lumbar Intervertebral Disc Herniation

<p class="abstract"><strong>Background:</strong> Sciatica resulting from a lumbar intervertebral disc herniation is the most common cause of radicular leg pain in adult working population. It can be treated with both conservative and operative methods. In our study, surgical treatment of lumbar disc prolapse has been done by open discectomy. We wish to assess the outcome of surgery in patients with lumbar disc prolapse undergoing lumbar discectomy.</p><p class="abstract"><strong>Methods:</strong> 40 patients were included in this study and were followed up for up to 1 year postoperatively. We assessed the outcome of each patient with ODI and VAS post-operatively and on follow-up at 3 weeks, 6 months and 1 year. Subjective evaluation of the patient’s satisfaction at the final follow-up was also done.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that males had higher incidence of PIVD with an average duration of symptoms before surgery about 8.62 months. Left side was most involved and level l4-l5 was most involved level. The mean ODI and VAS score pre-operatively were 26.85±4.20 and 7.73±0.88 respectively, which changed to 4.48±5.15 and 1.70±1.57, respectively at 1 year post-operative follow-up. These were statistically highly significant. Most of the patients (34) gave a subjective evaluation as excellent at 1 year follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Our study established that open discectomy has a satisfactory functional outcome and leads to a significant improvement in the patients’ quality of life.</p>

scholarly journals Caudal epidural steroid injection ultrasound-guided versus fluoroscopy-guided in treatment of refractory lumbar disc prolapse with radiculopathy

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mohamed Ahmed Elashmawy ◽  
Reham M. Shaat ◽  
A. M. Abdelkhalek ◽  
Ebrahim El Boghdady
Keyword(s):  
Steroid Injection ◽  
Lumbar Disc ◽  
Epidural Steroid Injection ◽  
Successful Outcome ◽  
Post Injection ◽  
Disc Prolapse ◽  
Lumbar Disc Prolapse ◽  
Straight Leg Raising ◽  
Epidural Steroid ◽  
Caudal Epidural

Abstract Background Lumbar disc prolapse is a localized herniation of disc beyond intervertebral disc space and is the most common cause of sciatica; the aim of this study is to investigate the efficacy of ultrasound (US)-guided caudal epidural steroid injection (CESI) compared with fluoroscopy (FL)-guided CESI in treatment of patients with refractory lumbar disc prolapse (LDP) with radiculopathy. Results At the beginning of the study, there was no significant difference between both groups in all parameters. (a) Group 1 had significantly improved the straight leg raising and modified Schober tests, VAS, and ODI at 1-month and 3-month post-injection evaluation in comparison to baseline recordings (p < 0.001); (b) Group 2 had significantly improved the straight leg raising and modified Schober tests, VAS, and ODI at 1-month and 3-month post-injection evaluation in comparison to baseline recordings (p < 0.001); and (c) US-guided CESI was not statistically different from the FL-guided CESI in the improvement of the straight leg raising (p = 0.87, 0.82) and modified Schober tests (p = 0.87, 0.82) as well as VAS (p = 0.40, 0.43) and ODI (p = 0.7, 0.2) at 1-month and 3-month post-injection evaluation. In a multivariate analysis using CI = 95%, the significant predictors for a successful outcome were duration < 6 months (p = 0.03, OR = 2.25), target level not L2-3/L3-4 (p < 0.001, OR = 4.13), and LDP other than foraminal type (p = 0.002, OR = 3.78). However, age < 40 years was found to be non-significant in predicting a successful outcome (p = 0.38, OR = 0.98). Conclusion US is excellent in guiding CESI with similar treatment outcomes as compared with FL-guided CESI. Trial registration ClinicalTrials.gov Identifier: NCT03933150.

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.

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