scholarly journals Rational approach, technique and selection criteria for the treatment of lumbar disc herniation with Regenerative Selective Disc therapy

Ozone Therapy ◽  
2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Calogero Riccardo Buscemi ◽  
Andrea Licata
Keyword(s):  
Disc Herniation ◽  
Lumbar Disc ◽  
Repair Process ◽  
Biological Action ◽  
Primary Objective ◽  
Italian Society ◽  
Inflammatory Factors ◽  
Rational Approach ◽  
Lumbar Region ◽  
Area Of Interest

Low back pain is one of the most common and important clinical, social, economic, and public health problems affecting the human population worldwide. The mechanism of radicular pain in the lumbar region is multifactorial but is likely due to mechanical and/or inflammatory factors. The natural history of disc herniation tends to be favourable. The Italian Society for Oxygen-Ozone Therapy (SIOOT) and the Italian Society for Spinal Surgery (SICV) guidelines recommend a conservative therapeutic approach. The biological action of medical ozone is still under investigation but some mechanisms of action have been proposed to explain its efficacy in disc herniation treatment: i) reduction of the inflammatory components; ii) hyper-oxygenation of the area of interest; iii) diminishing the size of the herniation; iv) stimulation of the repair process. The primary objective of this pilot study was to compare pain and function scores from patients before and after the treatment with Regenerative Selective Disc. The metrics that were established to define significant improvement were: i) improvement >1.8 on the Visual Analogue Scale (VAS) score; ii) improvement of 1 level or more on the modified Macnab criteria; iii) improvement >15% on the Oswestry Disability Index (ODI). Primary endpoints of this study were changes in the pretreatment and 1 month post treatment VAS, ODI and Macnab scores of the patients. After treatment results show that the patient population’s mean VAS, ODI and modified Macnab scores improved beyond the significant improvement scores. In fact, results showed that the mean patient’s population improvement scores were 2.9 for VAS, 22 for ODI and 1.4 for modified Macnab. Additionally, significant improvements were shown for 87% of the patients for VAS scale (>2.0), 80% of the patients for the ODI scale (>15 points) and 80% patients for the modified Macnab criteria (>1 point).

scholarly journals A Rare Case of Spinal Subdural Hematoma Complicating Minimally Invasive Lumbar Micro Discectomy and Decompression for Recurrent Lumbar Disc Herniation

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Failed Back Surgery Syndrome ◽  
Neurological Deficits ◽  
Unusual Complication ◽  
Lumbar Region ◽  
Failed Back Surgery ◽  
Spinal Subdural Hematoma ◽  
Recurrent Lumbar Disc Herniation

Spinal subdural hematomas is a very rare and unusual complication of spinal interventions. We present a case of subacute SSDH in the lumbar region of a 60 year-old woman following microdiscectomy for recurrent lumbar disc herniation. By presenting this rarely seen case of postoperative subacute SSDH, we want to bring attention to the possible postoperative complications like spinal hematomas in the differential diagnosis of failed back surgery syndrome in patients who do not respond to conservative treatment or develop neurological deficits and to the importance of radiological imaging in such cases.

scholarly journals Sequestered lumbar disc herniation mimicking spinal tumor

2013 ◽  
Vol 32 (04) ◽  
pp. 268-270 ◽  
Author(s):  
Pedro Radalle Biasi ◽  
Adroaldo Baseggio Mallmann ◽  
Paulo Sérgio Crusius ◽  
Cláudio Albano Seibert ◽  
Marcelo Ughini Crusius ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Lumbar Disc ◽  
Spinal Tumor ◽  
Herniated Disc ◽  
Histopathological Analysis ◽  
Lumbar Region ◽  
Complete Excision ◽  
Dural Sac ◽  
Magnetic Resonance Imaging Mri ◽  
Peripheral Enhancement

AbstractThe occurrence of herniated disc simulating diseases in neuroimaging it's an uncommon situation. However, due to changes that occur in sequestered disc fragment, some cases can mimic spinal neoplasms. Thus, we present the case of a female patient, 60 year-old, with left back pain and left leg weakness. Left lower limb presented with strength grade IV, positive 45 degress Lasègue's signal and patellar areflexia. Lumbar spine magnetic resonance imaging (MRI) showed an expansive left centro-lateral lesion at L4-L5 level, hypointense on T1W, hyperintense on T2W, with peripheral contrast uptake, causing compression of the dural sac and L5 nerve root. A hemilaminectomy was performed, with complete excision of the lesion. Histological analisys confirmed discal hernia. Disc herniation is a condition characterized by the displacement of the disc content to the spinal canal, predominantly in the lumbar region, and manifesting as radiculopathy. The fragment sequestration occurs in 30% of the cases and is characterized by loss of continuity with remaining disc. MRI exams generally allow diagnostic confirmation; however, there may be diagnostic confusion with tumors, arachnoid cysts and abscesses. The inflammatory reaction occurred in the disc fragment produces the differences in MRI signal. The fragment is hypointense on T1W, hyperintense on T2W, with peripheral enhancement after contrast. Malignancies and Schwannomas have homogeneous or heterogeneous uptake. The epidural abscess is isointense on T1W and hyperintense on T2W, with homogeneous or peripheral enhancement, similar to discal herniation. Thus, sequestered disc herniation can mimic other space-occupying lesions, being necessary a surgical approach to obtain material for histopathological analysis and diagnostic confirmation.

Comparison of Myelography and Computed Tomography in Establishing Lumbar Disc Herniation

1989 ◽  
Vol 30 (3) ◽  
pp. 241-246 ◽  
Author(s):  
M. K. J. Fagerlund ◽  
U. E. Thelander
Keyword(s):  
Computed Tomography ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Soft Tissues ◽  
Lumbar Disc ◽  
False Negative ◽  
Herniated Disc ◽  
Intervertebral Disc Herniation ◽  
Lumbar Region ◽  
Negative Case

The results of lumbar myelography and computed tomography (CT) were compared in 51 consecutive patients with clinically suggested lumbar disc herniation. A total of 100 intervertebral levels were examined. At 62 levels, either L4/L5 or L5/S1, myelography was normal. CT showed no pathologic changes at 55 levels. The results concurred between myelography and CT in 89 per cent of the patients with normal findings. Four cases of disc herniation and one bulging disc, which had been missed at myelography because of a large epidural space at L5/S1, were picked up by CT. Two of these were verified by surgery and two were treated conservatively. There was one possible false negative case with CT as well. Abnormalities were shown at 38 intervertebral levels, 22 in the bulging and 16 in the herniated disc group. The pathologic changes concurred in 84 per cent between the two investigations. For intervertebral disc herniation the true negative rate was, for myelography 88 per cent and for CT 97 per cent. The treatment strategy could have been based on CT alone at 37 out of 38 levels (97%), and on myelography alone at 34 out of 38 levels (89%). Furthermore, at CT the imaging of soft tissues and intervertebral joints was superior to that at myelography. It is concluded that CT should be the primary examination method of imaging for lumbar disc herniation. Myelography is, however, to be preferred where the level of the lesion is clinically unclear or when the entire lumbar region and thoraco-lumbar junction are to be examined.

scholarly journals Effects of swimming on pain and inflammatory factors in rats with lumbar disc herniation

2019 ◽  
Author(s):  
Yizhuan Huang ◽  
Zhendong Zhong ◽  
Dandan Yang ◽  
Lingyuan Huang ◽  
Fengjiao Hu ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Inflammatory Factors

scholarly journals Rehabilitation and clinical-evolutive aspects in a case of paraparesis after multilevel lumbar disc herniation, spinal canal stenosis and spondylolisthesis iteratively operated, in a pluripathological context

2020 ◽  
pp. 536-537
Author(s):  
Mihaela OPREA (MANDU) ◽  
Elena CONSTANTIN ◽  
Cristinel Dumitru BADIU ◽  
Alina BAJENARU ◽  
Alexandru STAVRICA ◽  
...  
Keyword(s):  
Training Program ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Spinal Canal ◽  
Lumbar Disc ◽  
Spinal Canal Stenosis ◽  
Lumbar Region ◽  
Active Recovery ◽  
Canal Stenosis ◽  
Active Training

Introduction. Disc herniation occurs most commonly in the lumbar region (95% of the cases). The current trend is to have surgery on patients with disc herniation if the kinetic treatment was not beneficial. The data from the literature suggest that early active recovery after lumbar disc herniation is more beneficial than a traditional, less active training program. Material and method. Having the patient's consent and the approval of the Ethics Committee of “Bagdasar-Arseni” Clinical Emergency Hospital, N.O. 17464 / 14.06.2019, the paper presents the case of a 75-year-old patient with paraparesis after multilevel lumbar disc herniation, spinal canal stenosis and spondylolisthesis iteratively operated, in pluripathological context (hyperplastic type II obesity, hypertension, prostate adenocarcinoma operated in 2015, Clostridium enterocolitis). The patient was clinically and functionally evaluated, according to the standardized protocols implemented in our clinic, through the assessment scales (ASIA, FIM, FAC, QoL, Ashworth and Penn) and also paraclinically, in order to evaluate his biological reserve and his bearing availability of the recovery program. Results and discussions. The patient presented a slowly favorable evolution (slowed down not only by his multiple above-mentioned comorbidities) from a dysfunctional point of view. Conclusions. Early active recovery after lumbar disc herniation surgery is more beneficial than a traditional, less active training program for operated herniated discs. Keywords: Schizophrenia, spinal cord injury, multidisciplinary, suicide attempt, rehabilitation,

scholarly journals Herniated Lumbar Disc and Nursing Care

2018 ◽  
Vol 6 (2) ◽  
pp. 1-8
Author(s):  
Besnik Elshani ◽  
Salih Krasniqi ◽  
Rexhep Gjyliqi
Keyword(s):  
Disc Herniation ◽  
Nerve Root ◽  
Pain Control ◽  
Lumbar Disc ◽  
Central Portion ◽  
Lumbar Region ◽  
Anulus Fibrosus ◽  
Lower Back ◽  
Control Regimen ◽  
Disc Herniations

Spinal disc herniation, also known as a slipped disc, is a medical condition affecting the spine in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings. Disc herniation is usually due to age-related degeneration of the outer ring, known as the anulus fibrosus, although trauma, lifting injuries, or straining have been implicated as well. Tears are almost always postero-lateral (on the back of the sides) owing to the presence of the posterior longitudinal ligament in the spinal canal. Disc herniations are normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the anulus fibrosus are still intact, but can bulge when the disc is under pressure. In contrast to a herniation, none of the central portion escapes beyond the outer layers. Most minor herniations heal within several weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear are generally effective. Severe herniations may not heal of their own accord and may require surgery. The condition is widely referred to as a slipped disc, but this term is not medically accurate as the spinal discs are firmly attached between the vertebrae and cannot "slip" out of place. Lumbar disc herniations occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Symptoms can affect the lower back, buttocks, thigh, anal/genital region (via the perineal nerve), and may radiate into the foot and/or toe. The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica. The femoral nerve can also be affected[25]and cause the patient to experience a numb, tingling feeling throughout one or both legs and even feet or even a burning feeling in the hips and legs. A hernia in the lumbar region often compresses the nerve root exiting at the level below the disk. Thus, a herniation of the L4/5 disc will compress the L5 nerve root. With the patient and doctor, plan a pain control regimen. Encourage the patient to express his concerns about the disorder. Urge the patient to perform as much self-care as his immobility and pain allow. Use antiembolism stockings, as prescribed, and encourage the patient to move his legs, as allowed. Assess the patient’s pain status and his response to the pain-control regimen. Perform neurovascular checks of the patient’s legs such as color, motion, temperature, and sensation. Monitor vital signs, and check for bowel sounds and abdominal distention. Teach the patient about treatments, which include bed rest and pelvic traction. Urge the patient to maintain an ideal body weight to prevent lordosis caused by obesity. Discuss all prescribed medications with the patient. If surgery is required, explain all preoperative and postoperative procedures and treatments to the patient and his family.

Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

2019 ◽  
Vol 12 (2) ◽  
pp. 139-146
Author(s):  
Mladen E. Ovcharov ◽  
Iliya V. Valkov ◽  
Milan N. Mladenovski ◽  
Nikolay V. Vasilev
Keyword(s):  
Recurrence Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Reoperation Rate ◽  
University Hospital ◽  
Recurrence Rates ◽  
Chi Square ◽  
Common Procedure

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

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