scholarly journals Posterior Epidural Migration of a Sequestrated Lumbar Disk Fragment Causing Cauda Equina Syndrome in an Old Patient: A Case Report

2016 ◽  
Vol 9 ◽  
pp. CCRep.S39139 ◽  
Author(s):  
Kaveh Haddadi ◽  
Hamid Reza Ganjeh Qazvini
Keyword(s):  
Epidural Space ◽  
Cauda Equina ◽  
Lower Limbs ◽  
Leg Pain ◽  
Low Back ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk ◽  
Sagittal Image ◽  
Uncommon Case

Disk fragment relocation is commonly limited to the anterior epidural space, although posterior epidural movement of a sequestrated disk piece to the posterior epidural space is in frequent. We present an uncommon case of dorsal extradural sequestration of lumbar disk herniation. A 77-year-old man presented with severe leg pain, low back pain, and urinary incontinence. Deep tendon reflexes were inattentive at the knee and ankle, and the motor power in terms of ankle dorsiflexion and great toe dorsiflexion was 2/5 in both lower limbs. There was hypoesthesia in the S1, S2, and S3 dermatomes. Magnetic resonance imaging displayed a large isointensity lesion at the L4–L5 level on the T2 sagittal image, indenting circumferentially the thecal sac from lateral to posterior of the thecal sac. The patient underwent an L4–L5 central laminectomy. A large, solid epidural disk fragment was recognized dorsally, with major compression of the thecal sac. The patient report improved lower extremity motor function at three-month follow-up. A displaced disk fragment should be considered as causative when patients present with cauda equine syndrome and be treated as a surgical emergency.

Application of a Targeted and Quantificational Foraminoplasty Device in Percutaneous  Transforaminal Endoscopic Discectomy for L5-S1 Disc Herniation: Preliminary Clinical Outcomes

2021 ◽  
Author(s):  
Jinlong Liu ◽  
Junlong wu ◽  
Honglei Zhang ◽  
Rui Zuo ◽  
Jiabin Liu ◽  
...  
Keyword(s):  
Leg Pain ◽  
Fluoroscopy Time ◽  
Low Back ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk ◽  
Vas Score ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disk herniation(LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5-S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term effects of PTED with ZESSY at the L5-S1 level.MethodsBetween January to August of 2018, Fifty-six patients with lumbar disk herniation at the single level of L5–S1 and underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the the TESSYS group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time and fluoroscopy time evaluated for the operation efficiency. Clinical outcomes were assessed by visual analog scale(VAS) score and Oswestry Disability Index(ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively.ResultsThe average puncture time (5.29±2.05 minutes), foraminoplasty time (12.82±2.52 minutes) and fluoroscopy time (26.29±5.96 seconds) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07±3.13 minutes, p<0.01; foraminoplasty time, 17.18±2.92 minutes, p<0.01; fluoroscopy time, 34.73±6.86 seconds; p<0.01). No significant differences were observed between the 2 groups in the decompression time (p=0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoprative , in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05).ConclusionThe targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disk herniation at the L5-S1 level.

Tubular Diskectomy vs Conventional Microdiskectomy for the Treatment of Lumbar Disk Herniation: 2-Year Results of a Double-Blind Randomized Controlled Trial

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 135-144 ◽  
Author(s):  
Mark P Arts ◽  
Ronald Brand ◽  
M Elske van den Akker ◽  
Bart W Koes ◽  
Ronald HMA Bartels ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Roland Morris Disability Questionnaire ◽  
Leg Pain ◽  
Low Back ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk ◽  
Significant Difference ◽  
Disability Questionnaire

Abstract BACKGROUND: Transmuscular tubular diskectomy has been introduced to increase the rate of recovery, although evidence is lacking. OBJECTIVE: To evaluate the 2-year results of tubular diskectomy compared with conventional microdiskectomy. METHODS: Three hundred twenty-eight patients with persistent leg pain caused by lumbar disk herniation were randomly assigned to undergo tubular diskectomy (167 patients) or conventional microdiskectomy (161 patients). Main outcome measures were scores from Roland-Morris Disability Questionnaire for Sciatica, Visual Analog Scale for leg pain and low-back pain, and Likert self-rating scale of global perceived recovery. RESULTS: On the basis of intention-to-treat analysis, there was no significant difference between tubular diskectomy and conventional microdiskectomy in Roland-Morris Disability Questionnaire for Sciatica scores during 2 years after surgery (between-group mean difference [Δ] = 0.6; 95% confidence interval [CI], −0.3-1.6). Patients treated with tubular diskectomy reported more leg pain (Δ = 3.3 mm; 95% CI, 0.2-6.2) and more low-back pain (Δ = 3.0 mm; 95% CI, −0.2-6.3) than those patients treated with conventional microdiskectomy. At 2 years, 71% of patients assigned to tubular diskectomy documented a good recovery vs 77% of patients assigned to conventional microdiskectomy (odds ratio, 0.76; 95% CI, 0.45-1.28; P = .35). Repeated surgery rates within 2 years after tubular diskectomy and conventional microdiskectomy were 15% and 10%, respectively (P = .22). CONCLUSION: Tubular diskectomy and conventional microdiskectomy resulted in similar functional and clinical outcomes. Patients treated with tubular diskectomy reported more leg pain and low-back pain, although the differences were small and not clinically relevant.

Intact arch spondylolisthesis

1985 ◽  
Vol 63 (6) ◽  
pp. 840-844 ◽  
Author(s):  
Eben Alexander ◽  
David L. Kelly ◽  
Courtland H. Davis ◽  
Joe M. McWhorter ◽  
William Brown
Keyword(s):  
Intervertebral Disc ◽  
Cauda Equina ◽  
Leg Pain ◽  
Low Back ◽  
Content Type ◽  
The Past ◽  
Cauda Equina Compression ◽  
Male Patients ◽  
Almost All

✓ Over the past 11 years, the authors have treated 50 cases of intact arch spondylolisthesis. There were 38 female and 12 male patients, and all but 11 were older than 60 years of age. Almost all had severe low-back pain made worse by standing or walking. Other common manifestations were unilateral leg pain, numbness or weakness of the leg, and evidence of mild cauda equina compression. Severe cauda equina compression was rare. Myelography invariably showed an extradural dorsal compression. A waist deformity was characteristic in many patients, but 12 had a complete block. In 15 patients (30%) the myelographic impression was that of a herniated intervertebral disc. Most subluxations were of L-4 on L-5. At operation, the facets were found to be thickened, distorted, and irregular. All patients were treated with a wide decompression and laminectomy, which included a medial facetectomy of the inferior and superior facets. An intervertebral disc was removed in 10 patients. Follow-up monitoring of 41 patients (for an average period of 36 months) showed that 26 (63%) were pain-free, 11 had less pain, and four were unimproved. Five other patients with short follow-up periods (average 5 months) were all improved.

The Effect of Hydrotherapy on Pain Intensity and Functional Ability in Lumbar Disk Herniation (LDH) Patients that Undergo Non-operative Procedure Pre-experimental Study at Medical Rehabilitation Installation of RSUP dr. Mohammad Hoesin Palembang

2020 ◽  
Vol 3 (3) ◽  
pp. 42-50
Author(s):  
Theresa Rahmadhani ◽  
Nyimas Fatimah ◽  
Eka Febri Zulissetiana
Keyword(s):  
Experimental Study ◽  
Pain Intensity ◽  
Functional Ability ◽  
Operative Procedure ◽  
Medical Rehabilitation ◽  
Wilcoxon Test ◽  
Low Back ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk

The effect of hydrotherapy on pain intensity and functional ability in lumbar disk herniation (LDH) patients thatundergo non-operative procedure; pre-experimental study at medical rehabilitation installation of RSUPdr. Mohammad Hoesin Palembang. Lumbar disk herniation (LDH) is the most common disease that becaused low backpain and functional disability. Some studies mentioned that hydrotherapy is an effective treatment for low back pain.Therefore, this study was conducted to determine the effect of hydrotherapy on reducing pain intensity and improvingfunctional ability in LDH patients. This study was a pre-experimental study with one group pretest-posttest design. Datawas collected by direct interviews to the patients using visual analogue scale (VAS) to measure pain intensity andModified Oswestry Low Back Pain Disability Questionnaire to assess functional ability before and after underwenthydrotherapy once a week for 4 weeks. The data then undergo Shapiro-Wilk normality test and continue with Paired t-Test or Wilcoxon test. From 30 subjects, it was found that there are effects of hydrotherapy on reducing pain intensity(p<0,001) and improving functional ability (p<0,001) in LDH patients that undergo non-operative procedure at theMedical Rehabilitation Installation of RSUP Dr. Mohammad Hoesin Palembang. There are effects of hydrotherapy onpain intensity and functional ability in LDH patients that undergo non-operative procedure.

Percutaneous Endoscopic Interlaminar Unilateral Ventral Dural Approach for Symptomatic Bilateral L5–S1 Herniated Nucleus Pulposus: Technical Note

2018 ◽  
Vol 79 (06) ◽  
pp. 518-523 ◽  
Author(s):  
Sung Choi ◽  
Nitin Adsul ◽  
Ki Kim ◽  
Jeong Kim ◽  
Sung Chung ◽  
...  
Keyword(s):  
Nucleus Pulposus ◽  
Lower Limb ◽  
Leg Pain ◽  
Limb Pain ◽  
Lumbar Disk Herniation ◽  
Interlaminar Approach ◽  
Lower Limb Pain ◽  
Bilateral Lower Limb ◽  
Herniated Nucleus Pulposus

Background Percutaneous endoscopic lumbar diskectomy is a good treatment modality for lumbar disk herniation. However, when a patient complains of bilateral lower limb radicular pain with severe disk protrusion at the L5–S1 level, the transforaminal approach is often unable to resolve both lesions owing to anatomical limitations. It is also very difficult to resolve both lesions in an ipsilateral direction using the percutaneous interlaminar approach. We report our surgical technique and clinical results using a ventral dural approach of percutaneous endoscopic interlaminar lumbar diskectomy for L5–S1 herniated nucleus pulposus (HNP) in patients with bilateral radiculopathy due to a severe disk protrusion. Methods Twenty-seven patients with severe L5–S1 HNP complaining of back pain and bilateral lower limb pain were included in the study. The unilateral ventral dural approach of percutaneous full endoscopic interlaminar lumbar diskectomy technique was used. The visual analog scale (VAS) and Macnab criteria were used for clinical evaluation. All assessments were completed 1 day before surgery, 1 week after surgery, 6 months after surgery, and at final follow-up after surgery. Results The mean preoperative back and leg pain VAS scores decreased from 5.67 ± 0.78 and 7.81 ± 0.83 to 2.44 ± 0.58 and 2.26 ± 0.53 at 1 week, 1.78 ± 0.51 and 1.52 ± 0.58 at 6 months, and 1.56 ± 0.70 and 1.67 ± 0.96, respectively, at the final follow-up after surgery. With respect to the Macnab criteria, 51.85% of the results were excellent, 44.44% were good, and 3.70% were fair. Four cases recurred: three patients underwent conservative treatment and one patient operated with percutaneous endoscopic interlaminar lumbar diskectomy. Conclusion According to the results of this study, the ventral dural approach of percutaneous full endoscopic interlaminar lumbar diskectomy in patients with L5–S1 HNP associated with bilateral lower limb pain due to a severely protruded HNP is a good option for a minimally invasive surgical approach.

scholarly journals The many faces of primary cauda equina myxopapillary ependymoma: clinicoradiological manifestations of two cases and review of the literature

2017 ◽  
Vol 31 (3) ◽  
pp. 385-390
Author(s):  
Mohammad Zare Mehrjardi ◽  
Samira Mirzaei ◽  
Hamid Reza Haghighatkhah
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Imaging Modality ◽  
Cauda Equina ◽  
Young Patients ◽  
Clinical Manifestations ◽  
Conus Medullaris ◽  
Lower Limbs ◽  
Myxopapillary Ependymoma ◽  
Low Back

Abstract Introduction: Myxopapillary ependymoma (MPE) is a benign and slow growing tumor that originates exclusively from the conus medullaris and cauda equina nervous tissue. It occurs more commonly in young patients. In addition, clinical presentations are non-specific and may mimic benign conditions. Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating this tumor. We hereby report on two young patients with long-lasting non-specific symptoms, which were clinically attributed to benign conditions. However, cauda equina tumor was revealed on MRI in both patients. Case report: Two cases of cauda equina MPE, a 19-year-old female and a 38-year-old male, with different clinical manifestations are reported. The first patient presented with paresis and paresthesia of the lower limbs, and the second patient’s complaint was chronic low-back pain and urinary incontinence. In both cases, MRI detected a tumor originated from the cauda equina, and histopathologic examination was compatible with MPE. Conclusion: Cauda equina tumors should be considered as a differential diagnosis in the young patients presented with neurologic deficits in the lower limbs, sphincter or erectile dysfunction, and even a simple low-back pain (particularly when symptoms are long-lasting and/or progressive).

scholarly journals Low Back Pain with Lateral Lumbar Disk Herniation.

2000 ◽  
Vol 49 (3) ◽  
pp. 972-974
Author(s):  
Yukimasa Nishimura ◽  
Takehisa Tsuneoka ◽  
Katsuki Taguchi ◽  
Nanae Yuge ◽  
Atsushi Tagami
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk
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