scholarly journals Comparison of the histopathological differences between the spinal material and posterior longitudinal ligament in patients with lumbar disc herniation: A focus on the etiopathogenesis

2021 ◽  
Vol 41 (2) ◽  
pp. 115-120
Author(s):  
Asuman Kilitci ◽  
Ziya Asan ◽  
Abdulbaki Yuceer ◽  
Omer Aykanat ◽  
Fatih Durna
Keyword(s):  
Disc Degeneration ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Posterior Longitudinal Ligament ◽  
Small Sample ◽  
Histopathological Changes ◽  
Surgical Operation ◽  
Mri Findings ◽  
Disc Material

BACKGROUND: Lumbar disc herniation (LDH) occurs owing to the inability of the posterior longitudinal ligament (PLL) to preserve the disc material within the intervertebral space. There is apparently no study that has investigated the histopathological changes occurring in both PLL and disc material in patients with LDH. OBJECTIVE: Investigate and compare the histopathological changes occurring in PLL and disc material of the patients who underwent a surgical operation for LDH. DESIGN: Descriptive, cross-sectional. SETTING: Pathology and neurosurgery departments of a tertiary health care institution PATIENTS AND METHODS: The study included patients who underwent surgical operation for LDH from January 2018 to May 2019 and whose PLL and disc material were removed together, and had disc degeneration findings that were radiologically and histologically concordant. MAIN OUTCOME MEASURES: PLL degeneration scores according to the histopathological findings, changes in disc materials according to the MRI findings, disc degeneration scores according to the histo-pathological findings. SAMPLE SIZE: 50. RESULTS: MRI and histological examinations showed fully degenerated black discs (Grade 2) in 12 patients, partially degenerated discs (Grade 1) in 29 patients and fresh/acute discs (Grade 0) in 9 patients. The PLL showed grade 0 degeneration in 2 patients, grade 1 degeneration in 23 patients, and grade 2 degeneration in 25 patients. PLL degeneration grades were higher than the disc degeneration grades ( P =.002). CONCLUSION: Longitudinal ligament degeneration can play a significant role in the pathogenesis of LDH. To the best of our knowledge, this study represents the first to focus on the histopathological changes occurring in both the PLL and disc material in patients with LDH. LIMITATIONS: Small sample, retrospective CONFLICT OF INTEREST: None.

scholarly journals High Incidence Rate of Lumbar Spinal Disease Among Child and Adolescent Weightlifting Athletes: A Prospective 4-year Cohort Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0039
Author(s):  
Kazu Toyooka ◽  
Junsuke Nakase ◽  
Kengo Shimozaki ◽  
Kazuki Asai ◽  
Hiroyuki Tsuchiya
Keyword(s):  
Cohort Study ◽  
Resistance Training ◽  
Disc Degeneration ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Vertebrae ◽  
Child And Adolescent ◽  
Lumbar Disc Degeneration ◽  
Mri Findings ◽  
Lumbar Spondylolysis

Objectives: Resistance training, such as weightlifting, in child and adolescent athletes has been considered unsafe, leading to injuries to the musculoskeletal system and growth plate, and to low back pain (LBP). We focused on the lumbar vertebrae, as these are most frequently injured in weightlifting, and prospectively investigated LBP and abnormal lumbar findings in child and adolescent weightlifters. The purpose of this 4-year cohort study was to assess the incidence and characteristics of LBP and abnormal lumbar findings in child and adolescent weightlifting athletes using medical questionnaires and magnetic resonance imaging (MRI). This study was conducted to evaluate subclinical sports injuries. In the absence of reports on long-term implications of resistance training, the safety and validity of resistance training in children and adolescents, especially weightlifting at the competition level, has remained controversial. The findings may help prevent competition-specific injuries and improve performance levels. Methods: This prospective 4-year cohort study was conducted between 2014 and 2017. Twelve participants (6 boys and 6 girls) were enrolled. The participants were either children or adolescents without history of lumbar disease or surgery who participated in weightlifting for at least 2 years. The mean age of the participants at the start of this study was 11.4±2.0 years. Annual medical questionnaires and lumbar examinations using MRI were performed during the 4-year follow-up. The assessment items included a medical questionnaire, which was used to record the practice frequency and presence of LBP each year, and MRI findings. On MRI, lumbar spondylolysis, disc herniation, and lumbar disc degeneration at all lumbar vertebral levels (L1 to S1) in the sagittal and coronal plane were assessed. Pfirrmann classification was used for the assessment of lumbar disc degeneration. MRI findings were interpreted by two orthopedic surgeons; one was a specialist in spine surgery, and the other was an experienced orthopedic surgeon. Both readers were unaware of the participant’s other findings. Inter-reader and intra-reader agreements were assessed using the κ value. Results: The participants practiced approximately 2 hours per day for about 5 days per week under the guidance of a team coach. At the start of this study, there were no positive findings of LBP, lumbar spondylolysis, or disc herniation on MRI. Lumbar disc degeneration on MRI was observed in only 2 participants. The grade of degeneration was grade 2. During the 4-year study, LBP was confirmed in 5 participants, lumbar spondylolysis in 5, and lumbar disc herniation in 3; 1 of the herniation cases required operative treatment, and lumbar disc degenerations was found in all participants (Table) . In lumbar disc degenerations, 8 participants had lumbar disc degeneration in the second year, with 9 in the third year, and 12 (including 5 with grade 3 degeneration) in the final year. Lumbar disc degeneration changes were irreversible. The κ value of inter-reader agreement was 0.53, with 0.78 for intra-reader agreement. Conclusion: This prospective 4-year cohort study of 12 child and adolescent weightlifters revealed that abnormal lumbar findings occurred in all cases when assessed with MRI, and that the abnormal changes were irreversible. Regardless of the presence or absence of symptoms, resistance training at the competition level is likely to cause irreversible changes in the lumbar vertebrae. [Table: see text]

scholarly journals Pattern of Neurological Improvements in Patient with Lumbar Disc Herniation after Microdiscectomy: Experience at the Fourth Oldest Western Medical Facility in South Asia

2017 ◽  
Vol 14 (2) ◽  
pp. 8-15
Author(s):  
Kiran Niraula ◽  
Muhammad Irfan ◽  
Chandra P Limbu ◽  
Raj Kumar KC ◽  
Muhammad A Shaheen ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Muscle Power ◽  
Lumbar Disc ◽  
Sampling Technique ◽  
Neurological Status ◽  
T Test ◽  
Mri Findings ◽  
Chi Square ◽  
Paired T Test

The pattern of improvement in Neurological status after disc surgery is different. The chronology of improvement in Medical Research Council (MRC) scores, sensory status and improvement in Straight Leg Raise (SLR) test degrees is beneficial in management part to surgeons, relatives and the patients.To assess pattern of neurological outcomes in patients with lumbar disc herniation after microdiscectomy in terms of muscle power, sensory status and SLR.A Quasi experimental study comprising 70 consecutive cases though non-probability purposive sampling technique of both the sexes admitted in Neurosurgery department, Mayo Hospital operated for the 1st time for any disc pathology with no other spinal lesions giving consent themselves or though legal guardians was conducted. Pain for leg and back was measured pre and post-operatively was done by VAS which had 42 days of follow up. Standard Neurological examinations were conducted pertaining to muscle power (by MRC), sensory status and SLR test pre and post-operatively. Variables according to their nature were expressed in the form of Mean±SD, Median (Range) and Frequency (percentage). Mc Neumer’s chi square test and paired t test were used to see association between preoperative and post-operative Neurological status depending on their nature viz: qualitative or quantitative respectively in SPSS version 15.Out of 70 patients 74% were male and 26% were females. Mean±SD of patients was 37.6±13.0 years. Majority were Laborers after housewives. Illiterates, Poor lifting techniques were the most common characteristics in the respective headings of education and employment. Most common level of disc herniation was L4-L5, L5- S1 level (96%) where Prolapse and extrusion were most common MRI findings. As compared to pre-operative (3.4) muscle power 1st and 42nd day power were respectively 4.0 and 4.7 (p=0.001). Pre-operatively only 32 (45.7%) had normal sensation which improved to 38 (54.3%) and 51 (72.9%) respectively in 1st and 42nd day of surgery (p=0.001). Pre-operative mean SLR improved to 98.6 degrees in 1st POD and continued to be the same till 42nd day (p=0.001). All the MRC findings, sensory status and SLR values in each post-operative days were statistically significant with the baseline by paired t test (p=0.001). MRC and Sensory status had same pattern of improvement (r=0.0. p=0.04) unlike SLR which total improvements were see in 1st POD itself.In conclusion, muscle power and sensory improvement follows same improvement pattern whereas maximum SLR improves in the 1st POD itself.Nepal Journal of Neuroscience, Vol. 14, No. 2, 2017 Page: 8-15

scholarly journals The Association Between Preoperative MRI Findings and Surgical Revision Within Three Years After Surgery for Lumbar Disc Herniation

Spine ◽  
2019 ◽  
Vol 44 (11) ◽  
pp. 818-825
Author(s):  
Dorthe Schoeler Ziegler ◽  
Leah Carreon ◽  
Mikkel Oesterheden Andersen ◽  
Rikke Krüger Jensen
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Revision ◽  
Mri Findings

scholarly journals Does the sagittal spinal profile differ between the elderly Chinese populations with and without lumbar disc herniation?

2021 ◽  
Author(s):  
Jipeng Song ◽  
Fumin Pan ◽  
Chao Kong ◽  
Xiangyao Sun ◽  
Yu Wang ◽  
...  
Keyword(s):  
Disc Degeneration ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Age Groups ◽  
Lumbar Disc Degeneration ◽  
Roussouly Classification ◽  
Asymptomatic Volunteers ◽  
Two Populations

Abstract Background The influence of spinopelvic morphology on the Chinese elderly LDH population was not clear. The purpose of this study is to explore its influence on the characteristics of lumbar disc herniation or degeneration. Methods 212 elderly patients with LDH and 213 asymptomatic volunteers were involved. Spinal parameters were measured on full-length X-ray and compared between two populations. In herniated group, sagittal profiles were determined according to the Roussouly classification, the degenerative grades, the herniated location and the number of intervertebral lumbar disc degeneration were evaluated from the L1 to S1 on MRI scans. The differences on them among Roussouly types were analyzed. Results There were no significant differences in BMI, the mean value of age and sex distribution between two populations. Patients were found to have significantly smaller TK, LL, and SS than those volunteers (p < 0.05), while contradicting observations on PT and TPA were obtained (p < 0.05). Roussouly type 1 and type 2 ( 50.4% and 28.7% respectively) are predominant in the LDH population and the proportion of type 1 in elderly LDH is further increased. Subjects with LDH in type 1 and 2 had lower mean herniated locations and fewer mean herniated numbers than those with type 3 and 4. Conclusions Sagittal spinopelvic parameters were found to be significantly different in elderly LDH patients and asymptomatic volunteers. There were significant differences in the Roussouly distribution among different age groups of LDH. Different Roussouly subtypes have different effects on lumbar disc degeneration and herniation.

scholarly journals Role of Magnatic Resonance Imaging (MRI) in the Pre-Operative Diagnosis of Lumbar Disc Herniation

1970 ◽  
Vol 18 (1) ◽  
pp. 8-14
Author(s):  
F Kamal ◽  
MA Quddus ◽  
A Hossain ◽  
MM Rahman ◽  
RN Sarkar ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Radiological Investigation ◽  
Predictive Values ◽  
Female Ratio ◽  
Imaging Department ◽  
Sacral Spine

Objectives: To diagnose lumbar disc herniation by MRI, to compare the MRI findings with peroperative findings and to elucidate validity of MRI in pre-operative diagnosis of lumbar disc herniation. Methodology:The study was done between January 2008 to March 2009 with 40 patients (28 male and 12 female) who were clinically suspected as cases of lumbar disc herniation and was referred for MRI of Lumbo-sacral spine to the Radiology and Imaging department of Dhaka Medical College Hospital. Detail history, clinical examination and MRI of lumbo-sacral spine were performed in all cases and the Patients were followed up during the surgery. The peroperative findings were then correlated with MRI findings and for the validity of the study outcome, sensitivity, specificity, accuracy, positive predictive value and negative predictive values of MRI in the diagnosis of Lumbar disc herniation were calculated. Results: In this study 21(52.5%) cases were found in 3rd decade, 17(42.5%) cases in the 4th decade and 2 (5.0%) cases in 5th decade. Male female ratio of lumbar disc herniation is 2.33:1 (28:12). 60% of the study subjects were stressful and that of 40% was sedentary. Lumber disc herniation was mostly seen at L4-5 level (57.5%) and L5-S1 level (25%). MRI was 94.28% sensitive, 60% specific and showed an accuracy of 90%. Conclusion: This study established the use of MRI as the radiological investigation for detection of lumbar disc herniation. The procedure is safe and cost effective. Key words: Lumbar Disc Herniation; Magnatic Resonance Imaging (MRI). DOI: 10.3329/jdmc.v18i1.6298 J Dhaka Med Coll. 2009; 18(1) : 8-14

Modic changes in the adjacent vertebrae due to disc material infection with Propionibacterium acnes in patients with lumbar disc herniation

2016 ◽  
Vol 26 (12) ◽  
pp. 3129-3134 ◽  
Author(s):  
Javad Aghazadeh ◽  
Firooz Salehpour ◽  
Ehsan Ziaeii ◽  
Naghme Javanshir ◽  
Afshin Samadi ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Propionibacterium Acnes ◽  
Lumbar Disc ◽  
Modic Changes ◽  
Disc Material

scholarly journals Minimum of Two-Year Follow-up After Percutaneous Endoscopic Transforaminal Discectomy on Lumbar Disc Herniation: Clinical and Radiographic Outcomes

2021 ◽  
Author(s):  
Lei Yue ◽  
Hao Chen ◽  
Guanzhang Mu ◽  
Bingxu Li ◽  
Haoyong Fu ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Risk Factor ◽  
Intervertebral Disc ◽  
Clinical Outcomes ◽  
Disc Degeneration ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc

Abstract Background Percutaneous endoscopic transforaminal discectomy (PETD) is a widely-used minimally invasive technique in treating lumbar disc herniation (LDH), our aim was to investigate the long-term effect of PETD on clinical outcomes and magnetic resonance imaging (MRI) characteristics of LDH patients.Methods This is a retrospective case series to assess patients who underwent single level PETD from January 2015 to June 2019 with a minimum follow-up of 2 years. Clinical outcomes included numeric rating scale (NRS), Oswestry Disability Index (ODI) and adverse events. Radiographic parameters included sagittal spine geometry, characteristics of protrusion, and degeneration grading of intervertebral disc and facet joint. Sensitivity analysis and risk factor analysis were also performed.Results Thirty-eight patients (43.16 ± 13.32 years; M: F = 20: 18) were assessed. During the follow-up period (33.47±12.53 months), the mean disc height decreased from 10.27 ± 1.92 mm to 8.95 ± 1.74 mm (P=0.000), and lumbar lordosis increased from 31.31 ± 8.63° to 35.07 ± 8.07° (P=0.002). The size of protrusion significantly decreased after PETD (P=0.000). Disc degeneration grading was generally higher at last follow-up compared with baseline (p=0.002). Compared with baseline, significant improvements were observed on NRS and ODI at 3-months follow-up and the last follow-up. On risk factor analysis, facet tropism was correlated with radiographic recurrence of disc herniation (OR=6.00 [95% confidential interval (CI)1.176-30.624], p=0.031).Conclusions This study demonstrates that at long-term follow-up, despite the good clinical results, the PETD resulted in significant aggravation of intervertebral disc degeneration.

scholarly journals Synchronous Lumbar Disc Herniation in Adult Twins. Case Report

2004 ◽  
Vol 31 (4) ◽  
pp. 554-557 ◽  
Author(s):  
Ratan Bhardwaj ◽  
Rajiv Midha
Keyword(s):  
Case Report ◽  
Disc Degeneration ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Genetic Factors ◽  
Lumbar Disc ◽  
Relevant Literature ◽  
Lumbar Disc Degeneration ◽  
Adult Twins

Objective:To report an unusual case of large synchronous lumbar disc herniation in adult twins.Methods:Case report and relevant literature review.Results:The authors report a case of adult female monozygotic twins who synchronously presented with huge lumbar disc herniation. Rather than being a curious coincidence, this case highlights the potential importance of hereditary factors in the causation of lumbar disc degeneration. The relevant literature regarding the role of genetic factors and their relationship to other risk factors in lumbar disc degeneration is reviewed and discussed.Conclusion:Synchronous lumbar disc herniation in adult twins is a rare event. It, however, sheds light on the role of genetic factors in disc degeneration.

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