Clinical management of patients with vertebral lumbosacral radiculopathy. Description clinical cases

Lumbosacral radiculopathy one of the most difficult choices vertebrogenic pain syndromes characterized especially intense and prolonged pain, usually accompanied by a sharp restriction of mobility, and is the most common cause of disability. Most of the destruction of roots of spinal nerves caused by vertebral reasons the presence of a herniated disc, degenerative changes in the intervertebral joints, narrow spinal canal. This article describes a clinical case of practice management of patients with chronic vertebral lumbosacral radiculopathy. The main causes of pain in the lower back, the main approaches to the diagnosis and treatment of chronic pain. Special attention is paid to the differential diagnosis of chronic pain in his back and leg.

Ligamentum flavum hematoma: a case report and literature review

The aim is to present a rare case of ligamentum flavum hematoma in the lumbar region, discuss its physiopathology and treatment and review the literature. A woman aged 68 presented with neurogenic claudication due to degenerative lumbar spondylolisthesis that evolved into a sudden worsening with cauda equina syndrome. The magnetic resonance imagining (MRI) showed signs of degeneration of the lumbar spine, with a narrow spinal canal from L2 to S1, anterolisthesis L4 L5 and an expansive lesion hyperintense on T1-weighted and hypointense on T2-weighted images considered compatible with hematoma in the topography of the yellow ligament in L1-L2. The patient underwent laminectomy and lumbar fixation. Her evolution was good in the postoperative period and at 18 months of follow-up hse walked alone, despite the pain that is controlled with simple medications. Even though rare, it seems that ligamentum flavum hematoma has a relationship with the degeneration and rupture of small vessels associated with micro trauma to the spine. Its physiopathology is not well defined and treatment is similar to other spine compression processes.

Soft disc herniation in patients with lumbar stenosis

Over a period of 25 years, a surgical technique has evolved for removal of a soft disc herniation in patients with sciatica and lumbar stenosis demonstrated on neuroradiological studies. Initially emphasis was placed on decompression of the entire narrow spinal canal when there was evidence of single nerve root involvement and no history of neurogenic claudication. The author has performed 12 microsurgical discectomies since 1984 and eight percutaneous endoscopic discectomies over the past 6 years that have been successful in relieving radiculitis and radiculopathy in cases of a single herniated nucleus pulposus, even in the presence of a stenotic canal. No patient complained of generalized numbness, weakness, or pain in the lower extremities while walking. After at least 1 year of follow up, the 20 patients who underwent microsurgical or arthroscopic procedures limited to removing the ruptured disc have not required more extensive decompression.

Intermittent cauda equina compression due to narrow spinal canal

✓ Five patients with intermittent claudication due to compression of the cauda equina in the presence of lumbar spinal canal stenosis or midline intervertebral disc protrusion are described. The characteristic myelographic evidence was complete obstruction during extension of the spine and release of the block with flexion. The cause of this syndrome is considered to be intermittent bulging of the ligamentum flavum into a narrow spinal canal so as to compress the cauda equina during extension of the back.