Essential Aspects Of Physiotherapy In The Successful Treatment Of A Patient With Cervical Disc Herniation: A Case Report

Background: Cervical disc herniation is one of the major conditions resulting in neck pain, which in turn affects the patient's activities of daily living. The Conservative approach is always being challenging among these patients due to the feeling of insecurity and the related severity of symptoms. McKenzie's approach has been used worldwide for slipped disc issues in providing relief by reducing the disc pressure and radiating symptoms. Deep Cervical Flexors strengthening plays a vital role in providing neck stability and thereby improving the posture. Case Summary: A case of neck pain with radiation into the left upper extremity going down to the left hand in a 47-year-old female was presented to physical therapy and has been referred by an orthopedic surgeon with a diagnosis of acute cervical disc prolapse at the C5-6 level. After the initial evaluation, muscle energy techniques were initially given to increase the ROM of the cervical spine as the neck was stiff. Mckenzie techniques were executed, including manual traction for 15 days along with basic ROM, neck isometrics, and DCF strengthening. Outcome measures: Numeric Pain Rating Scale (NPRS), Cervical ROM, Neck Disability Index (NDI), Tampa Scale for Kinesiophobia (TSK) were used. Conclusion: Mckenzie protocols combined with Muscle Energy Techniques (MET) and DCF strengthening exercises revealed that there was a significant improvement in the patient's functional ADL with a marked reduction in disc herniation and its associated symptoms.

Management of Prolapse Intervertebral Disc by Lumbar Discectomy by Interlaminar Fenestration – A Review of 30 Patients

Background: We are presenting 30 patients who had disc prolapse and surgically treated by interlaminar fenestration and disc excision. Methods: All of them had pain and sciatica for a period of three months prior to surgery. Initially all the patients were treated by conservative measures which failed in the cases which were taken up for the surgery. Results: The diagnosis in all the cases was made on Magnetic Resonance Imaging (MRI), additional computed tomography (CT) scan was done in the cases presenting with sciatica and claudication or suspected LCS. We encountered no difficulty by this approach for the localization of the disc and decompression of the nerve root. Conclusion: This method is a safe, effective and reliable method for treating patients of prolapse intervertebral disc (PIVD).

Prescribing pattern in outpatient department of neurosurgery in a tertiary care hospital of North India

Background: The neurosurgical disorders are amongst the leading cause of global mortality and morbidity. Though surgical intervention is thought to be the main management protocol in the neurosurgical setup but drugs are being equally used especially in the outpatient setting. The present study was carried out in view of the sparse data available on prescribing pattern in neurosurgery.Methods: The present study was conducted by the department of pharmacology in outpatient department of neurosurgery in a tertiary care centre to look into the prescription pattern among these patients.Results: In 268 patients analyzed, mean age was 43.02±15.93 years and 52.23% were females. Majority of our participants (44%) were found to be of young to middle age group (21-40 years). The diagnosis among the study population was spread over large number of diseases. Lumbar Disc Prolapse (LDP) was found to be the leading cause of neurosurgical morbidity, amounting to 32%. As far as the prescription of various drugs in the outpatient of neurosurgery is concerned, Analgesics were the most common drugs prescribed constituting about 48% of the total drugs prescribed followed by GABA analogues and multivitamins which equally formed 41% of the total prescribed drugs.Conclusions: Although the prescription pattern studies among the outpatient neurosurgery patients are very scant, the analysis of prescription studies will be helpful to encourage the rational drug prescribing pattern.

Zygapophyseal Joint Orientation and Facet Tropism and Their Association with Lumbar Disc Prolapse

STUDY DESIGN: Cross-sectional study. PURPOSE: To evaluate the association between zygapophyseal joint angle (ZJA), facet tropism (FT), and lumbar intervertebral disc prolapse (IVDP). OVERVIEW OF LITERATURE: Several studies have shown that FT increases the risk of IVDP and have postulated that a more sagittally oriented zygapophyseal joint provides less mechanical resistance to axial torque, thereby exerting excessive rotational strain on the intervertebral disc, resulting in an annular tear. In contrast, other studies have found no definitive association between FT and IVDP. Therefore, conclusive evidence regarding the role of FT in the pathogenesis of disc prolapse is currently lacking. METHODS: Magnetic resonance imaging scans of 426 patients with single-level lumbar IVDP were analyzed. Right and left ZJAs of the lumbar segments were measured on axial sections. The frequency and severity of FT were determined by calculating the absolute difference between the right and left ZJAs. Patients without IVDP at L4–L5 and L5–S1 served as controls for those with IVDP at L4–L5 and L5–S1, respectively. Chi-square test and t-test were used to compare the severity and frequency of FT between patients with and without IVDP. The receiver operating characteristic analysis was performed to determine the critical FT values that were predictive of IVDP. RESULTS: Patients with IVDP exhibited a higher frequency (L4–L5: 47% vs. 15.08%; L5–S1: 39.62% vs. 22.69%; p=0.001) and severity (L4–L5: 7.85°±3.5° vs. 4.05°±2.62°; L5–S1: 7.30°±3.07° vs. 4.82°±3.29°; p < 0.001) of FT than those without IVDP. Critical FT values of 5.7° at L4–L5 and 6° at L5–S1 increased the likelihood of IVDP by a factor of 2.89 and 1.75, respectively. CONCLUSIONS: Our results confirm the existence of a significant association between lumbar IVDP and FT; however, a causal relationship could not be ascertained.

Effect of electroacupuncture on somatosensory evoked potentials in dog models of intervertebral disc prolapse / 中国实验动物学报

Objective To study the effect of electroacupuncture on repair of spinal cord injury and its effect on somatosensory evoked potential ( SEP) in dog models of intervertebral disc prolapse. Methods Nine Beagle dogs were randomly divided into three groups. In the model group and electroacupuncture group, the dog disc prolapse models were made by balloon compression, and in the electroacupuncture group, electroacupuncture was used every day for 14 days after operation. The model group was not treated after surgery. Sham operation was performed in the control group. Each dog was scored according to the Texas Spinal Cord Injury Scale for Dogs (TSCIS) scores before surgery (day 0) and on days 1, 4, 7, 14 after surgery. At the same time, SEP wave was measured using an EMG Evoked Potential Measuring Systerm and its latency and amplitude were analyzed. Results There was a significant difference in TSCIS scores between the model group, electroacupuncture group and control group at 1 day after operation. There was a significant difference between the electroacupuncture and model groups at 14 days after surgery. The amplitude of SEP in the model and electroacupuncture groups was significantly different from that in the control group at 1 day after operation, and there was a significant differ-ence between the electroacupuncture and model groups at 14 days after operation. There was a significant difference in the latency of SEP between the model and electroacupuncture groups at 4 days after operation, and between the electroacupunc-ture and model groups after at 14 days after operation. Conclusions Electroacupuncture can effectively promote healing of spinal cord injury in dogs with intervertebral disc prolapse, improve the TSCIS scores, restore SEP waveform, shorten the latency and enhance the amplitude. SEP can reflect the degree of spinal cord injury to a certain extent, and can be used to evaluate the effect of electroacupuncture treatment in these dogs.

Effect of electroacupuncture on somatosensory evoked potentials in dog models of intervertebral disc prolapse / 中国实验动物学报

Objective To study the effect of electroacupuncture on repair of spinal cord injury and its effect on somatosensory evoked potential ( SEP) in dog models of intervertebral disc prolapse. Methods Nine Beagle dogs were randomly divided into three groups. In the model group and electroacupuncture group, the dog disc prolapse models were made by balloon compression, and in the electroacupuncture group, electroacupuncture was used every day for 14 days after operation. The model group was not treated after surgery. Sham operation was performed in the control group. Each dog was scored according to the Texas Spinal Cord Injury Scale for Dogs (TSCIS) scores before surgery (day 0) and on days 1, 4, 7, 14 after surgery. At the same time, SEP wave was measured using an EMG Evoked Potential Measuring Systerm and its latency and amplitude were analyzed. Results There was a significant difference in TSCIS scores between the model group, electroacupuncture group and control group at 1 day after operation. There was a significant difference between the electroacupuncture and model groups at 14 days after surgery. The amplitude of SEP in the model and electroacupuncture groups was significantly different from that in the control group at 1 day after operation, and there was a significant differ-ence between the electroacupuncture and model groups at 14 days after operation. There was a significant difference in the latency of SEP between the model and electroacupuncture groups at 4 days after operation, and between the electroacupunc-ture and model groups after at 14 days after operation. Conclusions Electroacupuncture can effectively promote healing of spinal cord injury in dogs with intervertebral disc prolapse, improve the TSCIS scores, restore SEP waveform, shorten the latency and enhance the amplitude. SEP can reflect the degree of spinal cord injury to a certain extent, and can be used to evaluate the effect of electroacupuncture treatment in these dogs.

C2-3 Fusion, C3-4 Cord Compression and C1-2 Posterior Facetal Instability: An Evaluation of Treatment Strategy Based on Four Surgically Treated Cases

STUDY DESIGN: Four patients had C2-3 vertebral fusion and radiologically demonstrated cord compression at C3-4 level related to disc bulge with or without association of osteophytes and C1-2 posterior facetal dislocation. The outcome of treatment by atlantoaxial and subaxial facetal fixation is discussed. PURPOSE: The article evaluates the significance of atlantoaxial facetal instability in cases having C2-3 vertebral fusion and cord compression at the level of C3-4 disc. OVERVIEW OF LITERATURE: C2-3 vertebral fusions are frequently encountered in association with basilar invagination and chornic atlantoaxial dislocations. Even when basilar invagination and atlantoaxial dislocation are not identified by conventional parameters, atlantoaxial instability can be the nodal point of pathogenesis in cases with C2-3 vertebral fusion. METHODS: Between June 2013 and November 2014 four patients having C2-3 fusion presented with progressive symptoms of myelopathy that were related to cord compression at the level opposite the C3-4 disc space. Further investigations revealed C1-2 posterior facetal dislocation. RESULTS: All patients were males. Ages ranged from 18 to 50 years (average, 36 years). All patients were treated by atlantoaxial facetal plate and screw, and subaxial single or multi-segmental transarticular screw fixation. Follow-up (average, 15 months) using a recently described clinical grading system and the Japanese Orthopaedic Association scoring system confirmed marked improvement of symptoms. CONCLUSIONS: Identification and treatment of atlantoaxial facetal instability may be crucial for a successful outcome in cases having C2-3 fusion and high cervical (C3-4) disc related cord compression.

C2-3 Fusion, C3-4 Cord Compression and C1-2 Posterior Facetal Instability: An Evaluation of Treatment Strategy Based on Four Surgically Treated Cases

STUDY DESIGN: Four patients had C2-3 vertebral fusion and radiologically demonstrated cord compression at C3-4 level related to disc bulge with or without association of osteophytes and C1-2 posterior facetal dislocation. The outcome of treatment by atlantoaxial and subaxial facetal fixation is discussed. PURPOSE: The article evaluates the significance of atlantoaxial facetal instability in cases having C2-3 vertebral fusion and cord compression at the level of C3-4 disc. OVERVIEW OF LITERATURE: C2-3 vertebral fusions are frequently encountered in association with basilar invagination and chornic atlantoaxial dislocations. Even when basilar invagination and atlantoaxial dislocation are not identified by conventional parameters, atlantoaxial instability can be the nodal point of pathogenesis in cases with C2-3 vertebral fusion. METHODS: Between June 2013 and November 2014 four patients having C2-3 fusion presented with progressive symptoms of myelopathy that were related to cord compression at the level opposite the C3-4 disc space. Further investigations revealed C1-2 posterior facetal dislocation. RESULTS: All patients were males. Ages ranged from 18 to 50 years (average, 36 years). All patients were treated by atlantoaxial facetal plate and screw, and subaxial single or multi-segmental transarticular screw fixation. Follow-up (average, 15 months) using a recently described clinical grading system and the Japanese Orthopaedic Association scoring system confirmed marked improvement of symptoms. CONCLUSIONS: Identification and treatment of atlantoaxial facetal instability may be crucial for a successful outcome in cases having C2-3 fusion and high cervical (C3-4) disc related cord compression.

New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease

STUDY DESIGN: Clinical adjacent segment pathology (CASP) is common after cervical disc surgery. A critical examination of 320 patients operated for cervical disc prolapse revealed that CASP can also occur in patients with congenital and degenerative fusion of cervical spine. This has not been studied in depth and there is a need for a practically applicable classification of CASP. PURPOSE: To develop a new classification scheme of CASP. OVERVIEW OF LITERATURE: A review of the literature did not reveal a practically applicable classification incorporating the occurrence of CASP in congenital and degenerative fusion cases. METHODS: This was a retrospective analysis of 320 patients operated (509 disc spaces) on for cervical disc prolapse. Cases (n=316) were followed-up for 3-11 years. Random sampling of 220 patients with postoperative magnetic resonance imaging (MRI) in 165 cases was analyzed. RESULTS: Six symptomatic CASP cases required resurgery (1.9%), eight cases involved MRI proven CASP with axial neck pain only and 13 patients were asymptomatic with radiological adjacent segment pathology (RASP). The frequency rate was 8.5% (27/316). Four cases of congenital or degenerative fusion of vertebra developed CASP requiring surgery. CASP is classified as primary or secondary follows. Primary A1 was congenital fusion of vertebra and primary A2 was degenerative fusion of the vertebra. Secondary, which was after cervical disc surgery, comprised B1 (RASP in asymptomatic patients), B2 (CASP in patients with axial neck pain), and B3 (CASP with myeloradiculopathy). B3 was subdivided into single-level CASP (B3a) and multiple-level CASP (B3b). CONCLUSIONS: Symptomatic CASP requiring resurgery is infrequent. CASP can occur in patients with congenital and degenerative fusion of the cervical spine. A new classification for CASP along with treatment strategy is proposed. Patients in Primary CASP and B3 CASP require resurgery while others require only observation.

Migrated Disc at Cervicothoracic Junction Presenting as Acute Paraplegia

Herein, we report on an inferior migration of an intervertebral disc C6-7 to the cervicothoracic junction manifesting as acute paraplegia. The patient showed a remarkable recovery after the surgery. The diagnostic dilemma and management difficulties of such an entity are briefly discussed.

Effect of biopsy needle on decompression for lumbar disc prolapse / 现代临床护理

Objective To explore the effect of cutting biopsy needle on decompression for lumbar disc prolapse and nursing measures? Method One hundred and twenty patients with lumbar disc prolapse were managed with intervertebral disc decompression as well as perioperative nursing? Results All of them had their pains significantly relieved one or two days after decompression? The follow-ups for 3 months to 1 year confirmed the effectiveness rate of 96?7%,excellent effectiveness rate of 89?2% and no complication?Conclusions The decompression by cutting needle biopsy,is advantageous for its operative simplicity,alleviation of pains,fewer adverse reactions and lower rate of complications? The perioperative nursing strategy and recovery instruction are critical for improved curative effect and prevention of relapse?

Lumbar Interverterbral Disc Prolapse (PLID) Surgery and Our Experiences.

Background: Back pain and sciatica are very common in adult persons. These cause a great loss of working hours with financial loss of individual and the nation. Very careful evaluation must be done to treat these patients. Injudicious treatment, whether medical or surgical, may aggravate the sufferings. Objective: To study immediate and long term effect of the prolapsed intervertebral disc surgery. Materials and Methods: This observational study was done in Enam Medical College & Hospital, Savar, Dhaka during January 2007 to June 2011. Sixty four patients operated during this period for prolapsed lumbar intervertebral disc were included in the study. Fifty six (88%) were male and 8 (12%) were female. Age range was 30 to 50 years. Most of the patients presented with back pain and sciatica with no definite history of trauma or weight lifting. Diagnosis was confirmed by MRI. Results: Sixty (94%) patients had no pain after surgery and only 4 patients had occasional pain. Conclusion: Maintenance of strict criteria for the surgery yields very good result.

Posterior Epidural Migration of Sequestrated Cervical Disc Fragment: Case Series

STUDY DESIGN: A retrospective study was undertaken to delineate the characteristics of non-traumatic sequestrated epidurally migrated cervical disc prolapse. PURPOSE: To present first case series of eight such cases diagnosed preoperatively and to discuss their magnetic resonance imaging (MRI) characteristics and their management. OVERVIEW OF LITERATURE: Non-traumatic spontaneous migration of the sequestrated disc fragment epidurally behind cervical vertebral body is rare. Only ten cases have been reported in literature. METHODS: Detailed clinico-radiological profiles of these 8 cases are presented. In six cases their clinical picture was suggestive of cervical myelopathy. MRI scan showed single level epidural migrated disc behind body of C4, C6, and C7 in six patients and two cases with multiple levels (C5-C6). In six cases, anterior corpectomy with excision of the disc was performed and the seventh patient underwent dorsal laminectomy. The eighth patient chose not to undergo surgery. RESULTS: T1 images of the MRI scan showed an isointense signal in all the 8 cases. T2 images revealed a varying intensity. In six cases who underwent anterior corpectomy, there was a rent in the posterior longitudinal ligament. Among those in two cases multiple disc fragments were seen. In the rest four cases, a single large fragment was observed. These patients improved after anterior corpectomy and disc excision. There was no improvement in the patient who had undergone dorsal laminectomy. The eighth patient who refused surgery progressively deteriorated. CONCLUSIONS: We opine that MRI scan especially T1 images are useful in these cases. We prefer to treat these cases through anterior corpectomy with excision of the sequestrated disc which proved to result in excellent outcome.

Percutaneous Endoscopic Transforaminal LumbarDiscectomy An Early Experience

Percutaneous endoscopic spinal surgery performed in the awake state offers a new paradigm for treatment of symptomatic lumbar disc prolapse. We report the outcome of 23 patients who underwent this procedure. Visual analogue scale for pain improved from 7.3 to 2.1; 19 of the 23 patients achieved good to excellent results according to the MacNab criteria. Patient acceptance of the procedure was 91.3%. All but one patient were discharged from hospital within 24 hours. One patient developed foot drop post oper

Cauda Equina Syndrome by Disc Prolapse after Caesarian Section Delivery / 대한주산의학회잡지

Cauda equina syndrome develops as rapidly progressive neurologic deficit of lower extremities and urogenital system often resulting in serious outcome such as complete irreversible paraparesis, therefore prompt diagnosis and decompression is mandatory. However, if it occurs after childbirth, it may be overlooked being regarded as symptoms related to pregnancy and delivery. We experienced a cauda equina syndrome by prolased disc in a 32-year-old woman just after Caesarian section who was managed with prompt decompressive surgery and achieved favorable result. Because of the importance of early detect and prompt decompression for cauda equina syndrome and possible occurrence at perinatal period, we report this case reviewing the literature especially concerning about changes of spine and disc during pregnancy and after delivery.

Influence on curative effect of aescin in curing Lumbar intervertebral disc prolapse(LIDP) before and after operation / 中成药

Objective: To observe the influence on curative effect of aescine in curing Lumbar intervertebral disc prolapse(LIDP) before and after operation. Methods: 184 cases of patients with LIDP were divided into two groups. 96 cases in curative group began to be used 10mg of aescin by adding to infusion of iv drip bid 3 days before the operation, and contie for 6-8 days it. 88 cases in control group were only operated.Results: Curative group was superior to control group in lysis of pain, postoperative La feeling and improvement of muscle strength. The excellent and better rates in two groups are 72.91%, 91.67% and 43.18%, 85.22%. The excellent rate of curative group is higher than that of control group( P 0.05). There is no serious bad reaction of drug in curative group.Conclusion: Aescin used before and after operation is good to recovery of nervous function after LIDP operation.