Exercise Countermeasures for the Spine in Microgravity

Weakness and neuromuscular deconditioning of the anti-gravity spine muscles develop after 6-month missions in space. There is also a high incidence of herniated nucleus pulposus in cervical and lumbar discs with back pain post-flight. Prolonged microgravity reduces the physiological loading forces needed for spine homeostasis and may alter neuromuscular postural reflexes leading to injury upon return to 1G. Nine astronauts were tested using the Biering-Sorensen test to measure spine isometric endurance pre- and post-flight. The results show significant decrements in muscle isometric endurance and correlates with atrophy of the multifidus, erector spinae, quadratus lumborum and psoas, reduced cross-sectional area and functional cross-sectional area with MRI measurements. Current ISS exercise countermeasures appear to be insufficient in mitigating loss of spinal function due to lack of specifically designed exercises to address specific antigravity muscles. Intensity of resistance loading is proposed to be specific to the muscle isoform that needs the most optimal mechanotransduction using adjustable pulley resistance vectors in line or parallel to the target muscle fibre orientations. Pulley apparatus may be in the form of flywheel or pneumatic derived resistance. Since antigravity muscles are predominantly Type I muscle isoform, endurance and stability are the main functional qualities which would require higher repetitions in good form, moderate resistance, and multiple sets. This proposal is intended to define efficient type of spine exercises to counter the maladaptive effects from prolonged spaceflight and lead to accepted countermeasures. Supported by NASA Grants NNXlOAM18G and NNX13AM89G.

La debilidad y el desacondicionamiento neuromuscular de los músculos de la columna vertebral encargados de la anti-gravedad aparecen a partir del sexto mes de estancia en el espacio. En la etapa posterior al vuelo también se observa una elevada incidencia de núcleos pulposos herniados en discos cervicales y lumbares con dolor de espalda. La microgravedad prolongada reduce las fuerzas de carga fisiológica necesarias para la homeostasis de la columna vertebral, además de que puede alterar los reflejos posturales neuromusculares provocando lesiones al regresar a 1G. Nueve astronautas fueron evaluados con la prueba de Biering-Sorensen para medir la resistencia isométrica de la columna vertebral antes y después del vuelo. Los resultados muestran decrecimientos significativos en la resistencia isométrica muscular y correlatos con atrofia del multifidus, erector spinae, quadratus lumborum y psoas, reducción del área transversal y área transversal funcional con mediciones IRM. Las contramedidas actuales de la EEI para los ejercicios parecen ser insuficientes para mitigar la pérdida de función espinal provocada por la falta de ejercicios dirigidos a músculos antigravedad específicos. Se propone que la intensidad de la carga de resistencia sea específica para la isoforma muscular que requiere la mecanotransducción más óptima usando vectores de resistencia de polea ajustables alineados o paralelos a las orientaciones de la fibra muscular a que estén dirigidos. El dispositivo de poleas puede tomar la forma de volante o de resistencia derivada de fuerza neumática. Como los músculos antigravedad son predominantemente isoformas musculares Tipo I, la resistencia y la estabilidad son las principales cualidades funcionales que requerirían mayores repeticiones en buena forma, resistencia moderada y múltiples ciclos. La propuesta que aquí se presenta está dirigida a definir el tipo eficiente de ejercicios para la columna vertebral para contrarrestar los efectos de adaptación inadecuada provocados por un vuelo espacial prolongado, así como avanzar hacia la creación de contramedidas aceptables. Realizado con el apoyo de las subvenciones de la NASA NNXlOAM18G y NNX13AM89G.

Construction of HNP-3 Mature Peptide Bait Plasmid of Yeast Two-hybrid System and Detecting Its Self-activating and Toxic Effect / 航天医学与医学工程

Objective To construct the bait plasmid of HNP-3 mature peptide in yeast two-hybrid system and examine whether the recombinant bait plasmid has self-activating and toxicity effect.Methods Using RT-PCR technique,the cDNA fragments of HNP-3 mature peptide gene were amplified from the extracted RNA in cultured HL-60 cells.The fragment was firstly cloned into pBluescript-SK-II vector,confirmed by sequencing,then sub-cloned into the bait plasmid pGBKT7 and identified with PCR and sequence analysis techniques.The recombinant plasmid was introduced into the yeast cell AH109,and its self-activating and toxicity effect was tested by auxotrophic selective culture.Results DNA sequencing indicated that the inserted fragment in pBluescript-SK-II vector was HNP-3 mature peptide gene sequence,and the sub-cloned recombinant pGBKT7-HNP-3 was no mismatch.The recombinant bait plasmid didn't have self-activating effect and did not show toxicity to yeast AH109 cell.Conclusion The bait plasmid of HNP-3 mature peptide was constructed successfully.This was helpful for investigating the proteins interacting with HNP-3 mature peptide by yeast two-hybrid technique.

The changes of HNP and NE content in serum during perioperation of cardiac surgery under cardiopulmonary bypass / 临床检验杂志

Objective To observe the changes of HNP1-3 and NE content in serum quantitatively during perioperation of cardiac surgery under cardiopulmonary bypass(CPB),and to explore the role of changes of HNP1-3 and NE content in early diagnosis of system inflammatory response syndromes(SIRS)after cardiopulmonary bypass.Methods The contents of HNP1-3 and NE in serum during perioperation of 21 cardiac surgeries under cardiopulmonary bypass were measured quantitatively using ELISA method,and the contents of CK,CK-MB and C-RP in serum were measured at the same time points as that of HNP1-3 and NE.Results The contents of HNP1-3 and NE in serum were 54.55?26.45 ng/ml and 41.09?9.93 ng/ml respectively before CPB,and they were 435.45?500.13 ng/ml and 250.91?97.21 ng/ml respectively 0.5 h after CPB which were significantly higher than that before CPB(P

Reconstruction of J Chain Gene with HNP-1 Gene and Construction of Its Expression Vector / 中华医院感染学杂志

OBJECTIVE To recombine J chain gene with HNP-1 into a new germicidal(molecule) J-HNP-1,which can connect with pIgR by J chain,so that by using pIgR as a "bridge" the J-HNP-1(germicidal) peptide can be transported into the epithelial cell of mucous membrane to kill the intracellular microorganisms,then the recombinant is inserted into the mammalian expression system.METHODS The J chain and HNP-1 cDNA were amplified from the plasmids respectively by PCR,then the two cDNA fragments were recombined into J-HNP-1 by recombinant PCR.The J-HNP-1 cDNA fragment was inserted into the(mammalian) expression vector pcDNA3.1(-)/Myc-HisC.RESULTS The J-HNP-1 recombinant was obtained by(connection) of J chain and HNP-1 cDNA by PCR.The recombinant J-HNP-1 cDNA was 786bp.CONCLUSIONS The recombinant J-HNP-1 cDNA and the construction of expression vector are the basis for the new bactericidal peptide production.

Expression of Recombinant J-HNP-1 Gene with C Terminal of Double Marks Myc and Poly-histidine in Transfected COS-7 Cells / 中华医院感染学杂志

OBJECTIVE To reconstruct the HNP-1 into the J-HNP-1 with a J chain,and explore to set up a mammalian cell expression system which can express and secret J-HNP-1,so that the products could be examined and purified conveniently. METHODS The J-HNP-1 cDNA fragments were produced by recombinant PCR.Then the J-HNP-1 was inserted into the mammalian expression vector pcDNA3.1(-)/Myc-His which had the double marks Myc and 6?His.The recombinant vector rpcDNA3.1(-)/Myc-His /J-HNP-1 was transfected into the COS-7 cell.The J-HNP-1 expression was analyzed at the mRNA and protein level.The germicidal activity of cell culture supernatant and cellular solution protein was assayed. RESULTS By the use of RT-PCR with special primers,a band of 786bp was amplified from COS-7 cells transfected by this recombinant plasmid.Western blot analysis with specific anti-histidines antibody revealed that the cell culture supernatant and cellular solution protein of COS-7 cells transfected by rpcDNA3.1(-)/Myc-His /J-HNP-1 had a strong band with relative molecular mass of about 24?10~3.Antibacterial activity assay showed that obvious bacterial inhibition occurred in both lysate and supernatant of COS-7 cells transfected by rpcDNA3.1(-)/Myc-His /J-HNP-1. CONCLUSIONS The J-HNP-1 recombinant is obtained and inserted into the mammalian expression vector then to be expressed in vitro.The expression product is found to have the anti-bacterial effect in vitro.

The Changes of Disc Height and Degeneration in Patients with Lumbar Disc Herniation / 대한척추외과학회지

STUDY DESIGN: The changes of the disc height in patients diagnosed with lumbar disc herniation who underwent a discectomy were subjected to a retrospective study. OBJECTIVES: The goal of this study was to find the relationship between the disc height and degenerative disc changes in patients diagnosed with lumbar disc herniation who underwent a discectomy. SUMMARY OF LITERATURE REVIEW: Disc height changes according to age, degenerative change and the amount of removed disc. MATERIALS AND METHODS: The patients in this study were those diagnosed with HNP who undergone a discectomy in our hospital. The fifty seven observed patients had a discectomy in our hospital between March, 2001 and March, 2003. Patients who had posterior fusion during surgery were excluded. There were 35 males and 22 females, with an average age of 35.9 yrs old (17-55) and a mean follow-up period of 2.7 yrs. The degrees of HNP and degenerative disc were examined with MRI and measured through the T2 MRI, respectively, before the operation. The disc heights were measured before and after surgery, and the anterior, posterior and middle disc heights were measured with a simple lumbar lateral X-ray. There were 6, 20, 25 and 6 cases of degeneration grades II, III, IV and V, respectively. There were also 27, 25 and 5 cases of protruded, extruded and sequestrated discs, respectively. RESULTS: When patients with a lumbar disc herniation underwent a discectomy, the changes of disc height in people of those with a postoperative degenerative disc change were notable, but there was no difference in disc height change with regard to the degree of HNP. CONCLUSION: In lumbar disc herniation patients after a discectomy, the changes of disc height decrease significantly in severe degenerative discs in the short term; therefore, further long term periods of study will be required.

The Expression and Significance of TGF-beta Isoforms in Herniated Lumbar Intervertebral Disc / 대한정형외과학회잡지

PURPOSE: This study was conducted to determine the cellular role of TGF-beta in HNP specimens using immunohistochemistry stain (IHS) and reverse transcriptase-polymerase chain reaction (RT-PCR). MATERIALS AND METHODS: Disc tissues including the nucleus pulposus were collected from 19 patients who underwent disc resection due to radiculopathy. After performing IHS and RT-PCR on the HNP tissues, the correlation between TGF-beta isoform expression and other factors was investigated. RESULTS: In terms of isoform expression according to HNP types, TGF-beta 1 and- 2 were expressed weakly in the protruded type, whereas TGF-beta 1, - 2, and- 3 were expressed evenly in the extruded and sequestrated types. No significant differences in histological grades and TGF-beta expressions were observed according to the patients' age, sex, degree of intervertebral disc degeneration, sensory and motor nerve involvement, or symptomatic duration. A higher level of TGF-beta expression could be seen on immunohistological staining according to the grade of HNP exposure, and higher expression was also noted according to mRNA level using RT-PCR compared with the extruded and sequestrated types. CONCLUSION: However, further studies on differences in TGF-beta isofrom expression to the degree of degeneration are required, TGF-beta participates in wound healing and repair processes after the development of disc tissue damage. A possible application of TGF-beta as a new method for the treatment of HNP is expected.

Significance of Space-Occupying Ratio According to MRI Finding in Lumbar Disc Herniation / 대한척추외과학회지

STUDY DESIGN: Clinical significance of space-occupying ratio according to MRI finding in lumbar disc herniation. OBJECTIVES: To estimate relationship between patient's symptoms and space-occupying ratio in herniated lumbar vertebral disc in MRI according to JOA scoring system. SUMMARY OF LITERATURE REVIEW: Using MRI, herniated intervertebral disc may be estimated with the extent of derangement of the constituents of the disc. Symptoms and signs did not correlate with the degree of reduction of the herniation in MRI. MATERIAL AND METHOD: A retrospective analysis was performed upon 99 patients that underwent lumbar spine MRI. The degree of the occupied spinal canal was measured by 'Space-occupying ratio', which was the ratio of the longitudinal diameter at the spinal canal to the longitudinal diameter at the herniated nucleus purposus. Each '30% Space-occupying ratio' to '50% Space-occupying ratio' was classified to analysis I, analysis II. Under the percent was group A, above the percent was group B. We estimate the patient's condition related with lower back pain according to JOA scoring system. RESULTS: The herniation type of the nucleus purposus was classified to 5 protruded type, 62 subligamentous extruded type, 22 transligamentous extruded type, 10 sequestral type. The patients who have above 30% were 62 cases, under 30% were 26 cases in analysis I, have above 50% were 19 cases, under 50% were 69 cases in analysis II. So, there was not distinguished from analysis I to analysis II according to the degree of the herniation. Mean JOA score was 9.307 in group A, mean JOA score was 9.370 in group B in analysis I. Mean JOA score was 9.391 in group A, mean JOA score was 9.315 in group B in analysis II. There was not correlate statistically with analysis I (p value=0.5669) and analysis II(p value=0.5390) using the Wilcoxon score test. CONCLUSION: There was not correlate statistically with the degree of the herniation in lumbar spine MRI according to JOA scoring system.

Expression of b-FGF in Different Type of Herniated Nucleus Pulposus / 대한정형외과학회잡지

PURPOSE: To clarify b-FGF expression in different types of herniated nucleus pulposus (HNP) as angiogenesis marker, and to identify the novel vasculature in avascular nucleus pulposus. MATERIALS AND METHODS: Twenty-seven disc specimens removed surgically from patients who underwent discectomy for L4-5 HNP. The control disc specimens were obtained from five patients who underwent surgery for spine fracture or idiopathic scoliosis. According to MRI and operative findings, HNP was classified into 3 groups; protruded, extruded and sequestrated. The study involved; 7 protruded cases, 10 extruded cases and 10 sequestrated cases. Specimens were analyzed by western quantitative comparisons were performed upon the different bands. H-E stain and immunohistochemistry of CD 34 were performed to identify vessels in the avascular nucleus pulposus. RESULTS: The expression of b-FGF was not significantly increased in the protruded disc (p>0.05), but was significantly increased in the extruded disc as compared with the protruded disc (p<0.05) and in the sequestrated disc in compared with the extruded disc (p<0.05). Immunohistochemical study revealed novel vasculature at the periphery of the sequestrated disc. CONCLUSION: It is possible to confirm that sequestrated HNP is exposed to more vigorous regression via new vessel infiltration into the avascular nucleus pulposus tissue.

Construction and expression of eukaryotic expression vector harboring human neutrophil peptide 1 / 解放军医学杂志

Objective To explore the possibility of human neutrophil peptide 1 (HNP1) gene engineering, we construct the eukaryotic expression vector carrying HNP1 gene. Methods With RNA extracted from human neutrophil cell as template, cDNA encoding mature HNP1 was amplified by RT-PCR, and then it was inserted into vector pMD18-T. After restriction endonuclease digestion and DNA sequencing confirmation the gene was subcloned into eukaryotic expression plasmid pcDNA3.1/V5-His-TOPO to construct a recombinant expression plasmid pcDNA3.1/V5-His-TOPO/HNP1, then the recombinant plasmid was transfected into COS-7 cells by lipofectamine, and the expressed product was identified by biotin-avidin enzyme-linked immunosorbent assay ( BA-ELISA). Results The sequence of HNP1 completely matched those published in GenBank, thus eukaryotic expression vector pcDNA3.1/V5-His-TOPO/HNP1 was constructed correctly. The ELISA results showed that the eukaryotic expression plasmid pcDNA3.1/V5-His-TOPO/HNP1 could temporarily express HNP1 in COS-7 cells. Conclusion The successful construction and expression of pcDNA3.1/V5-His-TOPO/HNP1 pave the way for the stable expression HNP1 in mammalian engineering cells.

Comparison of Adolescents with Adults in Lumbar HNP / 대한척추외과학회지

PURPOSE: To evaluate the difference of clinical and radiological findings for patients who underwent surgery for lumbar HNP in adolescents and adults MATERIALS AND METHODS: We studied 70 patients ; 35 adolescents(below 20 years of age), 35 adults(21 to 40 years of age) retro-spectively from May 1992 through July 1999, whom we were able to follow up for more than one year after surgery. Patients with spinal instability and stenosis were excluded. RESULTS: By the JOA score, preoperative radiating pain of the lower leg was 1.0 point in adolescents, 0.6 point in adults, showing a statistically significant difference(p<0.05). Mean value was excellent as 9.5 points in adolescents and 9.3 points in adults at last follow-up of the JOA score, and there was no significant difference. Degree of disc degeneration was of higher grade in adults, but disc degeneration was not related to lower back pain in either group. In adolescents, severity of preoperative sensory or motor dysfunction affected duration of postoperative sensory or motor recovery respectively, while in adults, severity of either preoperative sensory or motor dysfunction affected that of both sensory and motor postoperative neurologic recovery(p<0.05). The longer the time of suffering from radiating pain, the lower the points of last follow-up JOA score in adolescents. The longer the time of lower back pain, the lower the points in adults(p<0.05). CONCLUSION: Preoperative radiating pain was more severe in adults, and no other clinical difference was seen between the two groups. In adolescents, severity of preoperative sensory or motor dysfunction affected duration of postoperative sensory or motor recovery respectively, while in adults, severity of either preoperative sensory or motor dysfunction affected that of both sensory and motor postoperative neurologic recovery. Duration of radiating pain in adolescents, and lower back pain in adults, can be used to predict prognosis.

The Effect of Percutaneous Injection of Lumbar Nerve Roots in Diagnosis and Treatment of Sciatica

Clinical evaluation and imaging studies such as magnetic resonance imaging, computed tomography, and/or myelography can localize the pathologic process in most patients with lumbar radiculopathy. However, these studies occasionally fail to demonstrate exactly the cause and site for ongoing radicular symptom. So we evaluated 54 patients for the efficacy of selective nerve root blocks to identify a symptomatic nerve. The lumbar nerve root injections were performed at L3 root in 1 patients, at L4 root in 4 patients, at L5 root in 46 patients, and at S1 root in 3 patients. Among them, forty two patients were done before operation(HNP 32, stenosis 5, spondylolisthesis 5), 9 patients were done after operation due to poor results (root injury 2, infection 2, adhesion 1, incorrect diagnosis 4), and 3 patients had improved radiculopathies following nerve root injection(HNP 2, stenosis 1). The results of the nerve root injections and of the operations were not affected by age and sex. There was a good correlation between the response of the nerve root injection and the result of the operation(p<0.05). The concentration of bupivacaine 0.5% has no additional effect comparing to 0.25%(70%/73.5%) solution in spite of its adverse effect causing transient motor weakness. Additional use of depomedrol(50mg) proved to be no more beneficial. Three patients had Improved symptoms for a long period after nerve root injection which consequently made operation unnecessary. Five patients with previous history of operations had moderate pain relief. In summary, lumbar nerve root injection can be used as a functional diagnostic tool to predict operative result and as a treatment modality following failure of a previous surgery.

Facet Joint Angle in Lumbar Spine: comparative study between HNP and spinal stenosis and control group / 대한정형외과학회잡지

The importance of facet joint asymmetry has been debated as a cause of the low back pain and sciatica. And many studies have been proposed about the relationship between facet joint angle or facet joint asymmetry and the development of the disc degeneration or disc herniation. In the diagnosis of the spinal disorder, we have been used mainly myelogram and computed tomography. Several years ago, more advancement has been achieved by use of magnetic resonance image (MRI). Author studied the relationship between the facet joint angle and facet joint asymmetry and the development of the herniated nucleus pulposis (HNP) or spinal stenosis by comparision of the facet joint angle and facet joint asymmetry in each groups. Author reviewed the patients who were diagnosed as HNP or spinal stenosis with computerized tomography (CT) or MRI and treated with operative method at the department of orthopaedic surgery, Dong-A University Hospital. Facet joint angles were measured on the mid-disc cut, which was parallel to the inferior vertebral end-plate of the superior vertebra. The angles were measured by a midsagittal line through the disc and intersecting lines formed by conneqting the two end points of each facet. Facet joint asymmetry was determined by the difference between right and left facet joint angles. The results were compared between each groups and comparison group and statistical analysis was performed with the Kruskal- Wallis test in 95% confidence interval. The patients had only one level involved and had no other spinal disorder. 85 cases of HNP (central in 35 cases and lateral in 50 cases) and 50 cases of spinal stenosis were evaluated. The results were as follows: l. At the level of L4-5, the mean facet joint angles (+/-SD) were 42.50+/-5.52 (Rt.), 46.71+/-9.68 (Lt.) in central HNP, 40.91+/-9.11 (Rt.), 41.23+/-8.51 (Lt.) in lateral HNP, 37.77+/-11.41 (Rt.), 37.95+/-11.91 (Lt.) in spinal stenosis and 42.38+/-5.07 (Rt.), 41.25+/-5.85 (Lt.) in control group. 2. At the level of LS-S1, the mean facet joint angles were 48.83+/-5.64 (Rt.), 48.17+/-4.62 (Lt.) in central HNP, 52.20+/-11.30 (Rt.), 51.60+/-9.06 (Lt.) in lateral HNP, 42.67+/-8.89 (Rt.), 43.50+/- 9.85 (Lt.) in spinal stenosis and 43.91+/-7.88 (Rt.), 43.76+/-7.81 (Lt.) in control group. 3. At the level of L4-5, the mean facet asymmery was 6.35+/-6.04 in central HNP, 6.95+/-6.76 in lateral HNP, 6.47+/-5.56 in spinal stenosis and 4.31+/-5.42 in control group. 4. At the level of L5-S1, the mean facet asymmetry was 4.95+/-5.18 in central HNP, 4.72+/-5.25 in lateral HNP, 5.50+/-4.83 in spinal stenosis and 4.42+/-4.96 in control group. In conclusion, there were no statistically significant relationships between the magnitude of the facet joint angle and development of the HNP and spinal stenosis, and between the facet asymmetry and development of the HNP and stenosis.

Lumbar HNP: Analysis of the MRI finding and comparative study between MRI and Operative finding / 대한정형외과학회잡지

Among the 413 patients of the lumbar herniated nucleus pulposus(HNP) who were admitted and treated at Dong-A University Hospital from March 1990 to May 1994, we analyzed 387 patients who checked magnetic resonance imaging(MRI). MRI study followed by open disectomy was carried out on 127 patients of the lumbar HNP, and we analyzed the clinical and operative findings of the lumbar HNP and compared these with MRI findings. The following results were obtained. 1. MRI findings of 387 patients consisted of bulging discs in 107 cases(27.6%), protruded discs in 165 cases(42.6%), extruded subligamentous discs in 73 cases(18.9%), extruded transligamentous discs in 34 cases(8.8%) and sequestered discs in 8 cases(2.1%). 2. MRI findings of 127 patients who had been treated with open discectomy consisted of protruded discs in 53 cases(41.7%), extruded subligamentous discs in 47 cases(37.0%), extruded transligamentous discs in 19 cases(15.0%) and sequestered discs in 8 cases(6.3%). 3. Operative findings revealed the protruded discs: 49 cases(38.6%), extruded subligamentous discs: 52 cases(40.9%), extruded transligamentous discs: 18 cases(14.2%) and sequestered discs: 8 cases(6.3%). 4. In sequestered disc, we could get the highest sensitivity, specificity and accuracy with MRI in distinguishing from another type of lumbar HNP. MRI can be available for accurate assessment of type and location of the lumbar HNP and it can show the high specificity, sensitivity and accuracy in preoperative diagnostic method.

Regression of Herniated Nucleus Pulposus after Anterior Interbody Fusion / 대한정형외과학회잡지

Low back pain and sciatica is one of the most frequent and troublesome problem in or thropedic field. There are many controversies about surgicsl procedure for the treatment of the patient with herniated nucleus pulposus. The advantages of anterior interbody fusion are through removal of remnsnt of the disc, restoration of disc height, correction of spinal alignment, preservation of posterior elements and neural component. The strut of ilisc bone was firmly impacted and patients could be mobilization earlier. It is well known that symptoms secondary to herniated nucleus pulposus can resolve after disc excision and anterior interbody fusion, but little has been written about regression of herniated nucleus pulposus. We analysed 20 cases in which serial C-T studies disclosed an unequivocal regression or complete disappearance of nucleus pulposus after anterior interbody fusion. The results were summerized as followings ; 1. Regression of herniated nucleus pulposus was average 2.65mm. 2. The clinical results were excellent in 20% of the patients, good in 60% and fair in 20% 3. The comparision are based on the finding at C-T, marked regression(>4mm), was in 19%, moderate regression(2~4mm) in 59% snd minimal regression(<2mm) in 22%. 4. The clinical results were correlated to amount of regression of herniated nucleus pulposus.

Comparative Study of the Clinically Diagnosed Herniated Nucleus Pulposus with the Computed Tomographic and Myelographic Finding / 대한정형외과학회잡지

79 patients with suspected H.N.P. of lumbar vertebrae were studied from June 1983 to June 1986 who had had both metrizamide myelography and computed tomography. Comparative study of the findings from clinical examination, CT and myelography of them are as follows. l. In physical examination, S.L.R.T. was most common sign, 58 patient(73.4% of study group) showed positive in S.L.R.T.(30~70 range). Of these positive patients in S.L.R.T. 41.4% was the patients who were younger than 30 years of age and also had pressure sign of nerve root on CT and myelography. These group showed highest positive rate in S.L.R.T. 2. In CT and myelographic study, the most frequent occurence of H.N.P. were seen in L4–5, L5–S1, L3–4 in order and myelography showed higher positive rate in L4–5 intervertebral space while CT showed higher positive rate in LS–S1. 3. On CT, facet joint arthritis or stenosis were seen in 49.4% of the study group and 53.7% of computed tomographic positive patients of H.N.P. 4. Corresponding rate of positive sign of H.N.P. between CT and myelographic findings were seen 71 intervertebral spaces, which means 84.5% of 84 positive spaces on CT and 88.8% of 80 positive spaces on myelography. 5. In 49 intervertebral spaces clinical sign, CT and myelographic findings were all positive. In another words 58.3% of 84 positive intervertebral spaces on CT and 61.3% of 80 positive spaces on myelography showed all positive sign on clinical examentation, CT and myelography. 6. L5–Sl intervertebral spaces showed most controversial results in comparative study of CT and myelography. 7. 25 of 26 positive spaces on CT(96.2%) and 23 of 26 positive spaces of myelography(88.5%) were confirmed by operation and all 3 false-negative on myelography were found in L5–Sl intervertebral space. 8. Most diagnostic differences were seen in L5–S1, which has wider epidural space. CT showed higher sensitivity than myelography in this study. For its higher sensitivity and non-invasiveness CT is thought to be first recommendable method for diagnosis of H.N.P. and myelography is recommended as second best choice where diagnostic differences are seen.

Clinical Analysis of Lumbar Myelography with Metrizamide

Metrizamide lumbar myelography were performed in 150 patients with suspected herniated lumbar disc. The examination is easier to perform than with gas or iophendylate. The advantage of metrizamide over gas or iophendylate are the improved root sleeve visualization and examination of small structure such as root, root pocket and blood vessel. And then this is a higher percentage of diagnostic accuracy than can be obtained with other myelogram. Most of adverse reactions during and after myelography are mild and transitory, and no serious adverse reactions occured. It probably has a lower neurotoxicity than any other water soluble contrast agent.