The effect of non-surgical spinal decompression on the paraspinal muscles of persons with lumbar disc herniation / 中华物理医学与康复杂志

Objective To explore the effect of non-surgical spinal decompression (SDS) on the surface electromyogram signals from the paraspinal muscles of patients with lumbar disc herniation (LDH).Methods Twelve patients diagnosed with L4.5 LDH were recruited and randomly dividcd into an SDS group and a control group,each of 6 according to their order of admission.The SDS group received spinal decompression,while the control group was given lumbar traction.The average surface electromyogram signals (AEMGs) were recorded before,during and after the treatment.Results Before the treatment,the AEMG values collected from the left and right erector spinae and multifidus of the SDS group were already significantly different from those of the control group.During the treatment,the AEMG values collected from the right erector spinae and multifidus of the SDS group remained significantly different from those of the control group.After the treatment,the AEMG values were still significantly different.Conclusions SDS relieves tension and fatigue of the paraspinal muscles better than lumbar traction.

Comprehensive rehabilitation is superior to surgical intervention for many patients with recurrent lumbar disc herniation / 中华物理医学与康复杂志

Objective To compare the effectiveness of comprehensive rehabilitation therapy with that of surgical intervention for patients with recurrent lumbar disc herniation (LDH).Methods A total of 124 LDH patients were recruited antd randomly divided into an experimental group and a control group,each of 62.The experimental group was given comprehensive rehabilitation consisting of medicine,physical therapy,and spinal stabilization exercises,while the control group received lumbar spine surgery.The patients' back and leg pain scores and their Oswestry Disability Index (ODI) scores were compared at admission and discharge,as well as 3 and 12 months after discharge.Anxiety and depression were also assessed at admission and 3 months after discharge.Results At discharge and 3 and 12 months later the average back and leg pain scores and ODI ratings were significantly lower than that at admisshin for both groups.There were no significant inter-group differences.In terms of anxiety and depression,however,these had decreased signifieantly in both groups,but the experimental group's average rating was significantly better at diseharge.Conclusions Comprehensive rehabilitation is superior to surgical intervention in relieving the depression of patients with recurrent LDH.Comprehensive rehabilitation should be considered as the first ehoiee for patients with rccurrent LDH,and only supplemented by surgical intervention if it is not effective.

The value of electromyography in localizing lumbosacral radiculopathy / 中华物理医学与康复杂志

Objective To evaluate the accuracy of electromyography (EMG) in localizing the compressed nerve root in lumbar intervertebral disc protrusion (LIDP) pre-operatively.Methods Data were collected on 198 cases of LIDP.Of those,152 cases had positive EMG findings and were treated surgically to relieve compression of the nerve roots caused by LIDP.The intra-operative findings were compared with the pre-operative EMG findings.Results The sensitivity of EMG in detecting radiculopathy was 76.8％ (152/198).Among those 152 EMG positive cases,140 were confirmed in the subsequent operation (92.1％),24 clinically suspected cases of single L5 or S1 compression had indicated of both L5 and S1 damage by EMG and subsequently confirmed on surgical exploration.Conclusions Almost all preoperative EMG findings were confirmed in the subsequent operations (92.1％).Moreover,the indication of combined double nerve root damage by EMG was valuable for guiding the surgical procedure.

Lumbar multifidus morphology assessed by ultrasonography in chronic lumbar disc herniation / 中华物理医学与康复杂志

Objective To observe any differences in the morphology of the lumbar multifidus (LM) muscles between normal subjects and persons with chronic lumbar disc herniation (CLDH).Methods Thirty-two persons with CLDH and thirty-five matched,healthy controls performed various maneuvers in prone lying.Ultrasound imaging was used to measure the antero-posterior diameter (A-P),lateral diameter (Lat),cross sectional area (CSA) and flattening ratio (FR) of the bilateral LM muscles at the L4/5 level.Results In the control subjects,A-P,Lat,CSA and FR were not significantly different between the left and right sides.In those with CLDH,A-P,Lat and CSA were significantly smaller on the painful side than on the no-pain side,and this difference showed asymmetry between the two sides.Average A-P,Lat,FR and muscle CSA were all significantly smaller among the CLDH subjects on both sides compared with the controls.Conclusion CLDH induces asymmetric local atrophy of the bilateral multifidus muscles which can be detected and measured using ultrasound.

A Clinical Study of Chemonucleolysis for Herniated Lumbar Discs

The authors analysed 522 patients treated with chymopapain for herniated lumbar discs from May 1984 to December 1985 at the Dept. Neurosurgery, Yongdong Severance Hospital, Yonsei University College of Medicine. The data were obtained from a questionnaire and clinical records. The favorable indications for chemonucleolysis were under the following conditions ; 1) The patient's major complaint was leg pain than low back pain. 2) Marked limitation on straight leg raising test. 3) Spine CT scans showing soft bulging diec herniation without calcification or degenerative changes. The results were more favorable in the younger groups and the more limited straight leg raising group. The favorable results were obtained in 89.8%. In conclusion, our findings suggest that before surgical intervention, chemonucleolysis is a safe and effective nonsurgical method for treatment of herniated lumbar discs.

Therapeutic Results of Chemonucleolysis in Patients with Herniated Lumbar Discs

We had experienced 60 cases of chemonucleolysis with Discase(R)(chymopapain for injection) under careful patient selection of herniated lumbar discs and had followed up thereafter at least 3 months since July, 1984. Therapeutic results were generally favorable, with 90% of patients achieving either excellent or good(satisfactory) results. Three patients only had poor or failure results. There was no major anaphylatic reaction and no serious neurologic complications. Back spasm and stiffness/soreness were the most frequently encountered complications.