Percutaneous Discectomy of Herniated Intervertebral Disc with a Dekompressor(R) / 대한통증학회지

BACKGROUND: Radicular pain, associated with herniated intervertebral disc, has been treated with either conservative treatments or a traditional surgical discectomy. Several modalities for minimally invasive percutaneous procedures have been developed as alternatives to a surgical discectomy. Percutaneous decompression using a Dekompressor(R) probe has been recently introduced. Herein, we report the outcome of percutaneous decompression with a Dekompressor(R) for the treatment of a herniated intervertebral disc. METHODS: Between August 2004 and April 2005, percutaneous decompression was performed using a Dekompressor(R), 1.5-mm percutaneous lumbar discectomy probe in 17 patients with a herniated lumbar intervertebral disc resistant to conservative treatments, with the results reviewed retrospectively. The procedure was performed under fluoroscopic guidance after local anesthesia. Disc access was gained with a posterolateral approach on the symptomatic side and intradiscal placement of the discectomy probe in the herniated disc confirmed from the anteroposterior and lateral views on the fluoroscopy. RESULTS: We obtained satisfactory clinical results in 14 patients with a decrease in the initial Visual analogue scale (VAS) of more than 55% and the elimination or reduction of analgesic medication, with a follow-up of 3 to 11 months. CONCLUSION: We concluded that a percutaneous discectomy with a Dekompressor(R) probe might be an effective alternative for the treatments of painful disc herniations resistant to conservative managements when performed under proper selection criteria.

Long Term Results of the Selective Spinal Nerve Root Block for the Herniated Lumbar Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To access the 5-year outcomes of patients with sciatica, not caused by spinal stenosis, spondylolysis, spondylolisthesis or congenital deformity, but by a lumbar herniated intervertebral disc (HIVD), treated by a selective nerve root block (SNRB). A review of the alternative treatments, during the follow up period, is also presented. SUMMARY OF LITERATURE REVIEW: Controversy exists about the therapeutic effects, particularly the long-term effects of a SNRB, in sciatica caused by a lumbar HIVD. MATERIALS AND METHODS: SNRB was performed on a total of 288 patients, diagnosed with a lumbar HIVD, through the clinical manifestations and physical and radiological findings, including MRI, between Jan. 1992 and Dec. 1997. Of the 288 patients, the 79 that underwent SNRB treatment only, and were minimally followed up for five years, were reviewed. The type of HIVD was based on the MRI findings, and the results of the SNRB were analyzed, with regard to the presence or absence of a relapse, the other treatments for recurrent or remnant symptoms following the SNRB, return to previous daily living and working activities and the degree of subjective symptomatic improvement, as assessed by a chart review, or an out patient department follow up or a telephone interview. RESULTS: With regard to the HIVD, there were 17 cases of bulging type (21.5%), 37 of protrusion (46.8%), 21 of extrusion (26.6%) and 4 of sequestration (5.1%) types. Medication and physical therapy was required in 13 cases (16.5%) and 35 cases (44.3%) used herbal medication and acupuncture. Thirteen of the 79 cases relapsed, and 10 were treated by microscopic discectomy. SNRBs were reperformed in 3 cases. Twenty-three cases (29.1%) required no treatment. Fifty-six cases (84.8%) returned to their previous daily living and working activities. SUMMARY: As this study did not accurately evaluate the change in the natural history of a HIVD following a SNRB, a further prospective study is still required. However, a SNRB is still a valuable non-operative treatment method for the acute radicular pain associated with a HIVD.

The Effect of Vertebral Endplate Area and Shape in the Patients with Lumbar Herniated Intervertebral Disc

OBJECTIVE: To determine whether the area and the shape of the vertebral body endplate in the magnetic resonance image (MRI) findings were risk factors for the development of symptomatic herniated lumbar intervertebral disc. METHOD: Sixty patients of low back pain with the age below 60 were enrolled. They didn't have spondylolisthesis or the history of spine surgery. MRI films of these patients were reviewed. Anteroposterior and transverse diameter of endplates, height of vertebral body and intervertebral discs were measured. The relation of these data and intervertebral disc herniation, body weight, height, body mass index (BMI) were statistically studied. RESULTS: Patients' weight, BMI, the vertebral body area and the shape of the endplate were related to disc herniations. Furthermore, the larger and circular vertebral body was observed in the patients with disc herniation. In the patients with lower back pain, men were diagnosed disc herniations of the MRI finding more than women. CONCLUSION: In anatomical aspect, the area and the shape of the vertebral body at the endplate level were important factors contributing to the development of disc herniations at L4-L5 and L5-S1.

A Clinical Study of Herniated Lumbar Intervertebral Disc in Teenagers / 대한정형외과학회잡지

Sixteen cases under the age of 19 were underwent surgical treatment for hernlated lumbar intervertebral disc over 10 years of period in the Department of Orthopaedic Surgery,Catholic Medical College. The results were obtained as follows: 1. The incidence was 5.2% of all herniated lumbar intervertebral disc patients who treated surgically, but no sexual predilection. 2. Nine cases (56.3%) had a definite previous history of injuries. 3. Average intervals between the onset of clinical symptoms and the operation were 9.2 months. 4. Neurologic deficits are less severe and frequent (8 cases, 50%) but the clinical symptoms do not differ from than that of the adult. 5. 7 cases (43.8%) revealed definite reptured lumbar intervertebral discs and 5 cases (31.3%) are diffuse buldging of annular fibers in operative findings. 6. According to histopathological study, 8 cases show degenerative fibrocartilagenous changes in surgical specimen. 7. The radiological abnormalities of lumbar spine are less common than that of the adult. 8. Excellent or good results were found in 12 cases (75%) but two cases required a further surgical procedure. 9. In generally, hernlated Iumbar intervertebral disc in teenagers show better results and more rapid recovery of clinical symptoms by surgical treatment, and less residual symptoms than that of the adult.