Clinical study of the diagnosis of thoracolumbar disc herniations
- VernacularTitle:胸腰段椎间盘突出症诊断的临床研究
- Author:
Qiang QI
;
Ning LIU
;
Zhongqiang CHEN
- Publication Type:Journal Article
- Keywords:
Thoracolumbar disc;
Disc herniation;
Clinical manifestation;
Diagnosis
- From:Chinese Journal of Minimally Invasive Surgery
2001;0(02):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical features of thoracolumbar disc herniations and to improve the quality of the diagnostic procedure.Methods Clinical data of 65 patients with thoracolumbar disc herniations confirmed by X-ray examinations,CT,MRI,and operations from September 1995 to January 2004 were retrospectively reviewed.The 65 patients were divided into three groups: lower thoracic disc herniations(T_(10-11)~T_(12)L_1) in 43 patients,upper lumbar disc herniations(L_(1-2)~L_(2-3)) in 16 patients,and multiple levels of herniations in 6 patients.Results Paresthesia and lower extremity weakness were the most frequent symptoms,with their occurrence proportions being 89.2%(58/65) and 83.1%(54/65),respectively.Among the 65 patients,9.2%(6/65) showed the presentation of upper motoneuron involvement,47.7%(31/65) manifested symptoms of lower motoneuron impairment,and 43.1%(28/65) presented as mixed motoneuron disorders.Neurological deficits were usually extensive and the cauda equino syndrome was commonly seen,while isolated radicular impairment was noticed only in 3 patients.Back pain(44.6%,29/65) and lower extremity weakness(40.0%,26/65) were the most common initial complaints.Lower thoracic disc herniations were characterized by mixed motoneuron disorders at the occurrence proportion of 58.1%(25/43),with a tendency leading to ambulatory dysfunction,drop foot,increased lower extremity muscle tension,and positive pathologic reflexes.By contrast,most upper lumbar disc herniations were manifested as lower motoneuron disorders at the occurrence proportion of 93.8%(15/16),with back pain,lower extremity pain,and the cauda equino syndrome frequently encountered.Conclusions The clinical presentation of thoracolumbar disc herniations is complicated with the large-scale distribution and diversity of the symptoms and the complexity of clinical signs.We put forward four circumstances under which a high suspicion of thoracolumbar disc herniation was recommended: ①if there is a sensory disturbance at the anterior and lateral aspect of the thigh or at the groin area;②if there is a lower extremity weakness,especially in the quadriceps and the tibialis anterior muscle(drop foot);③if an extensive and irregular range of sensory and motion disturbances exists,with a lack of typical radicular distribution;or ④if there are mixed motoneuron disorders,or lower motoneuron disorders unexplained by lumbar disc herniations.
