Disc fragment migration occurs in 35%-72% of lumbar disc herniations. Most of the herniated disc fragments migrate in the rostal, caudal and lateral directions. Posterior epidural disc fragment migration is a rare finding and posterior migration causing Cauda Equina syndrome is exceptionally rare. We report here on two cases of L4-5 disc fragment posterior epidural migration that caused Cauda Equina syndrome, and this was diagnosed by performing radiological examination, and we also include a review of the related literature.
Intervertebral Disc Displacement ; Polyradiculopathy

STUDY DESIGN: To study the correlation between the clinical outcomes and neovascularization and bFGF expression in the herniated disc tissues. OBJECTIVES: To study the difference of neovascularization and bFGF expression according to the types of disc herniation, and to study the correlation between the duration of radiculopathy, post-operative results and neovascularization and bFGF expression in the herniated disc tissues. SUMMARY OF LITERATURE REVIEW: Neovascularization has been found in herniated disc tissue. bFGF(basic Fibroblast Growth Factor) in the intervertebral disc has been implicated in the pathogenesis of injury and repair associated with granulation and neovascularization. There is no information on the relationship between clinical outcome and the neovascularization and bFGF expression in the herniated disc tissue. MATERIALS AND METHODS: Among 112 specimens, there are 48 cases in protrusion, 36 in extrusion and 28 in sequestration. Hematoxylin-eosin stain and immunochemical stain with CD 31 and bFGF were used. For the evaluation of post-operative results, Kirkaldy-Willis method was used. The results were analyzed with Chisquare test and t-test. RESULTS: Statistically there is no correlation between the types of disc herniation, duration of radiculopathy and post-operative outcomes and neovascularization and bFGF expression. CONCLUSIONS: The neovascularization and bFGF expression in herniated disc tissue are correlated with the injury of disc tissue. There are no correlation with the clinical outcomes and neovascularization and bFGF expression in herniated disc tissues.
Fibroblasts ; Intervertebral Disc ; Intervertebral Disc Displacement ; Radiculopathy

Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief. Post-procedural pain relief was maintained up to an average of 10 months after nucleoplasty. One patient with preoperative neurological signs improved postoperatively. There were no reported complications in all three patients. In view of the reduced morbidity and shorter operating time, thoracic intervertebral disc nucleoplasty can be considered in patients with pain due to thoracic disc herniation, with no calcification of the herniated disc, and in patients who may be otherwise be unfit for conventional surgery.
Humans ; Intervertebral Disc ; Intervertebral Disc Displacement

The most effective treatment methods for a herniated lumbar disc remain questionable. This report follows the patients course, from the onset of pain through the completion of the non-surgical treatment, and shows that a lumbar herniated disc, with radiculopathy, can be successfully treated with a non-surgical approach. This report discusses the possible explanations for disc resorption: retraction into the intervertebral space, dehydration/shrinkage and resorption due to an inflammatory reaction. A non-surgical approach can be an effective treatment option for a herniated lumbar disc.
Humans ; Intervertebral Disc Displacement ; Radiculopathy

Herniated nucleus pulposus (HNP) is a common disease that induces back pain and radicular pain. Some cases require surgical treatment due to persistent severe pain. However, in some cases, pain can be relieved with conservative treatment or at times relived spontaneously. Therefore, the most effective treatment method for HNP is undefinable. Spontaneous regression of HNP has been recognized with the advancement of radiological diagnostic tools and can explain the reason of spontaneous relief of symptoms without treatment.
Back Pain ; Intervertebral Disc Displacement

The purpose of this study is to introduce the various methods of indirect decompression of minimally invasive procedures available for treatment of lumbar spine surgery. A review of the literature, as well as our personal experience with minimally invasive approaches to the lumbar discs, was performed. The minimally invasive procedures for treatment of lumbar disc disease include the following: 1) chemonucleolysis; 2) automated percutaneous lumbar discectomy (APLD); 3) nucleoplasty; 4) microdecompressor; 5) percutaneous laser discectomy; and 6) hydrodiscectomy. Although all percutaneous techniques are reported to have high success rates, to date no studies have demonstrated any of these being superior to microsurgical discectomy, which continues to be regarded as the standard with which all other techniques must be compared.
Decompression ; Diskectomy ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Spine

Discal cyst is an intraspinal cyst with a distinct communication with the corresponding intervertebral disc. It is a rare condition and could present with radiculopathy similar to that caused by lumbar disc herniation. We present a patient with a large discal cyst in the ventrolateral epidural space of the 5th lumbar vertebral (L5) level that communicated with the adjacent 4th lumbar and 5th lumbar intervertebral disc, causing L5 radiculopathy. We alleviated the radiating pain with selective transforaminal epidural blocks.
Epidural Space ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Radiculopathy* ; Spine

The virtues of the pantopaque myelography in the study of the herniated intervertebral disc have been generally accepted. As expected, it shows the presence of ruptured disc in the accuracy over 80%. But it is open to discussion whether the myelographic defects can indicate the exact location and type of herniated discs or not. In this article, we attempted to find out some correlation between the myelographic defect and the operative finding in viewing the size and shape of myelographic defects. This consideration may be helpful to make a clear cut diagnosis in the lumbar disc disease. One hundred and sixtytwo operative cases undergoing pantopaque myelography were subjected. Some obtained results will be presented.
Diagnosis ; Intervertebral Disc ; Intervertebral Disc Displacement ; Iophendylate ; Myelography ; Virtues

The authors report the experience using the operating microscope in 112 lumbar, 19 cervical and 2 thoracic disc herniations. Partial laminectomies were done in the lumbar disc herniations. Transdiscal anterior foraminal decompression with removal of posterior spur of the uncinate process and interbody fusion were carried out for the cervical disc diseases. Decompressive wide laminectomies were performed in the thoracic disc lesions. We have been extremely satisfied with the results of the operation and especially with the technical advantages afforded by the microscope. The microscope is not only advantageous because of magnification, but particularly because it gives better illumination of the depth of the operating field. The microsurgery is essential for the cervical and thoracic disc herniations. It is helpful for the lumbar disc surgeries in cases of ruptured, or axillary herniated discs, reoperation, severe adhesion of nerve root and in cases of transdural approach.
Decompression ; Intervertebral Disc Displacement ; Intervertebral Disc* ; Laminectomy ; Lighting ; Microsurgery* ; Reoperation

In conventional percutaneous disc surgery, introducing instruments into disc space starts by inserting a guide needle into the triangular working zone. However, landing the guide needle tip on the annular window is a challenging step in endoscopic discectomy. Surgeons tend to repeat the needling procedure to reach an optimal position on the annular target. Obturator guiding technique is a modification of standard endoscopic lumbar discectomy, in which, obturator is used to access triangular working zone instead of a guide needle. Obturator guiding technique provides more vivid feedback and easy manipulation. This technique decreases the steps of inserting instruments and takes safer route from the peritoneum.
Diskectomy ; Endoscopes ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Needles ; Peritoneum