It has previously been reported that the incidence rate of intervertebral disc disease including cervical and lumbar vertebra is at the 8th position among the chronic and difficult treated diseases in China. There are great challenges on the improving diagnosis and treatment as well as reducing recrudescence of this degenerative disease. It was well known that the degeneration and bulge or herniatation of intervertebral discs are the main reasons for it, and the treatment for it always focuses on the disc recovery. However, the discrepancy of the effect and expectation indicated that there were other reasons for it. Based on the clinical knowledge of intervertebral discs disease and combined with the cognition of Traditional Chinese Medicine,we proposed that the pathogenesis of intervertebral disc disease was Gucuofeng and Jinchucao, which meant that the improper location of diapophysis and the declined of muscle strength may cause the unstable of spine, unstable spine thus aggravated the semiluxation of diapophysis.
Humans ; Intervertebral Disc Displacement ; diagnosis ; etiology ; therapy ; Medicine, Chinese Traditional

The mistakes in clinical diagnosis and treatment due to dealing with symptoms, signs and imaging data in isolation, and unclear differentiation of relative diseases are found by reviewing definition and cause of disease and pathogenesis of prolapse of lumbar intervertebral disc, so as to probe into mistakes and countermeasures in diagnosis and treatment of prolapse of lumbar intervertebral disc. Only combined analysis of clinical symptoms, signs and imaging data, can correct diagnosis and treatment be made.
Diagnostic Errors ; Humans ; Intervertebral Disc Displacement ; diagnosis ; etiology ; therapy ; Lumbar Vertebrae

Combined Modality Therapy ; Humans ; Intervertebral Disc Displacement ; diagnosis ; surgery ; Lumbar Vertebrae ; Medicine, Chinese Traditional

OBJECTIVETo apply needle-knife to treat lumber disc herniation (LDH) and surface electromyography were used to analyze biomechanical characteristic of patient's lumber muscle to make a comprehensive evaluation on its efficacy.

METHODSThirty patients who met the inclusive criteria were selected and treated with needle-knife, once a week for 2 weeks. Visual analogue scale (VAS), ASLR and JOA score before and after treatment were observed. Surface electromyography was applied to test the surface electromyography signals. AEMG, MFs and MPF were calculated before and after the treatment.

RESULTSAfter treatment, VAS was significantly reduced, ASLR, JOA, AEMG and MPF were obviously increased, and the absolute value of MFs was lowed (all P < 0.01).

CONCLUSIONThe needle-knife could significantly relieve lumbar muscle strength, muscle tone and muscle fatigue, improve in the imbalance of lumbar extensor muscle group, leading to the recovery of biomechanical characteristic, and the clinical efficacy is superior.

Acupuncture Therapy ; Adult ; Electromyography ; Female ; Humans ; Intervertebral Disc Displacement ; diagnosis ; physiopathology ; therapy ; Lumbar Vertebrae ; physiopathology ; Male ; Middle Aged

OBJECTIVETo explore the etiopathogenisis, diagnosis and early treatment of postoperative pyogenic infection in patients with lumbar disc diseases.

METHODSFrom March 2009 to March 2012,7 patients with postoperative pyogenic infection were retrospectivly analyzed. There were 6 males and 1 female,ranging in age from 42 to 62 years old,with an average of 46.5 years old. Among 7 cases,outside the spinal canal suppurative infection occurred in 6 cases and inside the spinal canal infection in 1 case and with temporary paralysis. All the patients were treated with continuous saline lavage-drainage of low pressure impulse during operation. Unitive sensitive antibiotics were applied for 4-6 weeks after operation until CRP and ESR completely normal or the biochemistry and routine examination of the cerebrospinal fluid completely normal for the patients with intracranial pyogenic infection.

RESULTSAll the 7 cases obtained recovery and the length of stay was for 2-3 months. No remnant symptoms of nervous system were found at the leave hospital.

CONCLUSIONPostoperative pyogenic infection in patients with lumbar disc diseases is an emergency,and easily results in misdiagnosis in clinic. So the early diagnosis is very important. Early debridement is the only measure to retrieve the life of patient,continuous saline lavage-drainage of low pressure impulse may remove the remnant focus of the deep soft tissue space,and removel of the internal fixation can ensure the postoperative pyogenic infection completely control.

Adult ; Bacterial Infections ; diagnosis ; therapy ; Debridement ; Early Intervention (Education) ; Female ; Humans ; Intervertebral Disc Degeneration ; surgery ; Intervertebral Disc Displacement ; surgery ; Length of Stay ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Postoperative Complications ; diagnosis ; therapy ; Retrospective Studies

Lumbar disk herniation (LDH) is a common orthopaedic disorder. Many clinical and basic science researches have been conducted recently on using Chinese medicinal herbs to treat LDH. Literature review reveals that the common basic formulas include Duhuo Jisheng decoction (DHJST), Buyang Huanwu decoction (HYBWT), Shentong Zhuyu decoction (STZYT), Taohong Siwu decoction (THSWT), Yanghe decoction (YHT) and Tongdu Huoxue decoction (TDHXT). A basic formula can be modified by adding more herbs or removing some herbs from the formula according to clinical symptoms and traditional Chinese medicine (TCM) syndrome differentiation. Literatures show that herbal treatment have better clinical effects, the medicinal herbs make low-back pain, sciatica and low limb numbness disappeared or alleviated; and restore normal low limb sensation, muscle strength and daily activity. These formulas have also been used to treat LDH postoperative remaining pain, postoperative discitis, postoperative recurrent LDH, and to prevent epidural scar formation and dura mata adhesion. Herbs in these formulas include 5 categories of drugs classified by TCM. They are blood circulation promoting herbs for relieving pain; liver and kidney nourishing and tendons and bones strengthening herbs; blood circulation promoting herbs for unblocking collaterals; pathogenic wind and dampness expelling herbs; and qi invigorating herbs. These herbs have actions of analgesia, anti-inflammation, immunomodulation, phagocytosis of macrophages enhancement, blood circulation improvement, nerve protection, collagen synthesis enhancement. Future research needs to focus on the effects of herbs on four aspects: to enhance collagen synthesis in the disks and inhibit disk degeneration; to promote the resorption of herniated nucleus pulposus and epidural hemorrhage; to prevent nerve cell apoptosis and promote nerve cell regeneration, and to inhibit nociception in the nerve system.
Diagnosis, Differential ; Drug Combinations ; Drugs, Chinese Herbal ; isolation & purification ; therapeutic use ; Humans ; Intervertebral Disc Displacement ; drug therapy ; Lumbar Vertebrae ; Medicine, Chinese Traditional ; Phytotherapy ; Plants, Medicinal ; chemistry

OBJECTIVETo study the correlation between the MRI and some symptom scores of the patients with lumbar disc herniation (LDH), such as VAS (visual analogue scale), JOA (Japanese orthopedic association scale),and SLR (straight leg raising test) before and after manipulative therapy.

METHODSFrom June to December in 2007, 70 patients with LDH were selected in the study. Among the patients, 40 patients were male and 30 patients were female, ranging in age from 21 to 56 years (averaged 39 years). MRI was used to measure the size and position of the protruded nucleus pulposus (size of disc protrution, the angle between nerve root canal and disc protrution). Correlation study was conducted between the MRI and VAS, JOA, and SLR before and after therapy. The correlation between the changes of MRI and that of the quantified clinical indexes of LDH patients was also analyzed.

RESULTSThere were significant differences before and after therapy in some quantified indexes for the clinical manifestation of the patients, such as VAS, JOA,and SLR. There were no significant changes in the shape and size of protrude nucleus pulposus after 20 days' therapy by CT or MR recheck. Correlation study between the quantified indexes of clinical manifestation (JOA) and MRI before and after the treatment showed that there was no significant correlation.

CONCLUSIONThe study proves again that the shape and size of protrude nucleus pulposus has no paralleled relation with the patient's clinical manifestation,which is demonstrated by the recheck of MRI after a successful spinal manipulative treatment in the study.

Adult ; Female ; Humans ; Intervertebral Disc Displacement ; diagnosis ; pathology ; therapy ; Lumbar Vertebrae ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Musculoskeletal Manipulations ; Treatment Outcome ; Young Adult

Transforaminal Epidural steroid injections (TFESI) have been widely adopted to alleviate and control radicular pain in accord with current guidelines. However, sometimes repeated steroid injections have adverse effects, and thus, this prospective randomized trial was undertaken to compare the effectivenesses of pulsed radiofrequency (PRF) administered to a targeted dorsal root ganglion (DRG) and TFESI for the treatment of radicular pain due to disc herniation. Subjects were recruited when first proved unsuccessful (defined as a score of > 4 on a visual analogue scale (VAS; 0-10 mm) and of > 30% according to the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI)). Forty-four patients that met the inclusion criteria were enrolled. The 38 subjects were randomly assigned to receive either PRF (PRF group; n = 19) or additional TFESI (TFESI group; n = 19) and were then followed for 2, 4, 8, and 12 weeks. To evaluate pain intensity were assessed by VAS. ODI and NDI were applied to evaluate functional disability. Mean VAS scores for cervical and lumbar radicular pain were significantly lower 12 weeks after treatment in both study groups. NDI and ODI scores also declined after treatment. However, no statistically significant difference was observed between the PRF and TFESI groups in terms of VAS, ODI, or NDI scores at any time during follow-up. PRF administered to a DRG might be as effective as TFESI in terms of attenuating radicular pain caused by disc herniation, and its use would avoid the adverse effects of steroid.
Adult ; Aged ; Female ; Ganglia, Spinal/radiation effects ; Humans ; Injections, Epidural ; Intervertebral Disc Displacement/*diagnosis ; Male ; Middle Aged ; Pain/*drug therapy/*radiotherapy ; Pain Measurement ; Prospective Studies ; *Pulsed Radiofrequency Treatment ; Steroids/*therapeutic use ; Treatment Outcome

Transforaminal Epidural steroid injections (TFESI) have been widely adopted to alleviate and control radicular pain in accord with current guidelines. However, sometimes repeated steroid injections have adverse effects, and thus, this prospective randomized trial was undertaken to compare the effectivenesses of pulsed radiofrequency (PRF) administered to a targeted dorsal root ganglion (DRG) and TFESI for the treatment of radicular pain due to disc herniation. Subjects were recruited when first proved unsuccessful (defined as a score of > 4 on a visual analogue scale (VAS; 0-10 mm) and of > 30% according to the Oswestry Disability Index (ODI) or the Neck Disability Index (NDI)). Forty-four patients that met the inclusion criteria were enrolled. The 38 subjects were randomly assigned to receive either PRF (PRF group; n = 19) or additional TFESI (TFESI group; n = 19) and were then followed for 2, 4, 8, and 12 weeks. To evaluate pain intensity were assessed by VAS. ODI and NDI were applied to evaluate functional disability. Mean VAS scores for cervical and lumbar radicular pain were significantly lower 12 weeks after treatment in both study groups. NDI and ODI scores also declined after treatment. However, no statistically significant difference was observed between the PRF and TFESI groups in terms of VAS, ODI, or NDI scores at any time during follow-up. PRF administered to a DRG might be as effective as TFESI in terms of attenuating radicular pain caused by disc herniation, and its use would avoid the adverse effects of steroid.
Adult ; Aged ; Female ; Ganglia, Spinal/radiation effects ; Humans ; Injections, Epidural ; Intervertebral Disc Displacement/*diagnosis ; Male ; Middle Aged ; Pain/*drug therapy/*radiotherapy ; Pain Measurement ; Prospective Studies ; *Pulsed Radiofrequency Treatment ; Steroids/*therapeutic use ; Treatment Outcome

OBJECTIVE: To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O2-O3) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. MATERIALS AND METHODS: A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O2-O3 mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) x 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O2-O3 therapy was determined. RESULTS: Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. CONCLUSION: This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O2-O3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.
Adult ; Aged ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Intervertebral Disc Displacement/*diagnosis/*therapy ; Lumbar Vertebrae/*pathology ; Male ; Middle Aged ; Oxygen/therapeutic use ; Ozone/therapeutic use ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Treatment Outcome ; Young Adult