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

Among 157 cases operated upon, under the diagnosis of herniated intervertebral disc, we experienced 34 cases of discrepancies between myelographic and operative findings. We analysed these cases in the respect of patterns, causes and clinical significance of these discrepancies and the results were as follow; 1. Thirty four cases (21.7%) among 157 cases operated upon showed discrepancies between myelographic and operative findings. 2. These 34 cases consisted of 17 cases of level discrepancies, 9 cases of false positive and 8 cases of false negative. 3. The main cases of level discrepancies was indentation due to bony spur with/without adhesion. 4. The main cause of false positive was degenerative changes of the spine. In the detection of this false positive, plain X-ray of lumbosacral spine give important clue. In false positive, explorative paitial laminectomy and removal of bony spur or adhesiolysis was indicated because the effect of the spur or adhesion was same as that of herniated disc. 5. The causes of false negative were giant canal, congenitally narrow cul de sac, high cul de sac and far laterally seated disc herniation. In false negative, plain X-ray of lumbosacral spine afforded little diagnostic aid. In case of being compatible to disc herniation at a certain level through clinical signs, normal myelographic finding has less meanings and exploration is to be performed according to the clinical signs.
Diagnosis ; Intervertebral Disc ; Intervertebral Disc Displacement ; Laminectomy ; Spine

PURPOSE: To evaluate surface configuration of herniated disc on three-dimensional CT. MATERIALS AND METHODS: Three dimensional surface images reconstructed from CT scans(1mm thick) of 24 surgically confirmed herniated discs in 23 patients were revieved. Disc surface was classified into peripheral and central zones in contact with consecutive peripheral ring and central endplate. Surface irregularity was categorized into two types(local andgeneral). The incidence, size, and extent of local irregularity were observed. General irregularity incidence and severity ranges in 4 grades, and peripheral width were evaluated. The findings were correlated with discography. RESULTS: Local irregularity compatible with anulus tear in discography was shown in all. It was large(13/24) andmainly peripheral tract extending to disc margin in protrusion(3/5) and sequestration(5/7), and cleft encompassing central zone to disc margin in extrusion(9/12). General irregularity was predominantly grade 3(15/22) and was shown in all except in 2 puotrusions. peripheral width was 0.56 of central radius. CONCLUSION: Extrusion inherniated disc shows characteristic cleft encompassing central zone to disc margin whereas sequestration or protrusion displays tract extending from peripheral zone to disc margin. Thus, three dimensional surface imagingmay aid the diagnosis, follow-up, prediction, and treatment of herniated disc.
Diagnosis ; Humans ; Incidence ; Intervertebral Disc Displacement* ; Radius

Pain is all lumbocrural pain cases very common clinical symptoms,but the etiology, pathology, site (range or area), intensity, nature, evolution situation and influence factors of pain usually has some certain characteristics and rules, these differences particularly are regarded as the primary and important basis or clue for the clinical diagnosis and differential diagnosis of related diseases. In addition, according to these differences can determine the individual diagnosis of lumbar intervertebral disc herniation as well, including typical and atypical, simple and compound, the general and special cases, these be- come the basis to determine the individualized therapeutic schedule of this disese.
Back Pain ; diagnosis ; Humans ; Intervertebral Disc Displacement ; diagnosis

Pain is common clinical symptoms of lumbocrural, but the etiology, pathology, sites (range or area), intensity, nature, evolution situation and influence factors of pain has some certain characteristics and rules. These differences particularly were regarded as the primary and important basis or clues for the clinical diagnosis and differential diagnosis of related diseases. A series of exclusive diagnosis for similar symptoms is premise of diagnosis of lumbar intervertebral disc protrusion. Ideas and methods of differential diagnosis of lumbar intervertebral disc herniation can help the diagnosis and identification.
Diagnosis, Differential ; Humans ; Intervertebral Disc Displacement ; diagnosis ; Lumbar Vertebrae

Intradural ruptured discs are very rare occurrences and the incidence is reported to be 0.13% among total herniated discs, 90% of intradural ruptured discs are known to occur in the lumbar area. The symtoms and signs of the intradural disc are much more severe than those of the usual extradural herniated disc. MR imagings of the intradural disc demonstrate several typical findings, but intradural tumors must be ruled out. The authors present a case of intradural ruptured lumbar disc L4-L5 level in a 46-year-old female. Characteristic MR and operative findings of this case are reported. Pathogenetic mechanisms and differential diagnoses with certain intradural tumors and the extradural ruptured disc with similar MR findings are discussed.
Diagnosis, Differential ; Female ; Humans ; Incidence ; Intervertebral Disc Displacement ; Middle Aged

Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH.
Diagnosis ; Humans ; Intervertebral Disc Displacement ; Leg ; Middle Aged

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 application of microsurgical techniques in the operation for lumbar disc herniation clearly reduces the overall surgical trauma suffered by the patient. A very small exposure of only about 2-3cm skin incision is necessary. No laminectomy is done. Flavotomy and an approach through interlaminar space is usually sufficient to remove the herniated disc by the microsurgical technique. Diagnosis is primarily made by spinal computed tomography(CT) scan. Between April and September 1982, 23 microlumbar discectomies were performed. Excellent recovery was 87% and good 13%. We have described our microsurgical technique and discussed its advantages.
Diagnosis ; Diskectomy ; Humans ; Intervertebral Disc Displacement ; Laminectomy ; Skin

Segmentary mobility of the mobile lumbar spines upon a total of 90 cases was studied by means of the functional radiographic examination. Segmentary mobility was determined by Falconer method. The cases were divided into four groups as Group I, 20 cases, who had no symptoms on low back, Group II, 20 cases, who had herniated disc in L4-5 confirmed either by surgery or by myelography, Group III, 30 cases, who had low back pain and neurological signs of L5 root irritation, and Group IV, 20 cases, who had low back pain as well as neurological signs of S1 root irritation. The result of the analysis was concluded as follows: 1. Total mobility of the lumbar spine in group I was significantly higher than other groups. Large normal variation in segmentary mobility of the lumbar spine was found, however, the mean angle of the segmentary mobility was highest in L4-5 and higher in the order of L5-S1, L4-3, L3-2 and L2-1. 2. Total mobility of the lumbar spine in group II was markedly reduced compared with group I, however, proportion of the segmentary mobility of L4-5 versus total mobility of the lumbar spine was somewhat higher than that of group 3. Total mobility of the lumbar spine in group III was significantly reduced than group I and significantly higher than group II. Proportion of the segmentary mobility of L4-5 versus total mobility of the lumbar spine in group III was somewhat higher than group I and the same as group II. 4. Total mobility of the lumbar spine in group IV was reduced than group I and group III, and higher than group II. Proportion of the segmentary mobility of L5-S1 was significantly higher than any other group. 5. In the groups with low back pain and herniated disc, in other words, there was found relatively increased segmentary mobility in the affected lumbar segments in contrast to reduced mobility of the total lumbar segments.
Diagnosis ; Intervertebral Disc Displacement ; Low Back Pain ; Methods ; Myelography ; Spine