PURPOSE: To evaluate MRI findings of lateral lumbar disc herniations (LLDHs) and to determine whether those correlate with clinical symptoms. MATERIALS AND METHODS: The study included 105 patients with LLDHs that were diagnosed by MRI. The distribution and location of the LLDHs (foraminal, extraforaminal, and foraminal and extraforaminal), the displacement of adjacent nerves, and the detection rate of LLDHs from axial and sagittal images were reviewed retrospectively by two radiologists. 36 patients were included in evaluating whether location of LLDHs and displacement of adjacent nerve correlate with radiculopathy. RESULTS: The distributions of the LLDHs were 3.4% at L1-2, 14.4% at L2-3, 33% at L3-4, 33% at L4-5, and 16.9% at L5-S1. The locations were foraminal in 38.6% of cases, extraforaminal in 45.4% of cases, and foraminal and extraforaminal in 16% of cases. In addition, 77.3% of the diagnosed LLDH cases displaced the adjacent nerve. The detection rates of LLDHs in the axial and sagittal images were 100% and 77.3%, respectively. In 36 patients, 47.4% had radiculopathy related to LLDHs. Location of LLDHs and displacement of adjacent nerve had no statistically significant difference between patients with or without radiculopathy. CONCLUSION: MRI is an effective method for evaluating the location of LLDHs and their influence on adjacent nerves. The axial image is more important than the sagittal image in diagnosing LLDHs. The location of LLDHs and the displacement of adjacent nerve were not found to be related to radiculopathy.
Displacement (Psychology) ; Humans ; Intervertebral Disc ; Lumbar Vertebrae ; Radiculopathy ; Retrospective Studies

OBJECTIVES: This study is designed to evaluate the fusion rate of anterior cervical discectomy and fusion (ACDF) using prefilled cage, and clinical features in patients with traumatic cervical injury. METHODS: Sixteen trauma patients at a single institute who underwent ACDF with prefilled cage and rigid plate fixation were evaluated for radiographic fusion status postoperatively every 1 month, 3 month, and 6 month after the surgery. ACDFs were done in 9 patients at one level, 3 patients at two levels, 3 patients at three levels, and 1 patient at four levels. Fourteen patients had fracture and instability, and 2 patients had traumatic herniated cervical discs without fracture and instability. Plain radiographs and CT scan were done for evaluation of bone fusion in all patients. RESULTS: Bone fusion was recognized in all patients. Intervertebral disc height was well maintained during follow-up period. There was no patient with graft failure and instability. Even though the patients with fracture and instability, there was no patient who needed posterior stabilization. There was one case of subsidence without clinical symptom which was needed additional surgical treatment. CONCLUSION: In the treatment of the patients with traumatic cervical diseases, prefilled cage is very effective to achieve cervical spinal stability after ACDF, and to maintain intervertebral disc height. We can achieve immediate postoperative stability and prevent graft displacement by reinforcement with cervical plate and screws.
Diskectomy ; Displacement (Psychology) ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Reinforcement (Psychology) ; Transplants

Vacuum disc phenomenon is a collection of gas in the intervertebral disc space but rarely causes nerve compression. However, some rare type of vacuum phenomenon in the spinal canal may bring about posterior gas displacement within the epidural space. The authors describe two patients with symptomatic epidural gas-containing cyst that seem to be originating from vacuum phenomenon in the intervertebral disc, causing lumbosacral radiculopathy. Radiographic studies demonstrated intervertebral vacuum phenomenon and accumulation of gas in the lumbar epidural space compressing the dural sac and the nerve root. The nerve root in both patients was compressed by gas containing cyst that was surrounded by thin walled capsule separable from the gaseous degenerated disc space. The speculative mechanism of the nerve root compression is discussed. The possibility of gas containing cyst should be considered in case of the nerve root compression in which epidural gas is present.
Displacement (Psychology) ; Epidural Space ; Humans ; Intervertebral Disc ; Radiculopathy ; Spinal Canal ; Vacuum

Schmorl nodes represent displacement of intervertebral disc tissue into the vertebral body and have been considered as an asymptomatic incidental radiological finding on plain radiographs, computed tomography and magnetic resonance imaging (MRI). Although uncommon, acute symptomatic Schmorl nodes causing severe back pain do occur. We report here an unusual case of acute painful Schmorl node in a young healthy woman, with no previous trauma, presenting with a sudden significant localized back pain within hours accompanied by characteristic findings on a MRI scan. We reviewed all reports of symptomatic Schmorl nodes known in the literature, focusing mainly on MRI findings, and recent treatment options.
Acute Pain ; Back Pain ; Displacement (Psychology) ; Female ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging

STUDY DESIGN: A retrospective radiologic analysis of 34 patients OBJECTIVES: To evaluate the factors influencing the radiographic degenerative changes in the adjacent segments in one-level ACDF SUMMARY OF LITERATURE REVIEW: There is a 25% incidence of adjacent segment degeneration after 5 years. MATERIALS AND METHOD: From 2002 to 2005, 34 patients (male 23, female 11) underwent anterior cervical spine fusion using a cage or bone block for degenerative cervical spine. The mean age of the patients was 51 years and the mean follow-up period was 24 months. The degenerative findings of the upper and lower adjacent segment were measured from the pre-operative MRI. The fused segment curvature, disc heights of the adjacent segments, displacement of the vertebral bodies and angular mobility in the adjacent segments were measured from the pre-operative and final follow-up lateral views in the neutral position, in both flexion and extension. RESULTS: Degenerative changes in the adjacent segments were observed in 19 of the 34 patients. The group with degenerative changes showed significantly more lordotic angular loss of the fusion segments (11.9+/-3.1degrees) at the follow-up observation than the group with no degenerative changes (9.0+/-1.1degrees) (p=0.04). The group with degenerative change showed a significantly larger increase in disc height of the fusion segments (2.8+/-0.2 mm) at the follow-up observation than the group with no degenerative changes (2.2+/-0.3 mm) (p=0.02).The group with a Grade IV or higher level of pre-operative disc degeneration showed more degenerative changes in the adjacent segments than those with Grade III or lower. CONCLUSIONS: It is important to preserve the lordotic angle of fused segments and avoid excessive increases in disc height. The recurrence of the neurological is not associated with the preoperative adjacent segmental degenerative changes in ACDF.
Diskectomy ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc Degeneration ; Recurrence ; Retrospective Studies ; Spine

Tubular retractor system as a minimally invasive surgery (MIS) technique has many advantages over other conventional MIS techniques. It offers direct visualization of the operative field, anatomical familiarity to spine surgeons, and minimizing tissue trauma. With technical advancement, many spinal pathologies are being treated using this system. Namely, herniated discs, lumbar and cervical stenosis, synovial cysts, lumbar instability, trauma, and even some intraspinal tumors have all been treated through tubular retractor system. Flexible arm and easy change of the tube direction are particularly useful in contralateral spinal decompression from an ipsilateral approach. Careful attention to surgical technique through narrow space will ensure that complications are minimized and will provide improved outcomes. However, understanding detailed anatomies and keeping precise surgical orientation are essential for this technique. Authors present the technical feasibility and initial results of use a tubular retractor system as a minimally invasive technique for variaties of spinal disorders with a review of literature.
Arm ; Constriction, Pathologic ; Decompression ; Intervertebral Disc Displacement ; Pathology ; Recognition (Psychology) ; Spine ; Surgical Procedures, Minimally Invasive ; Synovial Cyst

OBJECTIVE: We previously reported excellent early and midterm clinical results of anterior cervical microforaminotomy (ACMF) for patients with cervical radiculopathy caused by disc herniation or foraminal stenosis. ACMF is accepted as a minimally invasive functional spinal surgery, but its long-term outcomes are unknown. The purpose of this study is to evaluate the long-term clinical and radiographic results of ACMF. METHODS: We performed a questionnaire survey and retrospective analysis of 13 patients with cervical radiculopathy who underwent ACMF from 1998 to 2002. Clinical and radiographic data from these 13 patients (one-level operations in seven patients, and two-level operations in six patients) were analysed. We measured disc height, sagittal plane displacement and sagittal plane angulation to evaluate instability. RESULTS: Thirteen patients answered the questionnaires. Mean follow-up was 77.3 months (ranged from 498 to 110 months). The surgical outcome was excellent in three patients (23%) and good in nine patients (69%). One patient had only a fair outcome, but there were no cases of recurrence, reoperation or additional surgery. Twelve of 13 patients were satisfied with the results of their surgery. On the average, the loss of disc height was 0.84mm(16.6% of preoperative disc height), increase of displacement was 0.47mm and increase of sagittal plane angulation was 0.65degrees. All patients maintained stability during the follow-up period. Although the patient sample included in this study is a different sample from that surveyed in our previous study of mid-term results, the long-term radiographic outcomes showed that the parameters of instability tended to decrease in comparison to those midterm results. Three-dimensional computed tomography scans showed signs indicative of bone remodeling, including regrowth of the resected bone and gradual fusion around the uncovertebral joint (UVJ) where ACMF was performed. In spite of bone regeneration around the UVJ, the neural foramen appeared to be well maintained in all patients. CONCLUSION: In the long-term, ACMF is clinically effective method for the treatment of cervical radiculopathy, although disc height was decreased and sagittal angulation was increased. UVJ with mild hypermobility that was apparent at midterm appears to be restored during long-term follow-up. The efficacy of this procedure should be evaluated in additional studies involving large patient series.
Bone Regeneration ; Bone Remodeling ; Cervical Vertebrae ; Constriction, Pathologic ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Joints ; Surveys and Questionnaires ; Radiculopathy ; Recurrence ; Reoperation ; Retrospective Studies ; Spondylosis

OBJECTIVETo investigate the correlation between the coping style and mental health of patients with lumbar intervertebral disc herniation.

METHODSThe simplified coping style questionnaire and SCL-90 were used to conduct a survey of 106 patients with lumbar intervertebral disc herniation, and the scores were compared with the national norms.

RESULTSThe patients had a positive coping style score of 1.51-/+0.58 and negative coping style score of 1.13-/+0.58. The SCL-90 scores were significantly higher than the national norms. A significant correlation was found between the negative coping style and mental health of the patients.

CONCLUSIONNegative coping style is an important factor influencing the mental health of patients with lumbar intervertebral disc herniation.

Adaptation, Psychological ; Adult ; Female ; Humans ; Intervertebral Disc Displacement ; psychology ; Low Back Pain ; etiology ; psychology ; Male ; Middle Aged ; Quality of Life ; Stress, Physiological ; Surveys and Questionnaires

The Computed Tomography is the most exact method to find out some diesase, soft tissue or musculoskeletal system. It is searching examination distinguishing normal structure and abnormal states in the spine and spinal canal. This is almost an absolute diagnostic method for spinal stenosis, and it has a special forte becasue it can distinguish the soft tissue around the spine. Thus we can distinguish metastatic cancer, herniated intervertebral disc, hypertrophy of the yellow ligament, and spine tumor very easily. Thirty-two cases of herniated intervertebral disc in lumbar spine were treated for 18 months from Jan. 1981 to Jun. 1982. Of thirty two cases, 18 cases were underwent CT scanning and 9 cases were underwent CT scanning and myelography. We obtained following results: 1. In the 18 cases taking a CT scan we found 6 cases of bulging annulus, 7 cases of herniated disc, one case each of facet syndrome, lateral recess syndrome, and three cases had normal finding. 2. In 9 cases taking CT scan, myelography and operation, 7 cases showed the same positive findings, but one case showed the positive CT scan and myelography, negative surgical exploration, and another case showed positive myelography, negative CT scan surgical exploration. 3. In 9 cases who took only a CT scan, there were 6 cases in which myelography was impossible or refused. Among these 6 cases 4 patients took operation and showed positive findings. 4. The diagnosis of herniated intervertebral disc by means of the CT scan has been made more accurately by the supplementary use of metrizamide and improvement of interpretation. a. When the patient refuses myelography. b. For discrimination of other diseases than herniated intervertebral disc. c. When the patient is allergic to iodine dyes used in myelography. As mention above, not only herniated intervertebral disc, but also many other diseases in spine can be diagnosed and we can decide that the herniated intervertebral disc surgery would by desirable with only the CT scan as nonivasive diagnostic test.
Coloring Agents ; Diagnosis ; Diagnostic Tests, Routine ; Discrimination (Psychology) ; Humans ; Hypertrophy ; Intervertebral Disc Displacement ; Intervertebral Disc ; Iodine ; Ligaments ; Methods ; Metrizamide ; Musculoskeletal System ; Myelography ; Spinal Canal ; Spinal Stenosis ; Spine ; Tomography, X-Ray Computed

STUDY DESIGN: Retrospective study of clinical experiences. OBJECTIVES: The correct discrimination of a compressed root is very important for proper decompression. With a foraminal disc herniation, the cephalad root is compressed. The diagnostic importance of the clinical and radiological findings was investigated. SUMMARY OF LITERATURE REVIEW: A compressed root, due to a herniated disc, is known as a caudal root (i. e. L5 root compressed by L4-5 disc herniation). In some cases, a prolapsed disc may compress the cephalad root, resulting in a difficult diagnosis. MATERIAL AND METHOD: The medical records, plain X-ray and MRI of 17 patients were reviewed, and the physical examination and MRI findings were carefully evaluated to retrospectively document the efficacy of the diagnoses. Every MRI image of each patient was graded according to the 4 point ranking system of diagnostic efficacy devised by the authors. The clinical outcomes and postoperative complications were also investigated. RESULTS: Ten, 5 and 2 of the 17 patients had L4-5, L5-S1 and L3-4 foraminal disc herniations, respectively. Eight of 10 L4-5 cases showed a positive femoral nerve stretching test. The knee jerk reflex was diminished in 7 patients, with bilateral hyporeflexia in the other 3. The body-cut axial MRI image was the most effective, and the coronal images were also very helpful, whereas the routine axial images were of least value. Most cases achieved a satisfactory clinical result. CONCLUSIONS: Foraminal disc herniations seem to be reasonably common. For the accurate discrimination of a compressed root, a thorough physical examination seems to be very important. When MRI is performed for these cases, in addition to routine studies, the body-cut axial and coronal MRI images are effective and useful, and their use is strongly recommended.
Decompression ; Diagnosis ; Discrimination (Psychology) ; Femoral Nerve ; Humans ; Intervertebral Disc Displacement ; Knee ; Magnetic Resonance Imaging ; Medical Records ; Physical Examination ; Postoperative Complications ; Reflex ; Reflex, Abnormal ; Retrospective Studies