Forty canine patients with a presumptive diagnosis of the intervertebral disc herniation at the thoracolumbar region were imaged. A neurological examination was performed and all patients were classified under four grades by the examination. The degrees of attenuation of the herniated disc material were measured in Housefield units (HU) in each image. The ratio of the area to herniated disc material and the height to disc material were measured. The clinical grade was correlated with the area ratio of the herniated disc material to the spinal cord, but not correlated with the height ratio of that. In the patients with epidural hemorrhage at surgery, HUs of the herniated disc material was lower than those with no epidural hemorrhage at surgery. Non-contrast computed tomography scans of the spine can be useful in diagnosing acute intervertebral disc disease in chondrodystrophoid breeds, evaluating patient status and identifying concurrent epidural hemorrhage.
Animals ; Dog Diseases/*pathology/radiography ; Dogs ; Intervertebral Disk Displacement/radiography/*veterinary ; Lumbar Vertebrae/*pathology/radiography ; Retrospective Studies ; Thoracic Vertebrae/*pathology/radiography ; Tomography, X-Ray Computed/methods/standards/*veterinary

One hundred and fourteen cases of lumbar herniated nucleus pulposus were studied retrospectively. I reviewed the clinical records and radiographs of patients treated with diskectomy and anterior interbody fusion. I followed the patients from 2 years up to 15 years, for an average of 2.9 years. The results were calculated statistically by Fisher exact test and Chi-square test. Among 114 patients, 69 patients (60.5%) were male and 45 patients (39.5%) were female. The most common age group was in its twenties (28.1%), while the whole study group ranged from 19 to 65 years. The most commonly involved level was L4-5 (73 cases, 60.4%). In clinical results, 83.3% of cases were excellent or good. The rate of solid fusion was 87.8%. The most common type of fusing pattern was type 1. The satisfying clinical result had statistical correlation with the solid union of grafted bone and the fusion state of maintained intervertebral disk height, respectively, by Fisher exact test (p < 0.001). The affecting factors in clinical results were the solid fusion and fusion with the state of maintenance of intervertebral disk height (fusing pattern type I and II). I concluded that anterior diskectomy and interbody fusion is a recommendable method of treatment for lumbar herniated nucleus pulposus.
Adult ; Aged ; Female ; Human ; Intervertebral Disk Displacement/surgery* ; Intervertebral Disk Displacement/radiography ; Lumbar Vertebrae/surgery* ; Lumbar Vertebrae/radiography ; Male ; Middle Age ; Myelography ; Postoperative Complications ; Retrospective Studies ; Spinal Fusion/methods* ; Treatment Outcome

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK(TM) (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.
Treatment Outcome ; Spinal Fusion/*methods ; Middle Aged ; Male ; Lumbar Vertebrae/radiography/*surgery ; Joint Instability/radiography/*surgery ; Intervertebral Disk Displacement/radiography/*surgery ; Humans ; Follow-Up Studies ; Female ; Adult

This study sought to determine the outcomes of posterior lumbar interbody fusion (PLIF), via a unilateral approach, in selected patients who presented with unilateral leg pain and segmental instability of the lumbar spine. Patients with a single level of a herniated disc disease in the lumbar spine, unilateral leg pain, chronic disabling lower back pain (LBP), and a failed conservative treatment, were considered for the procedure. A total of 41 patients underwent a single-level PLIF using two PEEK(TM) (Poly-Ether-Ether-Ketone) cages filled with iliac bone, via a unilateral approach. The patients comprised 21 women and 20 men with a mean age of 41 years (range: 22 to 63 years). Two cages were inserted using a unilateral medial facetectomy and a partial hemilaminectomy. At follow-up, the outcomes were assessed using the Prolo Scale. The success of the fusion was determined by dynamic lumbar radiography and/or computerized tomography scanning. All the patients safely underwent surgery without severe complications. During a mean follow-up period of 26 months, 1 patient underwent percutaneous pedicle screw fixation due to persistent LBP. A posterior displacement of the cage was found in one patient. At the last follow up, 90% of the patients demonstrated satisfactory results. An osseous fusion was present in 85% of the patients. A PLIF, via a unilateral approach, enables a solid union with satisfactory clinical results. This preserves part of the posterior elements of the lumbar spine in selected patients with single level instability and unilateral leg pain.
Treatment Outcome ; Spinal Fusion/*methods ; Middle Aged ; Male ; Lumbar Vertebrae/radiography/*surgery ; Joint Instability/radiography/*surgery ; Intervertebral Disk Displacement/radiography/*surgery ; Humans ; Follow-Up Studies ; Female ; Adult

Discogenic pain is a leading cause of chronic low back pain. The authors investigated the efficacy of pressure-controlled discography to determine its role in clinical decision-making for the management of patients with discogenic pain. Pressure-controlled discography was performed in 21 patients (51 discs) with pain-provocation, followed by post-discography computerized tomography scans. Pain response was classified as positive response and negative response, and measured with visual analog scale scores. Discographic findings were graded by the modified Dallas discogram scale. Elastance, pain provocation on intradiscal pressure, pressure and volume of initial pain response, and pain response intensity were statistically analyzed. Elastance showed significant differences between Grade 0 and Grade 4 and 5. Decreased elastance with positive pain response group was a good indicator to imply that disc degeneration presumably is a pain generator. Results of pain response were well correlated with intradiscal pressure but not with the amount of injected volume. Among 31 discs of Grade 4 and 5, 74% showed negative pain response and 26% showed positive response. It was concluded that pressure-controlled discography was useful to diagnose discogenic pain and excellent guide in decision-making for spinal operations.
Tomography, X-Ray Computed ; Pressure ; Pain Measurement ; Middle Aged ; Male ; Low Back Pain/*radiography ; Intervertebral Disk/*radiography ; Humans ; Female ; Aged, 80 and over ; Aged ; Adult

Accurate pre-operative localization and removal of disc material are important for minimizing morbidity in dogs with thoracolumbar disc extrusions. Computed tomography (CT) is an established technique for localizing disc extrusions in dogs, however the effect of multi-planar reformatting (MPR) on surgeon diagnostic performance has not been previously described. The purpose of this study was to test the effect of MPR CT on surgeon diagnostic accuracy, certainty and agreement for localizing thoracolumbar disc extrusions in dogs. Two veterinary surgeons and one veterinary neurologist who were unaware of surgical findings independently reviewed randomized sets of two-dimensional (2D) and MPR CT images from 111 dogs with confirmed thoracolumbar disc extrusions. For each set of images, readers recorded their localizations for extruded disc material and their diagnostic certainty. For MPR images, readers also recorded views they considered most helpful. Diagnostic accuracy estimates, mean diagnostic certainty scores and inter-observer agreement were compared using surgery as the gold standard. Frequencies were compared for MPR views rated most helpful. Diagnostic accuracy estimates were significantly greater for MPR vs. 2D CT images in one reader. Mean diagnostic certainty scores were significantly greater for MPR images in two readers. The change in agreement between 2D and MPR images differed from zero for all analyses (site, side, number affected) among all three readers. Multi-planar views rated most helpful with the highest frequency were oblique transverse and curved dorsal planar MPR views. Findings from this study indicate that multi-planar CT can improve surgeon diagnostic performance for localizing canine thoracolumbar disc extrusions.
Animals ; Decision Making ; Dog Diseases/*radiography ; Dogs ; Female ; Humans ; Image Processing, Computer-Assisted/*methods/standards ; Intervertebral Disk Displacement/radiography/*veterinary ; Male ; Observer Variation ; Tomography, X-Ray Computed

Anterior cervical discectomy and fusion (ACDF) is currently the standard treatment for cervical disc disease. Some patients wish to be treated with a less invasive method, because of their social/physical situations. Here we present one method of treatments for socially/physically active patients. Three patients had triceps weakness and mild posterior neck pain. The offending lesions were at the C6-7 level. All were middle-aged soldiers with families. If conventional ACDF were performed, they would have to retire from the military according to the regulation. They had to be able to perform military drills after the treatment if they were going to be able to keep their jobs. Because of their social/physical situations, all wanted to choose method with that they could treat the disease and keep their jobs. For these reasons, the posterior cervical endoscopic discectomies were performed. Ruptured fragments were successfully removed in all. The arm pain improved by more than 90% in two patients by 7 days and in the other patient by 2 months, respectively (excellent outcome by Macnab's criteria). None of the operations caused instability. All of the patients are currently able to successfully perform their military drills without difficulty. The posterior cervical endoscopic discectomy may be a promising alternative for the physically/socially active patients.
Adult ; Cervical Vertebrae/radiography/*surgery ; *Diskectomy ; Endoscopy ; Humans ; Intervertebral Disk/radiography/surgery ; Magnetic Resonance Imaging ; Male ; Severity of Illness Index ; Tomography, X-Ray Computed ; Treatment Outcome

The objective of this study was to investigate the influence of the hip flexion upon parameters that are indicators of spinal mobility. These parameters include intervertebral disc angle and lumbar curvature by measurement of the radiography in twenty eight healthy men. The state of knowledge of how these parameters relate to lumbar mobility have resolved. The results of the parameters showed negligible changes in relation to the mobility of lumbar spine according to angle of hip flexion except at L4-L5 intervertebral disc angle and lumbar curvature (p< 0.05). This results of study confirms that hip joint movement therapy can be applied to these norms in patient management in supine position of for the stable spinal injuries in the upper lumbar region during early phase.
Adult ; Aged ; Hip Joint/*physiology/radiography ; Human ; Intervertebral Disk/radiography ; Lumbar Vertebrae/physiology/*radiography ; Male ; Middle Age ; Movement ; Pelvis/physiology/*radiography ; Range of Motion, Articular ; Supine Position ; Support, Non-U.S. Gov't

PURPOSE: A retrospective review of medical records and imaging studies. To investigate characteristic clinical features and surgical outcomes of spinal cord tumors (SCTs) of the thoracolumbar junction (TLJ). The spinal cord transitions to the cauda equina in the TLJ. The TLJ contains the upper and lower motor neurons of the spinal cord and cauda equina. As a result, the clinical features of lesions in the TLJ vary, and these anatomical characteristics may affect surgical outcome. MATERIALS AND METHODS: Pathological diagnosis, clinical features, neurological signs, and surgical outcomes were investigated in 76 patients surgically treated at our institute for SCTs arising from T11 to L2. The patients were divided into epiconus (T11-12, n=18) and conus groups (L1-2, n=58). RESULTS: Patients in the epiconus group had hyperactive deep tendon reflexes (DTRs), while those in the conus group had hypoactive DTRs (p < 0.05). Nine patients were misdiagnosed with intervertebral disc diseases (IVDs) before correct diagnoses were made. It was impossible to definitively determine the exact cause of symptoms in four patients who had both SCTs and IVDs. CONCLUSION: Among SCTs of the TLJ, the epiconus group displayed upper motor neuron syndrome and the conus group displayed lower motor neuron syndrome. SCTs of the TLJ were frequently misdiagnosed as IVDs due to symptomatic similarities. SCTs of the TLJ should be included in differential diagnosis of back and leg pain, and it is highly recommended that routine lumbar magnetic resonance imaging include the TLJ.
Cauda Equina/pathology/radiography ; Humans ; Intervertebral Disk Displacement/pathology/radiography ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Cord Compression/pathology/radiography ; Spinal Cord Neoplasms/*surgery ; Thoracic Vertebrae/*pathology/radiography ; Treatment Outcome

A cadaveric study was performed to investigate the relationship between disc degeneration and morphological changes in the intervertebral foramen of cervical spine, including the effect on the nerve root. Seven fresh frozen human cadavers were dissected from C1 to T1, preserving the ligaments, capsules, intervertebral disc and the neural structures. The specimens were scanned with MRI and then scanned through CT scan in the upright position. Direct mid-sagittal and 45 degree oblique images were obtained to measure the dimension of the intervertebral disc height, foraminal height, width, area and segmental angles. Disc degeneration was inversely correlated with disc height. There was a significant correlation between disc degeneration and foraminal width (p<0.005) and foraminal area (p< 0.05), but not with foraminal height. Disc height was correlated with foraminal width but not with height. The segmental angles were decreased more in advanced degenerated discs. There was a correlation between nerve root compression and decreased foraminal width and area (p<0.005). This information and critical dimensions of the intervertebral foramen for nerve root compression should help in the diagnosis of foraminal stenosis of the cervical spine in patients presenting with cervical spondylosis and radiculopathy.
Adult ; Aged ; Aged, 80 and over ; Cadaver ; Female ; Human ; Intervertebral Disk/*pathology/radiography ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Spine/*pathology/radiography ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/*methods