The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1 - 4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications.
Adolescent ; Adult ; Child ; Diskectomy/instrumentation/*methods ; Follow-Up Studies ; Humans ; *Intervertebral Disk Chemolysis ; Intervertebral Disk Displacement/*surgery/*therapy ; Lumbar Vertebrae/*surgery ; Microsurgery ; Spinal Fusion/instrumentation/*methods ; Treatment Outcome

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 was undertaken to prove that the selectively infiltrated parts of nucleus pulposus with indigo carmine was degenerated parts of nucleus pulposus. This study was done, between August and October 2002, in 5 patients, who received endoscopic discectomy, due to intervertebral disc herniation. Discogram was done with mixture of indigo carmine and radioactive dye. Blue discolored part was removed through endoscope, and small undiscolored part was removed together for the control. The two parts were stained with hematoxylin and eosin and compared under the microscope. Undiscolored part was normal nucleus pulposus, composed of chondrocytes with a matrix of type II collagen and proteoglycan, mainly aggrecan. However, in discolored part, slits with destruction of collagen fiber array and ingrowth of vessel and nerve were observed. Using indigo carmine in endoscopic discectomy gives us selective removal of degenerated disc.
Chondrocytes/metabolism/pathology ; Collagen Type II/metabolism ; Comparative Study ; Diskectomy/*methods ; Endoscopy ; Humans ; Indigotindisulfonate Sodium/*diagnostic use ; Intervertebral Disk/metabolism/pathology/*surgery ; Intervertebral Disk Displacement/diagnosis/*surgery ; Proteoglycans/metabolism ; Sensitivity and Specificity

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

Automated percutaneous lumbar discectomy (APLD) has been developed since 1984 when Gary Onik first attempted it. This procedure has many advantages and has been used widely in the treatment of protruded disc diseases. The success rate of APLD by authors from March 1988 to February 1993 when the discographic computed tomography (CT) had not been performed was 74%. In evaluating lumbar disc diseases, we have used discographic CT. According to the patterns of dye distribution in the disc, two different types of protrusion can be distinguished: broad dye base protrusion and narrow dye base protrusion. From April 1993 to July 1994, 52 patients with protruded disc diseases were performed discographic CT. 23 Patients had narrow dye base protrusion and 29 patients had broad dye base protrusion. 29 patients with a broad dye base on discographic CT were treated with APLD and evaluated. The success rate in these patients was 93% by Macnab's criteria. Thus, we suggest that it is mandatory to apply discographic CT to increase the success rate of APLD in patients with protruded disc diseases.
Adolescent ; Adult ; Child ; Diskectomy, Percutaneous/*methods ; Female ; Human ; Intervertebral Disk Displacement/*surgery ; Lumbar Vertebrae/*surgery ; Male ; Middle Age ; Tomography, X-Ray Computed/methods

Chronic lower back pain is one of the most common musculoskeletal problems; it is also the most expensive industrial injury. Not surprisingly, many treatments have been developed to combat this expensive and debilitating condition. One of these, intradiscal electrothermal treatment (IDET), was developed for patients with chronic discogenic lower back pain who failed to improve with any of the wide variety of non- surgical treatments. The present study sought to evaluate the efficacy of IDET for patients with chronic lower back pain. Twenty-five patients were enrolled in this prospective study; the patients received IDET between June 2001 and June 2003. MRI was used to confirm the diagnosis of internal disc disruption in all patients. The patients then underwent a pre-operative provocative test and discography. The follow-up duration was at least 1 year in all cases, and the visual analogue scale, recovery rate, and satisfaction of each patient were evaluated. The average age of the patients was 32 years (age range 18 to 49 years), and the patient group was 33% male and 67% female. Of the 25 patients, 5 underwent lumbar fusion surgery within 1 year of IDET. After IDET, 8 patients (32%) reported more pain than before, 14 patients (56%) reported less pain, and 3 patients (12%) experienced no change. Twelve patients (48%) were satisfied with IDET, 11 (44%) were dissatisfied, and 2 (8%) were undecided about the treatment. At least 1 year after IDET, nearly half the study patients were dissatisfied with their medical outcome. Consequently, 5 patients (20%) underwent fusion surgery at 1 year after IDET. Although other studies have shown good results with IDET for at least 2 years, this investigation suggests the IDET may be somewhat less effective. In order to firmly establish the efficacy of IDET for treating chronic discogenic lower back pain, additional studies with larger numbers of patients evaluated over longer time periods are recommended.
Adolescent ; Adult ; Chronic Disease ; Electrocoagulation/adverse effects/*methods ; Female ; Humans ; Intervertebral Disk Displacement/*surgery ; Low Back Pain/*surgery ; Male ; Middle Aged ; Prospective Studies

Intradural lumbar disc herniation is a rare pathological entity. The pathogenesis of intradural lumbar disc herniation is not known clearly. Intradural disc herniations usually occurred at the L4-L5 levels but have also been reported at other levels. However, intradural disc herniation at L5-S1 is quite rare. There are approximately nine reports in the English literature of intraradicular disc herniation at L5-S1. We described a 61-yr-old man with suspected intradural mass at the level of L5-S1 space. The patient presented with pain in the lower back and both lower legs for 4 months and a sudden exacerbation of the symptoms for 3 days. Gadolinium-enhanced magnetic resonance imaging (MRI) demonstrated a large disc herniation at the L5-S1 level with an intradural component. L5 and S1 laminectomy was performed, and dura was swollen and immobile. Subsequent durotomy was performed and an intradural disc fragment was removed. The patient had full recovery in 3 months. Intradural lumbar disc herniation must be considered in the differential diagnosis of mass lesions in the spinal canal. Contrast-enhanced MRI scans are useful to differentiate a herniated disc from a disc space infection or tumor.
Spinal Cord Neoplasms/*diagnosis ; *Sacrum ; Middle Aged ; Male ; *Lumbar Vertebrae ; Laminectomy ; Intervertebral Disk Displacement/*diagnosis/surgery ; Humans ; Dura Mater ; Diagnosis, Differential

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

PURPOSE: To evaluate the clinical outcomes of cantilever transforaminal lumbar interbody fusion (c-TLIF) for upper lumbar diseases. MATERIALS AND METHODS: Seventeen patients (11 males, 6 females; mean +/- SD age: 62 +/- 14 years) who underwent c-TLIF using kidney type spacers between 2002 and 2008 were retrospectively evaluated, at a mean follow-up of 44.1 +/- 12.3 months (2 year minimum). The primary diseases studied were disc herniation, ossification of posterior longitudinal ligament (OPLL), degenerative scoliosis, lumbar spinal canal stenosis, spondylolisthesis, and degeneration of adjacent disc after operation. Fusion areas were L1-L2 (5 patients), L2-L3 (9 patients), L1-L3 (1 patient), and L2-L4 (2 patients). Operation time, blood loss, complications, Japanese Orthopaedic Association (JOA) score for back pain, bone union, sagittal alignment change of fusion level, and degeneration of adjacent disc were evaluated. RESULTS: JOA score improved significantly after surgery, from 12 +/- 2 to 23 +/- 3 points (p < 0.01). We also observed significant improvement in sagittal alignment of the fusion levels, from - 1.0 +/- 7.4 to 5.2 +/- 6.1 degrees (p < 0.01). Bony fusion was obtained in all cases. One patient experienced a subcutaneous infection, which was cured by irrigation. At the final follow-up, three patients showed degenerative changes in adjacent discs, and one showed corrective loss of fusion level. CONCLUSION: c-TLIF is a safe procedure, providing satisfactory results for patients with upper lumbar degenerative diseases.
Adult ; Aged ; Back Pain/surgery ; Blood Loss, Surgical ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disk Displacement/surgery ; Lumbar Vertebrae/*surgery ; Male ; Middle Aged ; Scoliosis/surgery ; Spinal Diseases/*surgery ; Spinal Fusion/adverse effects/*methods ; Spinal Stenosis/surgery ; Spondylolisthesis/surgery ; Time Factors ; Treatment Outcome