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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors present the results they obtained in the first 100 operations performed between January 1989 and November 1990 for the treatment of lumbar sciatic pain related to disc and/or bone compression: microsurgery according to the Caspar method was used. A total of 113 spaces were submitted to surgery; discectomy at two levels was performed in 13 patients. Nerve root compression observed was based on three causes: 1) pure disc hernia (57.5%), 2) pure lateral stenosis (15.9%), 3) combined pathology (hernia+stenosis) (25.6%). In one of the cases the pathology remained unknown. At an average two-year follow-up there were 94 excellent or good results, 2 fair results, and 4 poor results. Complications included dural lacerations in 3 cases, with no sequelae. Eight patients were submitted to further surgery for recurrence of symptoms; the final results after reintervention were excellent in 7 cases, and fair in 1. The authors emphasize the advantages to using microsurgery as compared to macrosurgery, and stress a frequent finding of pure lateral stenosis or associated with disc pathology (47 out of 113 levels operated, equal to 41%), as well as the reliability of CT scan when dealing with disc pathology (97% positive diagnosis) but its unreliability when diagnosis is lateral stenosis (19 out of 47, equal to 40%).
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PMID:Microsurgery in the treatment of crural and sciatic pain due to disc and bone compression: considerations on the first 100 cases. 834 78

Fifteen patients with bilateral lumbar isthmic spondylolisthesis and unilateral sciatica were examined with magnetic resonance imaging. All patients had a disc protrusion at the level of the spondylolisthesis. Nine patients had a central herniated disc that caused dural sac deformation; in 6 of these patients there was extension to the disc tissue into the foramen. In 5 patients there was no clear dural sac deformation, but there was a foraminal disc protrusion that caused nerve root compression. In 1 patient there was a hernia lateral to the foramen. In none of the patients was there evidence of compression by bony elements. No abnormalities on adjacent levels were found. All 15 patients were treated with chemonucleolysis. There were no complications. A followup study was done after 19 months (range, 10-42 months). The result was rated as good or excellent in 10 of 12 patients with a spondylolisthesis of L5 and in 1 of 3 patients with a spondylolisthesis of L4. Magnetic resonance imaging showed a decrease in dural sac deformation in 4 patients, no clear decrease in 3, and a slight increase in 2. There were no distinct foraminal changes in 9 of 11 patients.
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PMID:Spondylolisthesis with sciatica. Magnetic resonance findings and chemonucleolysis. 862 Jun 35

In the pathophysiology of lumbosacral radiculopathy, inflammation of the nerve root is of critical importance. Additionally, free radicals have been shown to be associated with some inflammatory process. This study was designed to investigate whether free radicals participate in the pathophysiology of nerve root involvement. We measured superoxide dismutase (SOD) activity in cerebrospinal fluid (CSF) of 31 patients with unilateral lumbosacral radiculopathy caused by a herniated disc using electron spin resonance (ESR) spectrometry. Then SOD activity was compared with the type of nerve root compression as seen on preoperative myelography. SOD activity in the normal control group was 7U/ml, while that in the hernia group remarkably decreased. The concentration gradient of SOD activity was different between central herniation and centrolateral herniation. Our findings indicate that free radicals are generated after nerve root compression. Under severe deficiency of SOD activity in CSF, serum SOD penetrates into CSF after further compression. In addition, SOD in CSF may play an important role in protecting against nerve root involvement.
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PMID:Superoxide dismutase activity in cerebrospinal fluid and its relation to compression of the lumbosacral nerve root. 887 81

The rationale and indication, but also the efficacy and limitation of lumbar epidural corticosteroid injection in patients suffering from acute lumbosacral radicular pain are explained. Epidural administration of corticosteroids with longterm effect and bupivacaine by a translumbar approach in patients suffering from acute low back pain and sciatica causes an immediate, persistent pain relief and a more prompt regression of nerve root compression compared to patients just treated by bed rest and analgesics. The state of the art is based on recent meta-analyses and the understanding of the pathophysiology of discal hernia which includes inflammation. Contemporary concepts and data from recent reviews are summarized to elucidate current recommendations and suggestions for the management of patients with acute sciatica. The postulate of an application performed by an experienced anaesthesiologist is stressed. Advantages of this invasive form of therapy include reduction of addictive analgesic drugs, decreased time of absolute immobilisation, respectively strict bed rest, and of hospitalisation.
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PMID:[Acute lumbar disk displacement with nerve root compression. Indications for peridural steroid injection]. 914 89

The authors report a rare case of recurrence of lumbar nerve root compression caused by herniated intradiscal gas treated surgically with resolution of pain symptoms. They describe the possible causes of the formation of gaseous material reported in the literature. They believe that to avoid recurrence it is important to associated removal of the hernia with complete emptying of the disc and resection of the posterior longitudinal ligament.
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PMID:Lumbar nerve root compression caused by herniated intradiscal gas: description of a clinical case with recurrence. 1156 95

It was the purpose of this study to clinically follow-up 78 patients affected with lumbar disc herniation, aged from 60 to 81 years (mean 66 years), hospitalized in several wards at the Rizzoli Orthopaedic Hospital between 1987 and 1996, for surgical treatment. A minimum of 24 months after surgery (maximum 61 months), sciatic pain (present in all of the patients prior to surgery) had regressed in 90% of the patients and was reported to occur only occasionally in 10%. Low back lumbar pain was still present in 21%. Results concerning recovery of motor deficit (30%), deficit in reflexes (31%), and sensory deficit (24%) were good. Better results were obtained when the surgical findings were sequestered hernia and expulsed hernia, with excellent results observed in 70% and 60%, respectively (based on the Smiley-Webster scale), as compared to contained hernia, the results for which were excellent in 54% of patients. Complications were observed in 9 cases (11%); 5 of the cases (6%) after a period of time ranging from 20 to 45 days postsurgery required further surgery because of an error in level in 3 and a residual nerve root compression in 2.
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PMID:Lumbar disc herniation in the elderly patient. 1202 86