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

Intrathecal instillation of corticosteroid was used in treatment of 188 patients with persistent sciatica or lumbar pain caused by disc hernia or osteochondrosis and recurrent sciatica or lumbar pain after disc operation. 88 of 122 own patients were followed up. Indication, mechanism of steroid action, technic, complications and results are discussed. According to the good results in part of the patients, still after years, the authors believe, that intrathecal corticosteroid administration is a further useful method of conservative treatment of degenerative lumbar disc affections. This therapy can also be used in patients with recurrent, persistent lumbar or leg pain after disc operation.
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PMID:[Intrathecal cortison injection in lumbar disc problems (author's transl)]. 13 22

Eighteen patients (28 compartments) with chronic exertional compartment syndrome and 14 normal asymptomatic volunteers (18 compartments) were studied. Evaluation included clinical assessment followed by quantitative determination of intracompartmental pressures as monitored by wick or slit catheters before and after exercise. Intramuscular pressures measuring greater than or equal to 10 mmHg at rest and/or greater than or equal to 25 mmHg five minutes after exercise were defined as abnormally elevated. The patients with chronic compartment syndrome described reproducible exertional anterolateral leg pain, and 39% of these patients had a fascial hernia. Such a defect was present in less than five percent of the normal volunteers. Nonsurgical treatment was selected by five patients and all five reported persistent inability to participate in athletics because of their exertional pain. Of the remaining 13 patients, 12 were treated by decompressive fasciotomy and 11 of the 12 (92%) had pain relief and increased exercise tolerance. A single patient had had fascial closure instead of fasciotomy, and this procedure produced an acute compartment syndrome. Effective treatment of the chronic compartment syndrome consists of reduction of exertional activities or surgical decompression by fasciotomy.
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PMID:Management of chronic exertional anterior compartment syndrome of the lower extremity. 359 93

The diagnostic sensitivity of dermatomal somatosensory evoked potentials (DSEPs) was evaluated in a homogeneous group of fifteen patients with low back pain due to isolated lumbosacral radiculopathy. The normative values from L3 to S1 were defined, as were the parameters of abnormality. In seven patients with pseudoradicular or referred leg pain, a negative neurological examination and images indicative of protrusion or paramedian disc hernia, the DSEPs were normal in six cases and slightly altered in one. In eight patients with deafferentation leg pain, clinical signs of root damage and images indicative of an intraforaminal hernia, the DSEPs showed varying degrees of alteration which could generally be correlated to the severity of the clinical picture. This method can therefore be useful in differentiating pain due to stimulation of the receptors of the osteoarticular structures or the root sheath, in which the DSEPs are normal, from pain due to direct root damage, in which the DSEPs are altered. This functional evaluation of anatomical damage provides further information which may help to achieve a better therapeutic approach.
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PMID:Dermatomal somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies. 885 9

A prospective sequential MRI study was done to investigate the morphologic changes of the lumbar disc hernia (LDH). We also studied the relationship between the MRI changes and the type of LDH and the clinical outcome. MRI was performed every 3 months from the onset for a maximum of 24 months in 42 patients with radicular leg pain and symptoms definitely diagnosed as caused by LDH. The size of the herniated mass was determined by the ratio of the anteroposterior diameter of the spinal canal to the maximum diameter of the LDH mass on T2-weighted axial images. The clinical outcome was evaluated as excellent, good, or poor depending on leg pain and physical findings. The JOA (Japanese Orthopaedic Association) score for LDH was also used to assess the outcome. Thirty-seven (88%) of the 42 patients showed >50% reduction of the hernia on MRI 3-12 months after onset, and the morphologic changes of the herniated mass were well correlated with the clinical outcome.
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PMID:Natural history of lumbar disc hernia with radicular leg pain: Spontaneous MRI changes of the herniated mass and correlation with clinical outcome. 1246 36

A local inflammatory and potentially painful response, of which the ultimate cause is unknown, has been described in nervous tissues in contact with degenerated disc material in patients with low back and leg pain. With the rationale that a possible cause of such inflammation could be bacterial infection, we utilized PCR (polymerase chain reaction) amplification of the 16S rRNA (ribosomal RNA) gene followed by gene sequencing, to investigate whether bacterial DNA might be detected in the degenerative discs of 10 patients operated for disc herniation or post-discectomy syndrome. One patient with disc hernia harbored DNA homologous to Bacillus cereus, and in one patient suffering from post-discectomy syndrome, Citrobacter braaki/freundii DNA was detected. The finding demonstrates that 16S rRNA PCR can be a useful tool in search of bacterial DNA in degenerated discs, which in turn may be indicative of low-grade infection, manifesting itself only as pain rather than as clinical infection.
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PMID:Detection of bacterial DNA in painful degenerated spinal discs in patients without signs of clinical infection. 1513 61

At the Orthopaedics and Traumatology Unit of the Palmanova Hospital, between 27 October 1989 and 31 December 2003 we performed 506 automated percutaneous nucleotomies according to Onik for the treatment of lumbar disc hernia. The survey of 50 reviewed cases after evaluation of the subjective and objective clinical pictures according to the Cabot method allowed us to come to the conclusion that this percutaneous methodology is suitable to relieve damaged discs from compression. It is also well accepted by patients because it is not too traumatic, it requires short-term hospitalisation, presents no risk of post-operative fibrosis and does not create complications for the eventual traditional operation when unsuccessful. It is extremely important to accurately select the candidates keeping in mind the original indications given by Onik for percutaneous discectomy for which--in case of contained disc herniation--leg pain (sciatalgia) is more severe than low back pain affecting the lumbar region.
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PMID:A long-term review of 50 patients out of 506 treated with automated percutaneous nucleotomy according to Onik for lumbar-sacral disc herniation. 1583 Sep 78

Tarlov cysts and nerve roots anomalies usually involve lumbosacral roots and are often asymptomatic. MRI has enabled recognition of many conditions that used to be missed by CT or myelography investigations performed for back and leg pain. However, even without additional compressive impingement (disc hernia, spondylolisthesis or lumbar canal stenosis) these anomalies can be responsible for sciatica, motor deficit and bladder sphincter dysfunction. Tarlov cysts are perinervous dilatations of the dorsal root ganglion. CT and especially MRI can reveal these cysts and their precise relations with the neighboring structures. Delayed filling of the cysts can be visualized on the myelogram. MRI is more sensitive than CT myelography for a positive diagnosis of nerve root anomalies, a differential diagnosis with disc hernia and classification of these anomalies. Surgical treatment is indicated for symptomatic Tarlov cysts and nerve root anomalies resistant to conservative treatment. Better outcome is observed in patients with an additional compressive impingement component. We report two cases of sciatica: one caused by Tarlov cysts diagnosed by MRI and the other by nerve root anomalies diagnosed by CT myelography. In both cases, conservative treatment was undertaken. The clinical, radiological and therapeutic aspects of these disorders are discussed.
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PMID:[Sciatica due to unusual causes: Tarlov cysts and nerve roots anomalies]. 1880 89

An Intradiscal gas collection, referred to as the vacuum disc phenomenon (VDP) is a relatively common finding on radiographic studies of the lumbar spine, whereas gas-containing lumbar disc hernia is rarely observed. We report a case of a patient with left leg pain, provoked by a radiographically and surgically documented L4-5 gas containing disc hernia.
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PMID:An unusual case of nerve root compression by intradiscal gas pseudocyst of the lumbar spine. 2043 7

TLIF (transforaminal lumbar interbody fusion) is a method of interbody fusion, which is alternative to other vertebral fusion wherein, with an approach through intervertebral foramen, through lateral segment of intervertebral space, complications occurring with other methods are reduced. Today, there are numerous versions of this method in terms of implants and transplants. At our Department patients with axial pain resistant to conservative treatment of minimum six months underwent TLIF method with unilateral transpendicular fixation with polyaxial screws, CAGE filled with autologous transplant obtained by lamina resection, and posteromedial contralateral fusion. 22 procedures were performed at 22 levels, 10 for relapsing hernia, and 12 for disc herniation combined with degenerative changes on the same level. Pain reduction was significant; according to VAS score, lumbar pain was reduced from preoperative 8.5 +/- 0.8 to 2.4 +/- 0.85 (-72.63%) a year after, and leg pain was reduced significantly from preoperative 8.45 +/- 0.91 to 2.072 +/- 0.81 (71%) 12 months after surgery. The Wilcoxon paired test demonstrated a significant difference between preoperative VAS score and the value measured 12 months after surgery (n = 22, Z = 4.1, p < 0.001) leg and back, respectively. In 15 (68.2%) patients fusion was evidenced on standard X-ray of lumbar spine, and in 4 patients, with aggravated clinical presentation, fusion in 2 patients and pseudoarthrosis in 2 patients were evidenced by CT. Total 17 patients (77.3%) showed signs of fusion. In our study we demonstrated that unilateral ipsilateral transpedicular fixation, with positioning of one CAGE filled with local autologous transplant represents a reliable and successful method of treatment of axial lumbar pain.
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PMID:Transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular fixation. 2069 27

Lumbar disc hernia (LDH) is a common cause of low back pain and radicular leg pain. It is well known that the majority of LDH patients recover spontaneously. Since the advent of MRI, a spontaneous regression of fragment size of disc hernia occurs, as well as mitigation of subjective difficulties and neurological disorders. Therefore, surgical treatment is not always method of choice in this disease. Two cases of conservatively treated large disc extrusion which result in significant reduction of difficulties, with simultaneous reduction in fragment size of hernia which is documented by MR.
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PMID:Spontaneous regression of intervertebral disc herniation--case reports. 2166 74


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