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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The fourth lumbar vertebrae and L4-5 discs from six cadaveric lumbar spines were subjected to detailed strain gauge analysis under conditions of controlled loading. With central compression loads, maximal compressive strain was found to occur near the bases of the pedicles and on both superficial and deep surfaces of the pars interarticularis, which emphasises the importance of the posterior elements of lumbar vertebrae in transmitting load. Radial bulge and tangential strain of the disc wall were maximal at the posterolateral surface, in agreement with the fact that disc degeneration and prolapse commonly occur there. Under posterior offset loads simulating extension, both compressive and tensile strains were found to be increased on both surfaces of the pars interarticularis, which suggests that hyperextension may lead to stress fractures and spondylolisthesis. Posterior offset loads also increased the radial bulge of the posterior disc wall and tangential strain at the anterior surface of the disc. Anterior offset loads simulating flexion increased the radial bulge of the anterior disc wall and tangential strain at the posterior surface of the disc. These findings are compatible with movement of the nucleus pulposus within the disc during flexion and extension. This hypothesis was supported by post-mortem discography.
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PMID:The distribution of surface strain in the cadaveric lumbar spine. 65 74

Treatment of intervertebral disc herniation associated with spondylolisthesis is not different from common procedures concerning indication for surgery and surgical technique as far as sciatica is not related to retrolisthetic soft tissue or the posterior edge of the vertebral body. In a case of a disc herniation L5/S1 and an olisthesis grade I with radicular pain L5 a microdiscectomy of the prolapse and parts of the retrolisthetic soft tissue was performed. An immediate reintervention was necessary due to postoperative symptoms of paralysis. Derangement of the retrolisthetic soft tissue was found to cause the increased L5-symptoms.
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PMID:[Characteristics of an intervertebral disk herniation in spondylolisthesis]. 183 28

This paper reports the posterior lumbar interbody fusion (PLIF) that has been performed on fourteen patients. It includes 6 cases of spondylolytic spondylolisthesis, 3 cases of degenerative spondylolisthesis, 2 cases of postoperative recurrence of lumbar disc protrusion, 2 cases of unstable prolapse of intervertebral disc, 1 cases of consequent spinal canal stenosis after lumbar lamina fusion. As a result 92 per cent of the operations are successful. The method of operation and it's modification are reported in detail. The indication of operation and the evaluative criteria of interbody bone union discussed. The intact of lumbar posterior structures, the condition of bone grating bed, the quality and disperse of bone graft are main factors that influencing bone union. Bleeding from venous plexus of spinal canal and from vertebral cancellous bone, injury of lumbosacral nerve root and cauda equina are the main surgical complications that should be stressed.
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PMID:[Posterior lumbar interbody fusion]. 208 76

As an alternative to the well-established surgical procedures for the treatment of disk herniation, percutaneous nucleotomy has proved to be very satisfactory. In several cases this approach has brought complete relief to the patient without sacrifice of bone and without causing soft tissue damage as would have been inevitable with the usual surgical methods. Percutaneous nucleotomy is also a true alternative to chemical nucleolysis when leakage of contrast agent into the spinal canal has already been observed during diskography. Furthermore, this method avoids disagreeable complications encountered in chemical nucleotomy, for example, anaphylactic shock or the escape of the nucleolytic agent into the spinal canal. The method basically consists of removing the nucleus pulposus (or a major part of it) by means of a forceps that is introduced to the site through a cannula. In this manner a reduction of volume of the disk is achieved. The procedure can easily be carried out under local anesthesia. This method should be avoided in the case of prolapse within the spinal canal and especially when displacement beyond the level of the disk has occurred. In the period between 1979 and 1985 we carried out percutaneous nucleotomies in 51 patients with herniation mostly combined with a narrow spinal canal or spondylolisthesis. The clinical results from 32 of 51 patients can be assessed as very good, good, or satisfactory. We consider the proportion of patients showing good clinical results to be high, bearing in mind that the indication was not just disk herniation alone but, in most cases, combined with other lumbar pathologies as well.
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PMID:Percutaneous nucleotomy. An alternative to spinal surgery. 377 64

To our knowledge, the method of percutaneous nucleotomy dates back to the first description made by Hijikata in 1975. Compared to the classical hemilaminotomy, the main advantage of this method is that it reduces bone and soft tissue damage in the segment to a minimum. Furthermore, this method avoids disagreeable complications encountered in chemical nucleotomy, for a example, anaphylactic shock, the escape of the nucleolytic agent into the spinal canal, etc. The indication for this method should be avoided in the case of a prolapse within the spinal canal and especially when it is displaced outside the level of the disc. In the period between 1979 and 1981 we carried out percutaneous nucleotomies in 20 patients with a disc herniation mostly combined with a narrow spinal canal or spondylolisthesis. The clinical results from 14 of the 20 patients were described as "very good" or "good". We consider the proportion of patients showing good clinical results to be high, bearing in mind that the indication was not just disc hernia alone but was in most cases associated with other lumbar pathologies.
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PMID:[Indications, methods and results in percutaneous nucleotomy in lumbar disk hernia]. 684 25

An analysis is given of a series of 25 patients suffering from lumboischialgic pain of different causes, which have been treated by discolysis. Literature reports are taken into consideration. As a result of analysis, the following statements seem justified: In no kind of lumbar disc prolapse are the results of discolysis superior to those of modern operative treatment. Discolysis results are indisputably worse in cases with the usual operative indication, which consists of neurological deficit and large disc prolapse. Favourable results by discolysis can be obtained in cases with disc protrusion or small prolapse, but these cases can mostly be cured also by consequent conservative treatment. Contraindications are marked neurological deficit, demonstration of a large disc prolapse by contrast methods, Verbiest's stenosis of the lumbar spinal canal, low back pain and ischialgia without possible proof of a disc protrusion, cases with low back pain as the main or only feature, spondylolisthesis. Disc prolapse recurrences after discolysis often occur about one month afterwards. Structural instability at this stage is likely. Therefore, as with postoperative treatment, it is advisable to avoid major physical stress for the first weeks after discolysis. Major complications after discolysis are possible, and have occurred. Because discolysis offers no real advantages but some shortcomings compared to conservative treatment for disc protrusions, and to operative treatment in real disc prolapses, its justification seems more than questionable.
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PMID:Treatment of lumbo-ischialgias of different origins by intradiscal injection of chymopapain (discolysis). Analysis of literature and personal experiences. 704 37

The treatment of SL, especially in some cases, is mostly surgical. This lesion can be considered an extremely localised kyphosis (only two vertebrae) or a localized (sub-)luxation: at most hearetically pre-operative reduction should represent the first stage of the treatment, also because reduction makes further surgery easier and enables us to obtain the best results. After a glance at the various surgical techniques that have been used in the past, we describe our method of preoperative reduction in case of severe SL, an improvement of Scaglietti's original technique. According to the parameters taken into consideration, spondylolisthesis (SL) of the 4th and, above all, the 5th lumber vertebrae can be considered, especially in severe cases, as kyphosis or displacement (or even dislocation in the case of ptosis). In SL-kyphosis the antero posterior axes of the contiguous vertebral bodies are no longer parallel but tend to over-impose one to the other anteriorly forming an open posterior angle of varying degrees. It is an extremely short kyphosis (only two vertebrae) but from all points of view, even therapeutic, it reflects the characteristics of all types of vertebral kyphosis. SL-subluxation or SL-luxation (ptosis) is characterized by the respectively partial or total loss of normal alignment between the vertebrae involved. This can be explained by the fact that nearly all those who have dealt with the problem of treating SL, especially of L5, always ask themselves beforehand if it is possible and/or opportune to eliminate or improve the condition before surgery. In other words the question of reduction (pre or intraoperative, partial or total) of more or less severe L5 SL is always considered by all authors, even if their conclusions are often in disagreement.
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PMID:Preoperative reduction of spondylolisthesis. 1284 89

Between 1977 and 1987, posterior (n=29) or posterolateral (n=73) fusion was performed for mild to moderate (slip <50%) isthmic spondylolisthesis on 102 patients (46 females, 56 males). The patients' average age at the time of operation was 15.9 (range, 8.1-19.8) years. Clinical (physical examination and Oswestry disability index (ODI)) and radiological (MRI and plain radiographs) examinations were performed on these patients after an average follow-up time of 21.0 (range, 26.2-15.1) years. In the radiographs, the mean slip preoperatively was 27% (range, 5-50%) and at the last follow-up visit 26% (range, 5-78%). Inside the fusion, there were a total of 148 intervertebral discs, 121 (82%) of them had decreased signal intensity in T2-weighted MR images and 113 (76%) were narrowed. Above the fusion level, 27 (27%) discs were speckled and 27 (27%) were black; 21 (21%) intervertebral disc spaces were narrowed. Two levels above the fusion level the numbers were 8 (8%), 16 (16%) and 16 (16%), respectively. Six (6%) patients had a prolapse. Degenerative facet joint hypertrophy above fusion was seen at 80 (79%) of the levels studied. When compared to healthy subjects higher frequency of disc and facet joint degeneration was found. In MR images, none of the patients had lumbar spinal stenosis inside or above the fusion. Narrowing of one or both of the neural foramina at the level of the L5-S1 interververtebral disc was noted in 32 (31%) patients. Seventeen (17%) of the patients had, usually mild, muscular atrophy of the psoas and 33 (32%) of the paraspinal muscles. There was no difference in frequency of abnormal MRI findings between patients (n=93) with ODI 20 or less compared with patients (n=9) with ODI more than 20. In situ fusion due to isthmic spondylolsthesis at adolescence is associated with moderate degenerative changes in the lumbar spine during a 20-year follow-up. Changes were most commonly found at the level of the spondylolisthesis and above fusion level. Neural foramina stenosis seems to be associated with spondylolisthesis and its severity to severity of the slip. Muscle atrophy tended to be mild. However, there was no correlation between patient outcome (ODI) and abnormal lumbar MRI findings.
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PMID:No correlation between patient outcome and abnormal lumbar MRI findings 21 years after posterior or posterolateral fusion for isthmic spondylolisthesis in children and adolescents. 1641 Nov 29

Background. Discopathy most often occurs in persons from 20 to 50 years old, in the period of greatest physical and intellectual capacity, and thus poses a major social problem. The goal of our research was to evaluation the outcome of interbody fusion performed with metal cages. Material and methods. We operated 52 patients ranging in age from 29 to 60, who presented with prolapse of the nucleus pulposus (21 patients), instability (8 patients), lumbar stenosis (11 patients), and recurrent discopathy with spondylolisthesis (12 patients). Interbody fusion was performed on these patients from the posterior approach using metal implants. Results. Applying both subjective and radiological criteria, we obtained good outcome in 36 cases, satisfactory in 12 cases, and unsatisfactory in 4 cases. A follow-up at 4 years after surgery showed that the solution was effective in preventing lumbar stenosis and intervertebral instability. However, there were still difficulties in the assessment of bone union. Conclusions. Maintaining or expanding the height of the interbody space by using implants is indicated by radiography in our material to be the most important surgical intervention justifying the use of this method. Interbody fusion in discopathy using metal implants is a logical solution to prevent secondary stenosis of the vertebral canal and intervertebral instability. The outcomes obtained at 4-year follow-up should be regarded as satisfactory.
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PMID:Outcome in the treatment of discopathy by interbody fusion with the posterior approach using metal cages. 1767 85