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

Prolapse of the lumbar intervertebral disc is one of the commonly accepted causes of low back pain. Most patients respond well to conservative treatment, but some may not respond at all. Though the reason for this variation is not clearly understood, it is felt that a developmentally narrow spinal canal might have some relation to the persistence of backache and sciatica. The canal was therefore measured at each of the lumbar vertebral level by a method described by Jones and Thomson (1969) in 100 consecutive patients operated upon for prolapsed lumbar intervertebral discs, in 100 normal patients for comparison. This method does not give direct measurements of the bony spinal canal but provides a ratio of the size of the canal to the adjacent vertebral body. We found a trend towards the presence of a narrower than normal lumbar canal in patients with prolapsed lumbar intervertebral discs. It is concluded that in patients with prolapsed lumbar intervertebral discs necessitating operation, the canal tends to be narrower than normal, and such narrowing enhances the effect of any disc protrusion leading to severe symptoms of backache and sciatica.
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PMID:Variations in size of the bony lumbar canal in patients with prolapse of lumbar intervertebral discs. 13 69

Midline prolapse of a disc causing compression of the cauda equina is rare but needs urgent diagnosis and surgical treatment. The onset of bladder and rectal paralysis with saddle anaesthesia should be viewed with a high index of suspicion in a patient with backache and sciatica. Eight cases were seen over a period of five years, and they fell into three clinical groups. Group I patients presented with a sudden onset without any previous symptoms related to the back. Group II patients had a history of recurrent episodes of backache and sciatica, the latest episode resulting in involvement of the cauda equina. The group III patient was indistinguishable from one with a tumour as he presented with backache and sciatica slowly progressing to paralysis of the cauda equina. The prolapse was at the disc between L5 and S1 vertebrae in 50 per cent of the patients, most of whom did not have any limitation of straight leg raising. Urgent myelography and equally urgent removal of the disc within two weeks of the onset of the symptoms resulted in almost complete motor and bladder recovery within five months after the operation in most cases. However, recovery of sensation and sexual function was incomplete even four years after the operation.
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PMID:Midline prolapse of a lumbar intervertebral disc with compression of the cauda equina. 15 21

A case of sciatica with partial paralysis of both lower limbs is reported. At operation a prolapse of the L4/5 intervertebral disc on the right side was associated with an anomaly of the left fifth lumbar root which was lower and more horizontal than normal. The authors give a short review of the literature.
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PMID:[A nerve root anomaly with lumbar disc prolapse. Report of a case (author's transl)]. 15 79

Among 120 patients with lumbar disk prolapse treated conservatively over a seven-year period, 72 patients were submitted to follow-up examination, and questionnaires completed by 92 patients were evaluated. Some 23.8% of the patients reported freedom from pain following treatment in hospital. Sciatica cleared up in 43.2%. After discharge from hospital, the average working time lost in 54 patients was 11.1 weeks. Ninety-five percent of the patients reported a return to work within one year. Eighty percent were able to return to their original workplaces. Some 73.8% of the patients surveyed were satisfied or very satisfied with the results of treatment. With respect to sensory disorders 37%, and with respect to paresis 32%, of the patients, reported improvement. Overall, the general and local symptoms, such as changes in gait and posture, percussion pain and tenderness, all showed an appreciably greater tendency to regress than did the neurological deficits.
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PMID:[Lumbar intervertebral disk displacement. Results of conservative treatment]. 137 9

A prospective, randomized, double-blind study was performed to evaluate the clinical efficacy of intradiscal steroid injections. Criteria for entrance were one-level internal disc disruption or nonsequestered nuclear prolapse with or without sciatica and a positive pain response on awake discography. Exclusion criteria were multilevel disease, central or lateral stenosis, prior lumbar surgery, or medical disease requiring systemic steroids. A total of 25 patients were randomly assigned to Treatment Group A (methylprednisolone, Depo-Medrol 80 mg/ml, The Upjohn Co., Kalamazoo, Michigan) or Treatment Group B (bupivacaine, Marcaine .5% 1.5 ml, Sanofi Winthrop Pharmaceuticals, New York, New York). Fourteen patients received Depo-Medrol, with 21% showing subjective improvement and 79% no improvement; 0% were clinically worse. Eleven patients received intradiscal Marcaine, with 9% showing clinical improvement and 91% no improvement; 0% were clinically worse. To quantify clinical response, a pain diagram grid score, a visual analog scale, and the Oswestry Pain Questionnaire were used before injection and 10-14 days after injection. No statistically significant benefit was identified in the use of intradiscal steroids.
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PMID:Intradiscal steroids. A prospective double-blind clinical trial. 138 2

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

From a retrospective review of 932 patients undergoing surgery for prolapsed lumbar intervertebral disc a group of 33 cases with acute urinary retention was studied. There was no identifiable factor which predisposed this subgroup of patients to cauda equina compression. The mean duration of bladder paralysis prior to operation was 3.6 days. Ultimately almost 79% of patients claimed full recovery of bladder function, but only 22% were left without sensory deficit in the limbs or perineum. There was no correlation between recovery and the duration of bladder paralysis before surgery, except in three patients in whom there was no sciatica and where the correct diagnosis was delayed for many days. Retention developing less than 48 h after an acute prolapse was associated with a poorer prognosis. Despite claims that bladder paralysis should be treated with the same urgency as an extradural haematoma, there is no evidence in this study or in the literature to support the view that emergency surgery has any bearing upon the degree of clinical recovery. The exception may be if decompression can be undertaken within 6 h, the time estimated for axonal ischaemia to become irreversible. This should not however engender complacency in the management of this condition, which still requires prompt treatment. Whilst any apparent delay to surgery may have medicolegal implications should the patient fail to recover completely, in the majority of cases the die is cast at the time the prolapse occurs.
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PMID:Prognosis for recovery of bladder function following lumbar central disc prolapse. 239 46

An analysis included 187 patients treated surgically for sciatica due to vertebral disk pathologies. Nerve roots compression was noted in all examined patients, including 54% of left-sided compression, 43% of right-sided, and 3% of bilateral compression. Majority of cases involved nerve roots in L5 (51%) and L4 (36%) segments of the spine. Intra-operationally 139 (87%) out of 160 abnormal radiculographies have been confirmed. Disk disease was diagnosed in 11 patients despite the lack of changes in radiculography. It may be explained by the extremely lateral prolapse of the vertebral disk. Long term course of the disease and clinical picture decide on surgery in such cases.
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PMID:[Clinico-radiological analysis of surgically treated sciatica cases]. 253 66

Seventeen patients with intractable sciatica due to prolapse of a lumbar disc, treated by intradiscal injection of chymopapain (chemonucleolysis) were studied. Analysis of serial 24 hour urine collections showed a significant increase in urinary glycosaminoglycan after chemonucleolysis. This was not detected in four patients undergoing routine discography. Enzymic analysis of urinary glycosaminoglycan after chemonucleolysis suggested that the increase in levels was largely due to an increase in the amounts of chondroitin sulphate present, probably resulting from proteoglycan breakdown in the intervertebral disc. Eight of the patients treated by chemonucleolysis underwent serial computed tomography (CT). One month after the injection the only change seen was a loss of definition of the disc prolapse, which could be interpreted as a loss of turgidity in the disc as a result of proteoglycan breakdown by chymopapain. By six months the CT of those patients whose symptoms had improved showed that the degree of disc prolapse was usually less marked and the disc margin more clearly defined, suggesting that by this stage anatomical remodelling had occurred.
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PMID:Mechanism of action of intradiscal chymopapain in the treatment of sciatica: a clinical, biochemical, and radiological study. 372 72

A very unusual case if described of ischialgia coexistent with phantom pains in the amputated extremity. The cause of pain was prolapse of a lumbar intervertebral disc diagnosed only during operation. The case points out the necessity of differentiating between postamputation pains and pains not directly related to amputation. This differentiation may help in successful treatment.
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PMID:[Atypical pain syndrome after amputation of the lower limb]. 672 13


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