1/7. Disc herniation after lumbar fusion.STUDY DESIGN: Eight patients with a herniated disc after lumbar spinal fusion are reported. Their clinical features, imaging studies, and management are reported. OBJECTIVES: To identify the incidence and features of disc herniation above a spinal fusion, and to describe their management. SUMMARY OF BACKGROUND DATA: Late complications of lumbar spinal fusions have been reported in the literature, but disc herniation has not been specifically addressed in detail. The motion segment above a spinal fusion undergoes additional stresses, as documented by increased pressure and excessive motion, resulting in degenerative changes. These factors likely predispose to disc herniation. methods: Of 601 consecutive lumbar fusion cases over an 8-year period, herniated nucleus pulposus above the fusion was diagnosed in 8 patients. The clinical findings and imaging studies were reviewed, including a myelogram computed tomography scan, a magnetic resonance image with positive documentation of the herniation, or both. The management of these cases was reviewed. RESULTS: Eight patients (1.3%) (4 men and 4 women) were identified, whose average age was 56.4 years. Nonoperative treatment failed in six patients. Two of these patients underwent simple discectomy, and the remaining four underwent discectomy and fusion. All four patients went on to fusion. The average time from disc herniation onset to fusion was 28.4 months. CONCLUSIONS: Herniated disc after lumbar spinal fusion was found in approximately 1.3% of patients. Although rare, this entity that should be considered when patients complain of recurring back pain after a lumbar spinal fusion.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
2/7. Two anaphylactic deaths after chemonucleolysis.Chemonucleolysis is a procedure for treatment of low back pain due to discogenic disease in which the drug chymopapain is injected into lumbar disks to produce chemical dissolution of the nucleus pulposus. More than 15,000 cases have been treated by chemonucleolysis world-wide. anaphylaxis after the injection of chymopapain occurs in about 1% of such cases. The two cases described in this paper are the only known deaths due to anaphylaxis. Both patients suddenly became hypotensive after injection of chymopapain into a disk. One patient died shortly after this, whereas the second patient died of the complications of prolonged shock.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
3/7. Management of herniated intervertebral disks during saturation dives: a case report.During research saturation dives at 5.0 and 5.5 atm abs, 2 divers developed an acute herniation of the nucleus pulposus of the L5-S1 intervertebral disk. In both cases the pain was severe enough to require intravenous morphine or intramuscular meperidine. Although the symptoms presented by these divers are frequently considered to be an indication for immediate surgical consultation, we decided that emergency decompression posed an unacceptable risk that decompression sickness (DCS) would develop in the region of acute inflammation. In both cases strict bedrest and medical therapy were performed at depth. In the first case, 12 h was spent at depth before initiating a standard U.S. Navy saturation decompression schedule with the chamber partial pressure of oxygen elevated to 0.50 atm abs. In the second case, a conservative He-N2-O2 trimix decompression schedule was followed to the surface. In both cases, no initial upward excursion was performed. The required decompression time was 57 h 24 min from 5.5 atm abs and 55 h 38 min from 5.0 atm abs. During the course of decompression, the first diver's neurologic exam improved and he required decreasing amounts of intravenous narcotic; we considered both to be evidence against DCS. The second diver continued to have pain and muscle spasm throughout decompression, however he did not develop motor, reflex, or sphincter abnormalities. Both divers have responded well to nonsurgical therapy.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
4/7. Resolution of back pain with the wide abdominal rectus plication abdominoplasty.Back pain is classified most easily into three types (1) muscle spasm, (2) herniated nucleus pulposus (HNP), and (3) facet syndrome and/or nerve compression. It is possible the wide abdominal rectus plication procedure will be beneficial to all three groups, but currently I limit the procedure to those back pain patients who are improved with a back brace or corset and those without back pain undergoing elective abdominoplasty. Contraindications would be (1) anticipating additional pregnancy, (2) back pain not relieved or improved by corset or brace, (3) severe or progressive disk signs, and (4) bladder and/or bowel dysfunction. Further detailed studies of the mechanism of action and of the biomechanical effect as evaluated by conventional radiology, CAT scan, and nuclear magnetic resonance imaging, as well as physical measurement, are in progress and will be forthcoming.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
5/7. Extradural lipomatosis simulating an acute herniated nucleus pulposus. Case report.A 48-year-old laborer presented with a 1-year history of low-back pain radiating into the posterior aspects of both thighs. Two weeks before admission, acute exacerbation resulted in signs and symptoms of compressive radiculopathy at L-5. myelography revealed concentric constriction of the lower thecal sac due to abundant fat, as shown by computerized tomography. laminectomy produced immediate relief of pain. The significance of these findings and a review of the literature are presented.- - - - - - - - - - ranking = 4keywords = nucleus (Clic here for more details about this article) |
6/7. New-onset sciatica after automated percutaneous discectomy.This is a case report of a 24-year-old patient who underwent percutaneous discectomy at L5-S1 for relief of lower back pain. Postoperatively, new-onset acute right lumbar radicular syndrome developed and the postoperative MRI scan confirmed a far lateral extraforaminal disc herniation at L5-S1 with compression of the right nerve. This corresponded to the nucleotomy site of the probe. This case report emphasizes that all physicians who treat herniated nucleus pulposus should be well versed in all aspects of treatment including complications.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
7/7. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain.Approximately 12 million Americans undergo spinal manipulation therapy (SMT) every year. Renewed interest in this method requires an analysis of its reported risks and possible benefits. This review describes two patients with spinal cord injuries associated with SMT and establishes the risk/benefit ratios for patients with lumbar or cervical pain. The first case is a man who underwent SMT for recurrent sciatica 4 years after chemonucleolysis. During therapy, he developed bilateral sciatica with urinary hesitancy. After self-referral, myelography demonstrated a total block; he underwent urgent discectomy with an excellent result 3 months after surgery. The second patient with an indwelling Broviac catheter and a history of lumbar osteomyelitis underwent SMT for neck pain. Therapy continued for 3 weeks despite the development of severe quadriparesis. After self-referral, he underwent an urgent anterior cervical decompression and removal of necrotic bone and an epidural abscess with partial neurological recovery. An analysis of these cases and 138 cases reported in the literature demonstrates six risk factors associated with complications of SMT. These include misdiagnosis, failure to recognize the onset or progression of neurological signs or symptoms, improper technique, SMT performed in the presence of a coagulation disorder or herniated nucleus pulposus, and manipulation of the cervical spine. Clinical trials of SMT have been summarized in several recent articles.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |