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Sample records for vacuum disc herniation

  1. Herniated Cervical Disc

    MedlinePLUS

    ... Your doctor or physical therapist may also use traction, electric stimulation, hot packs, cold packs and manual (" ... point injections do not help heal a herniated cervical disc. For patients whose pain does not improve ...

  2. Herniated Lumbar Disc

    MedlinePLUS

    ... 50. A herniated lumbar disc may also cause back pain, although back pain alone (without leg pain) can have many causes ... 90% success); surgery is less effective in relieving back pain. Nonsurgical treatment Your doctor may prescribe nonsurgical treatments ...

  3. LUMBAR DISC HERNIATION

    PubMed Central

    Vialle, Luis Roberto; Vialle, Emiliano Neves; Suárez Henao, Juan Esteban; Giraldo, Gustavo

    2015-01-01

    Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physiotherapy, sometimes associated with percutaneous nerve root block. Surgical treatment is indicated if pain control is unsuccessful, if there is a motor deficit greater than grade 3, if there is radicular pain associated with foraminal stenosis, or if cauda equina syndrome is present. The latter represents a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence over the long term.

  4. Thoracic disc herniations.

    PubMed

    Dietze, D D; Fessler, R G

    1993-01-01

    Because of the protean nature of thoracic disc disease, surgeons should maintain a high order of suspicion of a thoracic disc herniation in the patient with unexplained localized back or torso pain and sensorimotor deficits. These patients should have MR imaging performed as a screening test, and, if suspicious for a thoracic disc herniation, confirmatory myelogram and postmyelogram CT imaging. Though the natural history is anecdotal, there appears to be a tendency for myelopathic symptoms and signs to be progressive, warranting surgical intervention. For radicular dysfunction or localized back pain, a conservative therapeutic plan is recommended. If intractable pain is demonstrated, and the diagnosis is certain, then surgical intervention is recommended. Once surgical intervention is recommended the surgical approach needs to be individualized according to the surgeon's skills and experience and the specifics of the patient's pathology. Appropriate surgical decision-making depends on an understanding of the variety of surgical options and their advantages and disadvantages, and an understanding of the biomechanical factors of the spine of the individual patient. Surgical concepts important to successful thoracic disc removal are (1) minimal spinal cord manipulation, (2) preservation of the neurovascular supply whenever possible, (3) minimal manipulation of the intercostal nerve, and (4) preservation of maximal bony and ligamentous attachments allowable for adequate exposure. Lastly it is recommended that the posterior longitudinal ligament be removed to ensure complete spinal cord decompression. PMID:8428158

  5. Radicular interdural lumbar disc herniation.

    PubMed

    Akhaddar, Ali; Boulahroud, Omar; Elasri, Abad; Elmostarchid, Brahim; Boucetta, Mohammed

    2010-07-01

    Intraradicular lumbar disc herniation is a rare complication of disc disease that is generally diagnosed only during surgery. The mechanism for herniated disc penetration into the intradural space is not known with certainty, but adhesion between the radicular dura and the posterior longitudinal ligament was suggested as the most important condition. The authors report the first case of an intraradicular lumbar disc herniation without subdural penetration; the disc hernia was lodged between the two radicular dura layers. The patient, a 34-year-old soldier, was admitted with a 12-month history of low back pain and episodic left sciatica. Neurologic examination showed a positive straight leg raising test on the left side without sensory, motor or sphincter disturbances. Spinal CT scan and MRI exploration revealed a left posterolateral osteophyte formation at the L5-S1 level with an irregular large disc herniation, which migrated superiorly. An intradural extension was suspected. A left L5 hemilaminectomy and S1 foraminotomy were performed. The exploration revealed a large fragment of disc material located between the inner and outer layers of the left S1 radicular dura. The mass was extirpated without cerebrospinal fluid outflow. The postoperative course was uneventful. Radicular interdural lumbar disc herniation should be suspected when a swollen, hard and immobile nerve root is present intraoperatively. PMID:19888608

  6. The Actual Level of Symptomatic Soft Disc Herniation in Patients with Cervical Disc Herniation

    PubMed Central

    Choi, Su Yong; Kim, Woo Kyung; Son, Seong; Jeong, Tae Seok

    2015-01-01

    Objective The aim of this study was to predict the relationship between the symptomatic disc herniation level and the osteophyte level or decreased disc height in patients with cervical disc herniation. Methods Between January 2011 and December 2012, 69 patients with an osteophyte of the cervical spine underwent surgery at a single center due to soft cervical disc herniation. Data including soft disc herniation level, osteophyte level in the posterior vertebral margin, Cobb's angle, and symptom duration were retrospectively assessed. The patients were divided into three groups according to the relationship between the degenerative change level and the level of reported symptoms. Results Among the 69 patients, 48 (69.6%) showed a match between osteophyte level and soft disc herniation level. Disc herniation occurred at the adjacent segment to degenerative osteophyte level in 12 patients (17.4%) and at both the adjacent and the osteophyte level in nine (13.0%). There was no significant difference in Cobb's angle or duration among the three groups. Osteophyte type was not significant. The mean disc height of the prominent degenerative change level group was lower than the adjacent segment level, but this was not significant. Conclusion Soft cervical disc herniation usually occurs at the level an osteophyte forms. However, it may also occur at segments adjacent to that of the osteophyte level. Therefore, in patients with cervical disc herniation, although a prominent osteophyte alone may appear on plain radiography, we must suspect the presence of soft disc herniation at other levels. PMID:26512266

  7. [Lumbar disc herniation and andrological diseases].

    PubMed

    Jin, Bao-fang

    2015-10-01

    Lumbar disc herniation is a common male disease. In the past, More academic attention was directed to its relationship with lumbago and leg pain than to its association with andrological diseases. Studies show that central lumber intervertebral disc herniation may cause cauda equina injury and result in premature ejaculation, erectile dysfunction, chronic pelvic pain syndrome, priapism, and emission. This article presents an overview on the correlation between central lumbar intervertebral disc herniation and andrological diseases, focusing on the aspects of etiology, pathology, and clinical progress, hoping to invite more attention from andrological and osteological clinicians. PMID:26665671

  8. [Physiotherapy in lumbar disc herniation ].

    PubMed

    Stoll, T; Germann, D; Hagmann, H

    2001-08-01

    Physiotherapy is the treatment of choice in patients with symptoms caused by a lumbar disc herniation. In clinical practice a broad range of physiotherapeutic modalities has been revealed to be helpful. During the acute stage the efficacy of the McKenzie-concept, mobilisation therapies and traction has been demonstrated in randomized controlled trials with a blind assessor. In addition, pain reducing physical therapies such as cold or electrotherapy and non-steroidal anti-inflammatory drugs, analgesics and/or muscle relaxants are sensible initial accompanying treatments. The effectiveness of active physiotherapies such as training of local strength endurance of back and abdominal muscles has been proven in patients during the chronic stage. The indications for a in-patient rehabilitation programme, for surgery and the danger of developing chronic low back pain are discussed. PMID:11552355

  9. Clinical and Radiological Characteristics of Lumbosacral Lateral Disc Herniation in Comparison With Those of Medial Disc Herniation.

    PubMed

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-02-01

    Lateral disc herniation (foraminal and extra foraminal) has clinical characteristics that are different from those of medial disc herniation (central and subarticular), including older age, more frequent radicular pain, and neurologic deficits. This is supposedly because lateral disc herniation mechanically irritates or compresses the exiting nerve root or dorsal root ganglion inside of a narrow canal more directly than medial disc herniation. The purpose of this study was to investigate clinical and radiological characteristics of lateral disc herniation in comparison with medial disc herniation. The 352 subjects diagnosed with localized lumbosacral disc herniation and followed up for at least 12 months after completion of treatment were included and divided into medial and lateral disc herniation groups, according to the anatomical location of the herniated disc in axial plain of magnetic resonance image. Clinical and radiological data were obtained and compared between the two groups. The lateral group included 74 (21%) patients and the medial group included 278 (79%). Mean age of the lateral group was significantly higher than that in the medial group. The lateral group showed a significantly larger proportion of patients with radiating leg pain and multiple levels of disc herniations than the medial group. No significant differences were found in terms of gender, duration of pain, pretreatment numeric rating scale, severity of disc herniation (protrusion and extrusion), and presence of weakness in leg muscles. The proportion of patients who underwent surgery was not significantly different between the 2 groups. However, the proportion of patients who accomplished successful pain reduction after treatment was significantly smaller in the lateral than in the medial group. In conclusion, patients with lateral disc herniation were older and had larger proportion of radiating leg pain than those with medial disc herniation. Lateral disc herniation was more associated with multiple disc herniations and worse clinical outcomes after treatment than medial disc herniation. PMID:26886615

  10. Chemonucleolysis as Treatment for Herniated Lumbar Disc

    PubMed Central

    Alexander, David I.

    1986-01-01

    Herniated disc, while not the most common cause of low back pain, is the most common reason for surgery to relieve back pain. An alternative to surgery when sciatic pain is the result of disc herniation is chemonucleolysis with chymopapain. Since this enzyme is effective only in very specific circumstances, proper patient selection is crucial. Five criteria for selection are presented, emphasizing that since chemonucleolysis is not conservative treatment, it should be reserved for patients whose pain is unrelieved by conservative methods. There are several important contraindications to chemonucleolysis: allergy to chymopapain, risk of injury to the cauda equina, disc lesions at cord levels, pregnancy, patient's age (not recommended for adolescents) and sequestrated disc. Technique is exacting and should be limited to surgeons with the opportunity for concentrated experience. ImagesFig. 1 PMID:21274248

  11. Risk Factors for Recurrent Lumbar Disc Herniation

    PubMed Central

    Huang, Weimin; Han, Zhiwei; Liu, Jiang; Yu, Lili; Yu, Xiuchun

    2016-01-01

    Abstract Recurrent lumbar disc herniation (rLDH) is a common complication following primary discectomy. This systematic review aimed to investigate the current evidence on risk factors for rLDH. Cohort or case-control studies addressing risk factors for rLDH were identified by search in Pubmed (Medline), Embase, Web of Science, and Cochrane library from inception to June 2015. Relevant results were pooled to give overall estimates if possible. Heterogeneity among studies was examined and publication bias was also assessed. A total of 17 studies were included in this systematic review. Risk factors that had significant relation with rLDH were smoking (OR 1.99, 95% CI 1.53–2.58), disc protrusion (OR 1.79, 95% CI 1.15–2.79), and diabetes (OR 1.19, 95% CI 1.06–1.32). Gender, BMI, occupational work, level, and side of herniation did not correlate with rLDH significantly. Based on current evidence, smoking, disc protrusion, and diabetes were predictors for rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. More evidence provided by high-quality observational studies is still needed to further investigate risk factors for rLDH. PMID:26765413

  12. Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

    PubMed Central

    O'Connell, Grace D.; Leach, J. Kent; Klineberg, Eric O.

    2015-01-01

    Abstract The intervertebral disc is a critical part of the intersegmental soft tissue of the spinal column, providing flexibility and mobility, while absorbing large complex loads. Spinal disease, including disc herniation and degeneration, may be a significant contributor to low back pain. Clinically, disc herniations are treated with both nonoperative and operative methods. Operative treatment for disc herniation includes removal of the herniated material when neural compression occurs. While this strategy may have short-term advantages over nonoperative methods, the remaining disc material is not addressed and surgery for mild degeneration may have limited long-term advantage over nonoperative methods. Furthermore, disc herniation and surgery significantly alter the mechanical function of the disc joint, which may contribute to progression of degeneration in surrounding tissues. We reviewed recent advances in tissue engineering and regenerative medicine strategies that may have a significant impact on disc herniation repair. Our review on tissue engineering strategies focuses on cell-based and inductive methods, each commonly combined with material-based approaches. An ideal clinically relevant biological repair strategy will significantly reduce pain and repair and restore flexibility and motion of the spine. PMID:26634189

  13. Sacral Perineural Cyst Accompanying Disc Herniation

    PubMed Central

    Ju, Chang Il; Shin, Ho; Kim, Hyeun Sung

    2009-01-01

    Although most of sacral perineural cysts are asymptomatic, some may produce symptoms. Specific radicular pain may be due to distortion, compression, or stretching of nerve root by a space occupying cyst. We report a rare case of S1 radiculopathy caused by sacral perineural cyst accompanying disc herniation. The patient underwent a microscopic discectomy at L5-S1 level. However, the patient's symptoms did not improved. The hypesthesia persisted, as did the right leg pain. Cyst-subarachnoid shunt was set to decompress nerve root and to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and cyst. Immediately after surgery, the patient had no leg pain. After 6 months, the patient still remained free of leg pain. PMID:19352483

  14. [Cervical disc herniation--diagnosis and treatment].

    PubMed

    Corniola, M-V; Tessitore, E; Schaller, K; Gautschi, O P

    2015-10-28

    A cervical disc herniation (CDH) is a frequently encountered pathology in primary care medicine. It may give rise to a compression of a nerve root (a radiculopathy, with or without sensory-motor deficit) or of the spinal cord (myelopathy). The majority of CDHs can be supported by means of a conservative treatment. When a radiculopathy is found and a clinico-radiological correlation is present, a moderate neurological deficit appears suddenly, or if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during 6 to 8 months, surgery is then recommended. A symptomatic cervical myelopathy is, by itself, an indication for a surgical treatment. PMID:26672182

  15. Spinal Neurofibroma Masquerading as a Herniated Disc: A case report.

    PubMed

    Lamki, Tariq; Ammirati, Mario

    2012-11-01

    We present the only case in English medical literature of a spinal neurofibroma misdiagnosed as a herniated disc using magnetic resonance imaging (MRI). This case presented with typical symptoms and radiological findings of a herniated disc. Intraoperatively, an abnormality was noted at the S1 nerve root sleeve. Further exploration revealed a spinal neurofibroma which was completely resected, resulting in an improvement in the patient's symptoms. Currently, there is heavy reliance on MRI as a highly sensitive and specific tool used in the diagnosis of herniated lumbar discs. Although there have been occasional reports of misdiagnoses using MRI, there are no reported cases of a spinal neurofibroma being misdiagnosed as a herniated lumbar disc. Despite great advances in radiological diagnostic imaging, surgical surprises do still occur. Ultimately, instinct is still essential in intraoperative surgical decisions. PMID:23275853

  16. A symptomatic spinal extradural arachnoid cyst with lumbar disc herniation.

    PubMed

    Kadono, Yoshinori; Yuguchi, Takamichi; Ohnishi, Yu-Ichiro; Iwatsuki, Koichi; Yoshimine, Toshiki

    2015-01-01

    Spinal epidural arachnoid cyst (EAC) is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression. PMID:25861499

  17. Concomitance of fibromyalgia syndrome and cervical disc herniation

    PubMed Central

    Gler, Mustafa; Ayd?n, Teoman; Akgl, Erdal; Ta?p?nar, zgr

    2015-01-01

    [Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C23, 16.6% C56, 16.6% C67, 33.3% C45, C56 (two levels in two patients) and 16.6% C45, C56, C71 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population. PMID:25931731

  18. Clinical Outcomes of Epidural Neuroplasty for Cervical Disc Herniation

    PubMed Central

    Park, Eun Jung; Park, Sun Young; Lee, Se Jin; Koh, Do Yle

    2013-01-01

    Cervical disc herniation is a common disorder characterized by neck pain radiating to the arm and fingers as determined by the affected dermatome. This condition has a favorable prognosis, but pain can have a serious detrimental impact on daily activities. Epidural neuroplasty has been applied as a treatment option for cervical disc herniation; however, no study has addressed the clinical outcomes. This retrospective study evaluated the clinical outcomes of epidural neuroplasty on 128 patients for the treatment of cervical disc herniation. To measure pain-related disabilities over time, the changes of pain scores in neck and arm were evaluated using a numerical rating scale (NRS) and the neck disability index (NDI). Compared with preprocedural values, the pain NRS of neck and arm demonstrated significant improvement at day 1, and 1, 3, 6, and 12 months after the procedure (P < 0.001). Likewise, the NDI was significantly reduced at 3, 6, and 12 months after the procedure (P < 0.001). There were no serious complications. Cervical epidural neuroplasty shows good clinical outcomes in the treatment of cervical disc herniation and can be considered a treatment modality for cervical disc herniation refractory to conservative treatment. PMID:23487574

  19. Spontaneous Intracranial Hypotension Secondary to Lumbar Disc Herniation

    PubMed Central

    Kim, Kyoung-Tae

    2010-01-01

    Spontaneous intracranial hypotension is often idiopathic. We report on a patient presenting with symptomatic intracranial hypotension and pain radiating to the right leg caused by a transdural lumbar disc herniation. Magnetic resonance (MR) imaging of the brain revealed classic signs of intracranial hypotension, and an additional spinal MR confirmed a lumbar transdural herniated disc as the cause. The patient was treated with a partial hemilaminectomy and discectomy. We were able to find the source of cerebrospinal fluid leak, and packed it with epidural glue and gelfoam. Postoperatively, the patient's headache and log radiating pain resolved and there was no neurological deficit. Thus, in this case, lumbar disc herniation may have been a cause of spontaneous intracranial hypotension. PMID:20157378

  20. Treatment of lumbar disc herniation by percutaneous laser disc decompression (PLDD) and modified PLDD

    NASA Astrophysics Data System (ADS)

    Chi, Xiao fei; Li, Hong zhi; Wu, Ru zhou; Sui, Yun xian

    2005-07-01

    Objective: To study the micro-invasive operative method and to compare the effect of treatment of PLDD and modified PLDD for Lumbar Disc Herniation. Method: Vaporized part of the nucleus pulposus in single or multiple point after acupuncture into lumbar disc, to reach the purpose of the decompression of the lumbar disc. Result: Among the 19 cases of the regular PLDD group, the excellent and good rate was 63.2%, and among the 40 cases of the modified PLDD group, the excellent and good rate was 82.5%. Conclusion: The modified PLDD has good effect on the treatment for lumbar disc herniation.

  1. [Minimally invasive surgery in treatment of lumbar intervertebral disc herniation].

    PubMed

    Rotim, Kreimir; Sajko, Tomislav; Bori?, Marta; Subai?, Ante

    2015-01-01

    Surgical treatment of lumbar intervertebral disc herniation is one of the most common neurosurgical procedures. Besides conventional surgical techniques, in the last more than 30 years, different methods with minimal damage to neuromuscular spine structures are being developed and introduced, all having the purpose of reducing postoperative back pain. The advantages of the minimally invasive spine surgery include: possibility of performing procedures under local anaesthesia, reduced hospital stay, limited blood loss with consecutively reduced fibrous tissue development. Patients are capable of return to work and everyday activities early after surgery. From the economical point of view, this kind of treatment is considered to be a cost-effective intervention. Three methods that are being used for treatment of lumbar intervertebral disc herniation are: percutaneous laser disc decompression (PLDD), microdiscectomy using tubular retractor system and selective endoscopic discectomy (SED). Conducted prospective studies have shown that minimally invasive methods are adequate alternative to classic surgical procedures. PMID:26065287

  2. Spontaneous regression of cervical disc herniation: a case report.

    PubMed

    Han, Seong Rok; Choi, Chan Young

    2014-12-01

    Spontaneous regression of cervical disc herniation is a rare, and such reports are few. A 39 year-old woman complained of severe neck pain associated with tingling and numbness of right upper extremity. The MRI of the cervical spine revealed a posterior disc extrusion at the C4-C5 level in the right para-central location. The patient was treated with conservative management without any surgical treatment. The patient's symptoms were significant improvement. After two years later, we performed follow-up cervical MRI that revealed significant spontaneous regression of the C4-C5 intervertebral disc extrusion. PMID:25620984

  3. Huge Intracanal lumbar Disc Herniation: a Review of Four Cases.

    PubMed

    Omidi-Kashani, Farzad; Faraji Rad, Mohammad

    2016-01-01

    Lumbar disc herniation (LDH) is the most common cause of sciatica and only in about 10% of the affected patients, surgical intervention is necessary. The side of the patient (the side of most prominent clinical complaints) is usually consistent with the side of imaging (the side with most prominent disc herniation on imaging scans). In this case series, we presented our experience in four cases with huge intracanal LDH that a mismatch between the patient's side and the imaging's side was present. In these cases, for deciding to do the operation, the physicians need to rely more on clinical findings, but for deciding the side of discectomy, imaging characteristic (imaging side) may be a more important criterion. PMID:26853296

  4. Automatic diagnosis of lumbar disc herniation with shape and appearance features from MRI

    NASA Astrophysics Data System (ADS)

    Alomari, Raja'S.; Corso, Jason J.; Chaudhary, Vipin; Dhillon, Gurmeet

    2010-03-01

    Intervertebral disc herniation is a major reason for lower back pain (LBP), which is the second most common neurological ailment in the United States. Automation of herniated disc diagnosis reduces the large burden on radiologists who have to diagnose hundreds of cases each day using clinical MRI. We present a method for automatic diagnosis of lumbar disc herniation using appearance and shape features. We jointly use the intensity signal for modeling the appearance of herniated disc and the active shape model for modeling the shape of herniated disc. We utilize a Gibbs distribution for classification of discs using appearance and shape features. We use 33 clinical MRI cases of the lumbar area for training and testing both appearance and shape models. We achieve over 91% accuracy in detection of herniation in a cross-validation experiment with specificity of 91% and sensitivity of 94%.

  5. Changes in disc herniation after CT-guided Percutaneous Laser Disc Decompression (PLDD): MR findings

    NASA Astrophysics Data System (ADS)

    Brat, Hugues G.; Bouziane, Tarik; Lambert, Jean; Divano, Luisa

    2004-09-01

    The aim of Percutaneous Laser Disc Decompression (PLDD) is to vaporize a small portion of the nucleus pulposus. Clinical efficacy of this technique is largely proven. However, time-evolution of intervertebral disc and its hernia after PLDD is not known. This study analyses changes in disc herniation and its native intervertebral disc at a mean follow-up of 7.5 months after PLDD in asymptomatic patients. Main observations at MRI are appearance of a high signal on T2WI in the hernia in 59%, shrinking of the hernia in 66% and overall stability of disc height.

  6. Soft disc herniation of the cervical spine.

    PubMed

    Yamano, Y

    1985-01-01

    The definition of soft disc hernia of the cervical spine is not always clear, so we have studied 34 cases where soft disc material was extruded or had migrated outside the intervertebral space. There were 22 cases of the paracentral-central type and 12 cases of the posterolateral type. The diagnosis was made by discography using anteroposterior, lateral and both oblique radiographs. All the patients complained of pain or discomfort in the neck or the interscapular region which was increased by the neck compression test and reproduced during discography. Severe pain in the area was present in all the cases of the posterolateral type and in about half of the paracentral-central type. Cord signs, such as increased reflexes in the lower limbs, were found in 15 cases of the paracentral-central type and in 5 cases of the posterolateral type. These signs correlated with the width of the spinal canal and the amount of prolapsed disc material. Discography and reproduction of pain were most useful for the diagnosis of this type of hernia. It has now become possible to differentiate the paracentral type from the central type by performing computerised tomography scanning after discography. We treated 12 cases conservatively and 22 cases surgically, and obtained good results in both groups. PMID:4018967

  7. Psychopathological Influence of Lumbar Disc Herniation in Male Adolescent

    PubMed Central

    Kim, Tae Woo; Oh, Chang Hyun; Shim, Yu Sik; Park, Hyeong-chun; Park, Chong Oon

    2013-01-01

    Purpose There is no report about psychopathological effect causing by disc herniation. The disease could impose psychopathological influence on the social life, the treatment period, and response to the treatment. This study was to evaluate retrospectively the psychopathological influence of lumbar disc herniation (LDH) among Korean 19-year-old males. Materials and Methods We compared the Korean military multiphasic personality inventory (KMPI) profiles of 74 LDH cases with the KMPI profiles of 150 controls. The LDH groups were categorized to 2 groups according to the presence of thecal sac compression by disc materials, and evaluated the relation between the KMPI and LDH. Results The decrease of the faking-good response scale and increase of the faking-bad response scale were observed more in the LDH group than in the normal volunteer group (p<0.05). The neurosis set such as anxiety, depression and somatization was markedly increased in the LDH group compared to the normal volunteers group (p<0.05). The scale of personality disorder was also increased more in the LDH group (p=0.002). The differences of KMPI scales were not correlated with the severe pathology of LDH. Conclusion Young male with LDH may tend to have more abnormal results of multiphasic personality inventory test compared to the normal volunteers, suggesting that LDH may be related to the psychopathology in young males in Korea. Therefore, clinicians are recommended to evaluate and treat the psychopathological aspects in patients with LDH. PMID:23709412

  8. Anterior Herniation of Partially Calcified and Degenerated Cervical Disc Causing Dysphagia.

    PubMed

    Ozdol, Cagatay; Turk, Cezmi Cagri; Yildirim, Ali Erdem; Dalgic, Ali

    2015-08-01

    We report a rare case of anterior cervical disc herniation associated with dysphagia. A 32-year-old man presented with complaints of dysphagia and concomitant pain in the right arm resistant to conservative therapy. On physical examination with respect to the muscle strength, the right shoulder abduction and flexion of the forearm were 3/5. Lateral X-ray revealed calcified osteophytes at the anterior C4-5 level. Magnetic resonance imaging showed soft disc herniation involving the right C6 root at the C5-6 level and anterior herniation of the C4-5 cervical disc. Anterior discectomies for C4-5 and C5-6 levels stabilized and ameliorated the dysphagia and pain. Cervical disc herniation usually presents with radicular findings. However, dysphagia may be an uncommon presentation. Anterior cervical disc herniation should be considered in a patient presenting with dysphagia. PMID:26240723

  9. Anterior Herniation of Partially Calcified and Degenerated Cervical Disc Causing Dysphagia

    PubMed Central

    Turk, Cezmi Cagri; Yildirim, Ali Erdem; Dalgic, Ali

    2015-01-01

    We report a rare case of anterior cervical disc herniation associated with dysphagia. A 32-year-old man presented with complaints of dysphagia and concomitant pain in the right arm resistant to conservative therapy. On physical examination with respect to the muscle strength, the right shoulder abduction and flexion of the forearm were 3/5. Lateral X-ray revealed calcified osteophytes at the anterior C4-5 level. Magnetic resonance imaging showed soft disc herniation involving the right C6 root at the C5-6 level and anterior herniation of the C4-5 cervical disc. Anterior discectomies for C4-5 and C5-6 levels stabilized and ameliorated the dysphagia and pain. Cervical disc herniation usually presents with radicular findings. However, dysphagia may be an uncommon presentation. Anterior cervical disc herniation should be considered in a patient presenting with dysphagia. PMID:26240723

  10. Interlaminar discectomy and selective foraminotomy in lumbar disc herniation.

    PubMed

    Garg, Manish; Kumar, Sudhir

    2001-12-01

    Our objective was to assess the clinical outcome of interlaminar discectomy in patients suffering with degenerated lumbar disc lesions. We made a prospective study of 50 consecutive patients who underwent limited lumbar discectomy. The clinico-radiological parameters, type of surgery performed and the post-operative follow up were assessed. We found that interlaminar discectomy without laminotomy was adequate in 33 cases (66%). Most patients requiring laminotomy (17 cases -34%) for discectomy had associated lumbar canal stenosis, herniation at proximal levels (L3-4) and/or sacralization of L5 vertebra. Selective foraminotomy in addition to discectomy was performed in 28 cases (56%). The post-operative results were good in 43 (86%fair in 6 (12%) and poor subjective in 1 case (2%). No patient was classified as poor objective. In conclusion, interlaminar discectomy without laminotomy is a safe, effective and reliable surgical technique for treating properly selected patients with herniated lumbar disc at L4-5 and L5-S1 levels. PMID:12118125

  11. Chronic abdominal pain caused by thoracic disc herniation.

    PubMed

    Whitcomb, D C; Martin, S P; Schoen, R E; Jho, H D

    1995-05-01

    A patient with 7 yr of severe disabling chronic epigastric abdominal pain attributed to chronic pancreatitis was seen in consultation before a 95% pancreatectomy for pain control. Previous attempts to identify and treat the pain lead to extensive radiographic, pharmacological, endoscopic, and surgical interventions, including a Roux-en-Y pancreaticojejunostomy. Pain control was poor despite implantation of a continuous intrathecal morphine infusion pump. A focused physical examination, however, raised the suspicion of thoracic disc disease, which was confirmed after myelogram with computed tomography. Disruption of the T7-T8 disc with protrusion into the vertebral canal and displacement of the spinal cord with an associated bone spur were identified. A microsurgical thoracic discectomy was performed. Immediately, the pain began resolving, and she was pain free and off her medications within several weeks. To our knowledge, this is the first description of a herniated thoracic disc presenting as the pain of chronic pancreatitis. The diagnosis of thoracic disc syndrome requires a high index of suspicion and should be considered in patients with chronic abdominal pain. PMID:7733103

  12. Disappearing large calcified thoracic disc herniation in a patient with thalassaemia.

    PubMed

    Ahmad, Faiz U; Schallert, Erica; Bregy, Amade; Post, Judith D; Vanni, Steven

    2016-01-01

    Regression of herniated disc fragments with subsequent improvement in clinical symptoms has been reported in the lumbar and cervical spine. Such regressions in the thoracic spine are extremely rare. We report a case of a 38-year-old patient with thalassaemia who had regression of a large calcified herniated thoracic disc causing cord compression, with subsequent herniation of a second calcified disc at a different level and discuss the possible aetiopathogenesis. This is the first such case reported in the thalassaemia population. PMID:26823353

  13. Adolescent lumbar disc herniation in a Tae Kwon Do martial artist: a case report

    PubMed Central

    Kazemi, Mohsen

    1999-01-01

    Lumbar disc herniations are rare in children. The etiology and clinical picture may be different in children than in adults. Conservative management is the treatment of choice. Tae Kwon Do is a Korean martial art which is notorious for its high fast kicks. Tae Kwon Do will be an official Olympic sport in the year 2000. Low back pain is occasionally reported by Tae Kwon Do athletes but there are no reported cases in the literature on disc herniation in a Tae Kwon Do athlete. A case report is presented to illustrate clinical presentation, diagnosis, radiological assessment and conservative management of lumbar disc herniation in children. ImagesFigure 1Figure 2

  14. The use of opioids in a pregnant woman with lumbar disc herniation: a case report.

    PubMed

    Matsumoto, Emi; Yoshimura, Kazuaki; Nakamura, Eiichiro; Hachisuga, Toru; Kashimura, Masamichi

    2009-01-01

    It is not easy to diagnose lumbar disc herniation during pregnancy due to the limitation of the examinations and it is also difficult to control the severe pain during this time. A pregnant woman with lumbar disc herniation was transferred to our hospital at the 23rd week of gestation. The pain was successfully controlled with opioids and epidural anesthesia. At the 35th week of gestation, she delivered a girl weighing 2316 g smoothly with an Apgar score of 8/9 without neonatal abstinence syndrome from morphine. In this case, opioid administration was found to be useful for perinatal care with lumbar disc herniation. PMID:20073412

  15. Spontaneous regression of herniated lumbar discs: Report of one illustrative case and review of the literature.

    PubMed

    Yang, Xiaohui; Zhang, Qin; Hao, Xiaoning; Guo, Xinghua; Wang, Liping

    2016-04-01

    Lumbar disc herniation (LDH) is a common disease that induces back pain and radicular pain. The most efficient method for the treatment of lumbar disc herniation is still controversial. Spontaneous regression of LDH has been recognized with the advancement of radiological diagnostic tools and can explain the reason of spontaneous relief of symptoms without treatment. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed. PMID:26907997

  16. Analysis of crucial molecules involved in herniated discs and degenerative disc disease

    PubMed Central

    Qu, Zhigang; Miao, Weiwei; Zhang, Qi; Wang, Zhenyu; Fu, Changfeng; Han, Jinhua; Liu, Yi

    2013-01-01

    OBJECTIVES: Herniated discs and degenerative disc disease are major health problems worldwide. However, their pathogenesis remains obscure. This study aimed to explore the molecular mechanisms of these ailments and to identify underlying therapeutic targets. MATERIAL AND METHODS: Using the GSE23130 microarray datasets downloaded from the Gene Expression Omnibus database, differentially co-expressed genes and links were identified using the differentially co-expressed gene and link method with a false discovery rate <0.25 as a significant threshold. Subsequently, the underlying molecular mechanisms of the differential co-expression of these genes were investigated using Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. In addition, the transcriptional regulatory relationship was also investigated. RESULTS: Through the analysis of the gene expression profiles of different specimens from patients with these diseases, 539 differentially co-expressed genes were identified for these ailments. The ten most significant signaling pathways involving the differentially co-expressed genes were identified by enrichment analysis. Among these pathways, apoptosis and extracellular matrix-receptor interaction pathways have been reported to be related to these diseases. A total of 62 pairs of regulatory relationships between transcription factors and their target genes were identified as critical for the pathogenesis of these diseases. CONCLUSION: The results of our study will help to identify the mechanisms responsible for herniated discs and degenerative disc disease and provides a theoretical basis for further therapeutic study. PMID:23525320

  17. Diagnosis of disc herniation based on classifiers and features generated from spine MR images

    NASA Astrophysics Data System (ADS)

    Koh, Jaehan; Chaudhary, Vipin; Dhillon, Gurmeet

    2010-03-01

    In recent years the demand for an automated method for diagnosis of disc abnormalities has grown as more patients suffer from lumbar disorders and radiologists have to treat more patients reliably in a limited amount of time. In this paper, we propose and compare several classifiers that diagnose disc herniation, one of the common problems of the lumbar spine, based on lumbar MR images. Experimental results on a limited data set of 68 clinical cases with 340 lumbar discs show that our classifiers can diagnose disc herniation with 97% accuracy.

  18. Who should have Surgery for an Intervertebral Disc Herniation?

    PubMed Central

    Pearson, Adam; Lurie, Jon; Tosteson, Tor; Zhao, Wenyan; Abdu, William; Mirza, Sohail; Weinstein, James

    2012-01-01

    Study Design Combined prospective randomized controlled trial and observational cohort study of intervertebral disc herniation (IDH), an as-treated analysis. Objective To determine modifiers of the treatment effect (TE) of surgery (the difference between surgical and nonoperative outcomes) for intervertebral disc herniation (IDH) using subgroup analysis. Summary of Background Data SPORT demonstrated a positive surgical TE for IDH at the group level. However, individual characteristics may affect TE. No prior studies have evaluated TE modifiers in IDH. Methods IDH patients underwent either discectomy (n=788) or nonoperative care (n=404) and were analyzed according to treatment received. Thirty-seven baseline variables were used to define subgroups for calculating the time-weighted average TE for the Oswestry Disability Index (ODI) over 4 years (TE=?ODIsurgery-?ODInonoperative). Variables with significant subgroup by* treatment interactions (p<0.1) were simultaneously entered into a multivariate model to select independent TE predictors. Results All analyzed subgroups improved significantly more with surgery than with nonoperative treatment (p<0.05). In minimally adjusted univariate analyses: being married, absence of joint problems, worsening symptom trend at baseline, high school education or less, older age, no workers compensation, longer duration of symptoms, and an SF-36 mental component score (MCS) less than 35 were associated with greater TEs. Multivariate analysis demonstrated: being married (TE ?15.8 vs. ?7.7 single, p<0.001), absence of joint problems (TE ?14.6 vs. ?10.3 joint problems, p=0.012), and worsening symptoms (TE ?15.9 vs. ?11.8 stable symptoms, p=0.032) were independent TE modifiers. TEs were greatest in married patients with worsening symptoms (?18.3) vs. single patients with stable symptoms (?7.8). Conclusions IDH patients who met strict inclusion criteria improved more with surgery than with nonoperative treatment, regardless of specific characteristics. However, being married, without joint problems, and worsening symptom trend at baseline were associated with a greater treatment effect. PMID:21681140

  19. Lumbar disc herniation with contralateral radiculopathy: do we neglect the epidural fat?

    PubMed

    Yang, Jun-Song; Zhang, Dong-Jie; Hao, Ding-Jun

    2015-01-01

    Lumbar disc herniation (LDH) is the most common cause of radiculopathy, whose pathological entity underlying nerve root compression is usually on the same side as the symptoms. However, LDH causing contralateral radiculopathy are sometimes encountered by pain physicians. There have been tremendous developments in the treatment options for LDH; the situation of LDH causing contralateral radiculopathy is indeed a dilemma for some pain physicians. We will report a case of a patient with a L4-5 disc herniation whose left herniated disc caused radiculopathy on the right side. After a percutaneous lumbar endoscopic discectomy via the side ipsilateral to the symptomatic side, this case obtained a significant symptom remission. The migrated epidural fat is discussed as a cause of associated contralateral neurological deficit. Only via a surgical approach ipsilateral to the herniated side, could there be a clinical improvement postoperatively. PMID:25794228

  20. Target radiofrequency combined with collagenase chemonucleolysis in the treatment of lumbar intervertebral disc herniation

    PubMed Central

    Zhang, Daying; Zhang, Yong; Wang, Zhijian; Zhang, Xuexue; Sheng, Mulan

    2015-01-01

    Both target radiofrequency thermocoagulation and collagenase chemonucleolysis are effective micro-invasive therapy means for lumbar intervertebral disc herniation. In order to analyze the clinical effects of target radiofrequency thermocoagulation combined with collagenase chemonucleolysis on lumbar intervertebral disc herniation, the contents of hydroxyproline and glycosaminoglycan were measured and the histological changes of nucleus pulposus was detected in the vitro experiments. Radiofrequency thermocoagulation reduced the hydrolyzation of herniated nucleus pulposus caused by collagenase, as well as the content of hydroxyproline and glycosaminoglycan. Furthermore, 236 patients with lumbar intervertebral disc herniation were treated by target radiofrequency thermocoagulation combined with collagenase chemonucleolysis. The efficiency was evaluated according to Macnab criteria, and the index of lumbar disc herniation (IDH) was compared pre-operation with 3 months post-operation. The post-operative good rate was 66.5% (157/236) at 2 weeks post-operation, and 88.1% (208/236) at 3 months post-operation. In the post-operative follow-up exam, 86.8% of the re-examined cases demonstrated smaller or ablated protrusion, with reduced IDH values from pre-operation, which was statistically significant. No serious complications were detected intra-operatively and post-operatively. In conclusion, target radiofrequency combined with collagenase chemonucleolysis was an effective and safe method for treatment of lumbar intervertebral disc herniation. PMID:25785026

  1. Unloaded Treadmill Training Therapy for Lumbar Disc Herniation Injury

    PubMed Central

    Simpson, Steve; Bettis, Brad; Herbertson, James

    1996-01-01

    The low back region is an area that is very susceptible to injury in athletes. Running is an activity that can be significantly affected by chronic overuse stress. The athlete presented in this case report suffered a herniation of the disc between L-4 and L-5 while training for and racing in a national championship marathon. The athlete was placed on a treatment program of heat, electrical muscle stimulation, and strength and flexibility exercises. The athlete also continued to train by unloaded treadmill training therapy. Unloaded treadmill training therapy produced an effect that reduced stress on injured joints and tissue. This enabled the athlete to maintain fitness while running pain-free on this specialized equipment. The athlete trained twice a week for 16 weeks and training runs ranged from 3 miles to a half-marathon (13.1 miles). Unloaded amounts decreased from 20 to 3 pounds. Training times improved at all distances and were maintained following resumption of normal training. ImagesFig 1.Fig 2.Fig 3. PMID:16558374

  2. Statistical shape model reconstruction with sparse anomalous deformations: Application to intervertebral disc herniation.

    PubMed

    Neubert, Aleš; Fripp, Jurgen; Engstrom, Craig; Schwarz, Daniel; Weber, Marc-André; Crozier, Stuart

    2015-12-01

    Many medical image processing techniques rely on accurate shape modeling of anatomical features. The presence of shape abnormalities challenges traditional processing algorithms based on strong morphological priors. In this work, a sparse shape reconstruction from a statistical shape model is presented. It combines the advantages of traditional statistical shape models (defining a 'normal' shape space) and previously presented sparse shape composition (providing localized descriptors of anomalies). The algorithm was incorporated into our image segmentation and classification software. Evaluation was performed on simulated and clinical MRI data from 22 sciatica patients with intervertebral disc herniation, containing 35 herniated and 97 normal discs. Moderate to high correlation (R=0.73) was achieved between simulated and detected herniations. The sparse reconstruction provided novel quantitative features describing the herniation morphology and MRI signal appearance in three dimensions (3D). The proposed descriptors of local disc morphology resulted to the 3D segmentation accuracy of 1.07±1.00mm (mean absolute vertex-to-vertex mesh distance over the posterior disc region), and improved the intervertebral disc classification from 0.888 to 0.931 (area under receiver operating curve). The results show that the sparse shape reconstruction may improve computer-aided diagnosis of pathological conditions presenting local morphological alterations, as seen in intervertebral disc herniation. PMID:26060085

  3. Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation.

    PubMed

    Hubbe, Ulrich; Franco-Jimenez, Pamela; Klingler, Jan-Helge; Vasilikos, Ioannis; Scholz, Christoph; Kogias, Evangelos

    2016-01-01

    OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 2.1 preoperatively to 1.7 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH. PMID:26384131

  4. Role of interleukin-17 in chondrocytes of herniated intervertebral lumbar discs

    PubMed Central

    TIAN, PENG; LI, ZHI-JUN; FU, XIN; MA, XIN-LONG

    2015-01-01

    Lumbar disc herniation (LDH) is a common cause of lumbosacral radiculopathy. An autoimmune response to a herniated nucleus pulposus (NP) has been suggested to play an important role in the initiation of radiculopathy. Interleukin-17 (IL-17) is a cytokine associated with inflammation and autoimmunity. The presence of IL-17 has been studied in patients with LDH; however, extensive investigation into the expression of IL-17 in different disc pathologies of LDH has not yet been conducted. The aim of the present study was to investigate the role of neovascularization and hypertrophic chondrocytes in herniated intervertebral lumbar discs. Fifty-two intervertebral lumbar disc specimens were extracted from 46 patients with LDH and were subsequently classified as either contained or non-contained disc herniation (CDH and NCDH, respectively). The specimens were stained with hematoxylin and eosin or toluidine blue, or were immunostained with polyclonal antibodies to IL-17 using the streptavidin-peroxidase method. The neovascular tissue and staining results were graded to establish the histological differences between the two herniation types. The intervertebral discs (IVDs) obtained from patients with NCDH showed significantly more neovascularization and granulation tissue than the discs obtained from patients with CDH (P<0.05). Furthermore, hypertrophic chondrocytes were more abundant in the NCDH specimens than in the CDH specimens (P<0.05). Similarly, the number of IL-17-immunoreactive cells was significantly higher in the NCDH specimens than that in the CDH specimens (P<0.01). In conclusion, local inflammation and autoreactive immune activation may play an important role in the pathogenesis of LDH. These results also suggest a role of chondrocytes in the repair of herniated IVDs. PMID:26170916

  5. Treatment of Lumbar Intervertebral Disc Herniation Using C-Arm Fluoroscopy Guided Target Percutaneous Laser Disc Decompression

    PubMed Central

    Zhao, Xu-Li; Xu, Yong-Guang; Zhao, Xue-Jun; Song, Wen-Ge; Zheng, Hong

    2012-01-01

    Abstract Objective: To evaluate the safety and therapeutic efficacy of target percutaneous laser disc decompression (T-PLDD) for the treatment of lumbar disc herniation. Background data: PLDD using the Nd:YAG laser has been regarded as an effective alternative treatment for disc herniation. However, all the previous studies were concentrated on vaporizing the nucleus pulposus in the intervertebral space. We hypothesize that insertion of the needle into the extruded part of the nucleus pulposus will decrease its volume and provide superior clinical effects compared to therapies that decrease the volume of the intradiscal nucleus pulposus. Materials and methods: A total of 25 patients suffering from posterolateral extruded but nonsequestered lumbar intervertebral disc herniation were treated with T-PLDD. After treatment, the patients were followed up and the therapeutic effect was assessed at 1, 3, 6, and 12 months using the modified MacNab criteria. Results: The success rate was 80.0% (18 of 25), 88.0% (22 of 25), 92.0% (23 of 25), and 92.0% (23 of 25) at 1, 3, 6, and 12 months respectively. No serious complications occurred in any of the patients. Furthermore, we did not observe any neurological sequelae. Conclusions: T-PLDD can significantly decrease pain and improve function of patients who have extruded but nonsequestered lumbar intervertebral disc herniation. PMID:22150064

  6. Magnetic Resonance Imaging Interpretation in Patients With Symptomatic Lumbar Spine Disc Herniations

    PubMed Central

    Lurie, Jon D.; Doman, David M.; Spratt, Kevin F.; Tosteson, Anna N. A.; Weinstein, James N.

    2009-01-01

    Study Design Retrospective review of imaging data from a clinical trial. Objective To compare the interpretation of lumbar spine magnetic resonance imaging (MRIs) by clinical spine specialists and radiologists in patients with lumbar disc herniation. Summary of Background Data MRI is the imaging modality of choice for evaluation of the lumbar spine in patients with suspected lumbar disc herniation. Guidelines provide standardization of terms to more consistently describe disc herniation. The extent to which these guidelines are being followed in clinical practice is unknown. Methods We abstracted data from radiology reports from patients with lumbar intervertebral disc herniation enrolled in the Spine Patient Outcomes Research Trial. We evaluated the frequency with which morphology (e.g., protrusions, extrusions, or sequestrations) was reported as per guidelines and when present we compared the morphology ratings to those of clinicians who completed a structured data form as part of the trial. We assessed agreement using percent agreement and the ? statistic. Results There were 396 patients with sufficient data to analyze. Excellent agreement was observed between clinician and radiologist on the presence and level of herniation (93.4%), with 3.3% showing disagreement regarding level, of which a third could be explained by the presence of a transitional vertebra. In 3.3% of the cases in which the clinician reported a herniation (protrusion, extrusion, or sequestration), the radiologist reported no herniation on the MRI. The radiology reports did not clearly describe morphology in 42.2% of cases. In the 214 cases with clear morphologic descriptions, agreement was fair (? = 0.24) and the disagreement was asymmetric (Bowkers test of symmetry P < 0.0001) with clinicians more often rating more abnormal morphologic categories. Agreement on axial location of the herniation was excellent (? = 0.81). There was disagreement between left or right side in only 3.3% of cases (? = 0.93). Conclusion Radiology reports frequently fail to provide sufficient detail to describe disc herniation morphology. Agreement between MRI readings by clinical spine specialists and radiologists was excellent when comparing herniation vertebral level and location within level, but only fair comparing herniation morphology. PMID:19333103

  7. [Blood flow changes in the legs of patients with disc herniation and spinal canal stenosis].

    PubMed

    Yamamoto, M

    1985-11-01

    Blood flow changes through the leg were examined by thermography, heated thermocouple technique and straingauge plethysmography in patients with lumbar-disc herniation and spinal canal stenosis. Hypothermal areas were observed in the affected leg in disc herniation and of both legs in spinal canal stenosis. An increased blood flow through the anterior tibial muscle during sustained contraction was slightly depressed, and post-contraction hyperemia showed an increase in amount and duration in disc herniation. Levels of resting arterial inflow through the leg were almost half that of healthy individuals, and reactive hyperemia after walking revealed a marked prolongation especially in spinal canal stenosis. In postoperative cases of spinal canal stenosis the thermogram and arterial inflow of the leg returned to their normal level. These results can provide evidence of latent ischemia of the leg that may be caused by a radicular or sympathetic dysfunction in the lumbar spinal diseases. PMID:3831163

  8. Effect of ligamenta flava hypertrophy on lumbar disc herniation with contralateral symptoms and signs: a clinical and morphometric study

    PubMed Central

    Yildizhan, Ahmet; Atar, Elmas K.; Yaycioglu, Soner; Gocmen-Mas, Nuket; Yazici, Canan

    2010-01-01

    Introduction The purpose of this study was to determine whether ligamentum flavum hypertrophy among disc herniated patients causes contralateral pain symptoms. For this reason we measured the thickness of the ligament in disc herniated patients with ipsilateral or contralateral symptoms. Material and methods Two hundred disc herniated patients with ipsilateral symptoms as group I were compared with five disc herniated patients with only contralateral symptoms as group II. Ligamenta flava thicknesses and spinal canal diameters of both groups were measured on magnetic resonance imaging (MRI) with a micro-caliper. Results Both groups underwent surgery only on the disc herniated side. The total thicknesses of the ligamenta flava in group II was thicker than in group I. There was no spinal stenosis in either group and no significance difference between the groups. Statistically significant differences were found for both ipsilateral and contralateral thickness of the ligament flava in both groups. We also compared thickness of the ligamenta flava for each level of disc herniation in group I; ligamenta flava hypertrophy was more common at L3-L4 and L4-L5 levels of vertebrae in females. Conclusions Aetiology of contralateral sciatica among disc herniated patients may be related to hypertrophy of the ligamenta flava, especially on the opposite side. Surgical approaches of the disc herniated side alone may be sufficient for a good outcome. PMID:22371809

  9. Translational research of herniated discs: current status of diagnosis and treatment.

    PubMed

    Haro, Hirotaka

    2014-07-01

    Lumbar herniated discs commonly occur in patients 20-40 years of age, and result in acute symptoms of shooting and intractable pain in the low back and/or lower extremities. However, the prognosis of these patients is considered to be very good. Moreover, 70% of these patients have been reported to be free from sciatica at approximately 6 months after the first onset. Magnetic resonance imaging (MRI) studies have described the spontaneous resorption process of herniated discs, which is a major cause of the reduction of symptoms in patients. New advancements in MRI have recently been developed that have facilitated the examination of nerve tract fibers and identification of symptomatic nerve tissue. Furthermore, the mechanism underlying the resorption process of a herniated disc has been determined. Inflammatory cytokines such as TNF (tumor necrosis factor)-?, angiogenic factors such as vascular endothelial growth factor, and enzymes such as matrix metalloproteinases are intricately related to each other. In our previous studies, matrix metalloproteinase-7 (MMP-7) has been shown to play a crucial role in the initiation of herniated disc resorption. Therefore, we developed recombinant human MMP-7 for intradiscal therapy through an industry-university joint research program. We have already performed in vitro and in vivo experiments to confirm its efficacy; this therapy avoids the side effects associated with surgery, such as nerve tissue damage. Moreover, the phase 1/2 studies of recombinant human (rh) MMP-7 are currently ongoing in the United States, and careful monitoring is required for these clinical trials. In conclusion, patients with lumbar herniated discs may benefit from the development of a less invasive treatment for disc herniation, which can be applied even immediately after the onset of disease symptoms. PMID:24777237

  10. Prevalence and Severity of Preoperative Disabilities in Iranian Patients with Lumbar Disc Herniation

    PubMed Central

    Omidi-Kashani, Farzad; Hasankhani, Ebrahim Ghayem; Moghadam, Mohammad Hallaj; Esfandiari, Mohammad Sadegh

    2013-01-01

    Background: Literature recommends that refractory cases with lumbar disc herniation and appropriate indications are better to be treated surgically, but do all the patients throughout the world consent to the surgery with a same disability and pain threshold? We aim to elucidate the prevalence and severity of disabilities and pain in Iranian patients with lumbar disc herniation who have consented to the surgery. Methods: In this case series study, we clinically evaluated 194 (81 female and 113 male) admitted patients with primary, simple, and stable L4-L5 or L5-S1 lumbar disc herniation who were undergoing surgical discectomy. The mean age of the patients was 38.311.2 (range: 18-76 years old). Disabilities were evaluated by the items of the Oswestry Disability Index (ODI) questionnaire and severity of pain by the Visual Analogue Scale (VAS). Chi-square test was used to compare the qualitative variables. Results: Severe disability (39.2%) and crippled (29.9%) were the two most common types of disabilities. Mean ODI score was 56.721.1 (range: 16-92). Total mean VAS in all patients was 6.11.9 (range: 0-10). Sex and level of disc herniation had no statistical effect on preoperative ODI and VAS. The scale of six was the most frequent scale of preoperative VAS in our patients. Conclusion: Iranian patients with lumbar disc herniation who consented to surgery have relatively severe pain or disability. These severities in pain or disabilities have no correlation with sex or level of disc herniation and are not equal with developed countries. PMID:25207293

  11. Plasma disc decompression for contained cervical disc herniation: a randomized, controlled trial

    PubMed Central

    Nardi, Pier Vittorio

    2009-01-01

    Prospective case series studies have shown that plasma disc decompression (PDD) using the COBLATION SpineWand device (ArthroCare Corporation, Austin, TX) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations. This prospective, randomized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care (CC) through 1year. Patients (n=115) had neck/arm pain >50 on the visual analog scale (VAS) pain scale and had failed at least 30days of failed CC. Patients were randomly assigned to receive either PDD (n=62) or CC (n=58). Clinical outcome was determined by VAS pain score, neck disability index (NDI) score, and SF-36 health survey, collected at 6weeks, 3months, 6months, and 1year. The PDD group had significantly lower VAS pain scores at all follow-up time points (PDD vs. CC: 6weeks, ?46.872.71 vs. ?15.261.97; 3months, ?53.162.74 vs. ?30.452.59; 6months, ?56.222.63 vs. ?40.262.56; 1year, ?65.732.24 vs. ?36.452.86; GEE, P<0.0001). PDD patients also had significant NDI score improvement over baseline when compared to CC patients at the 6weeks (PDD vs. CC: ?9.151.06 vs. ?4.610.53, P<0.0001) and 1year (PDD vs. CC: ?16.700.29 vs. ?12.401.26, P=0.005) follow-ups. PDD patients showed statistically significant improvement over baseline in SF-36 physical component summary scores when compared to CC patients at 6weeks and 1year (PDD vs. CC: 8.86+8.04 vs. 4.243.79, P=0.0004; 17.6410.37 vs. 10.5010.6, P=0.0003, respectively). In patients who had neck/arm pain due to a contained cervical disc herniation, PDD was associated with significantly better clinical outcomes than a CC regimen. At 1year, CC patients appeared to suffer a relapse, showing signs of decline in most measurements, whereas PDD patients showed continued stable improvement. PMID:19902277

  12. Clinical Outcomes of Percutaneous Plasma Disc Coagulation Therapy for Lumbar Herniated Disc Diseases

    PubMed Central

    Kim, Sung Chul; Cho, Ki Hong

    2012-01-01

    Objective This is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy. Methods Forty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. Results This study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.41.4, while the final follow-up VAS score was 1.40.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy. Conclusion PDCT is a safe and efficient treatment modality in a selective patient with HLD. PMID:22396836

  13. Genotypic and Antimicrobial Characterisation of Propionibacterium acnes Isolates from Surgically Excised Lumbar Disc Herniations

    PubMed Central

    Rollason, Jess; Albert, Hanne B.; Barnard, Emma; Worthington, Tony; Hilton, Anthony C.; Vernallis, Ann; Patrick, Sheila; Elliott, Tom

    2013-01-01

    The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence of P. acnes in their excised herniated disc tissue. Using recA and mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role of P. acnes in lumbar disc herniation should not be readily dismissed. PMID:24066290

  14. Genotypic and antimicrobial characterisation of Propionibacterium acnes isolates from surgically excised lumbar disc herniations.

    PubMed

    Rollason, Jess; McDowell, Andrew; Albert, Hanne B; Barnard, Emma; Worthington, Tony; Hilton, Anthony C; Vernallis, Ann; Patrick, Sheila; Elliott, Tom; Lambert, Peter

    2013-01-01

    The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence of P. acnes in their excised herniated disc tissue. Using recA and mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (?1 mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ?4 ?mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role of P. acnes in lumbar disc herniation should not be readily dismissed. PMID:24066290

  15. Does Duration of Preoperative Sciatica Impact Surgical Outcomes in Patients with Lumbar Disc Herniation?

    PubMed Central

    Ghayem Hasankhani, Ebrahim; Khanzadeh, Reza

    2014-01-01

    Background. In lumbar disc herniation, most authors recommend nonoperative treatment for the first few weeks of presentation, but what about the upper limit of this golden period? The aim of this study is to assess the effect of preoperative sciatica duration on surgical outcome of lumbar disc herniation. Methods. We retrospectively evaluated 240 patients (124 males and 116 females) with a mean age of 36.4 5.9 years (range 16 to 63) surgically treated due to primary stable L4-L5 disc herniation. The patients were placed into two groups: with more and less than 12-month duration of preoperative sciatalgia. Disability and pain were measured by Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). Wilcoxon test and Mann-Whitney U test were used for statistical analysis. Results. Total mean duration of preoperative sciatalgia and follow-up period were 13.3 months (range 2 to 65) and 33.7 5.1 months (range 24 to 72), respectively. Comparison between the groups showed that duration of preoperative sciatalgia either less or more than 12 months did not affect the surgical outcomes significantly. Conclusions. More or less than 12-month duration of preoperative sciatalgia may not affect the surgical outcomes of simple lumbar disc herniation in the patients undergoing discectomy. PMID:24616807

  16. Does duration of preoperative sciatica impact surgical outcomes in patients with lumbar disc herniation?

    PubMed

    Omidi-Kashani, Farzad; Ghayem Hasankhani, Ebrahim; Kachooei, Amir Reza; Rahimi, Mohammad Dawood; Khanzadeh, Reza

    2014-01-01

    Background. In lumbar disc herniation, most authors recommend nonoperative treatment for the first few weeks of presentation, but what about the upper limit of this golden period? The aim of this study is to assess the effect of preoperative sciatica duration on surgical outcome of lumbar disc herniation. Methods. We retrospectively evaluated 240 patients (124 males and 116 females) with a mean age of 36.4 ± 5.9 years (range 16 to 63) surgically treated due to primary stable L4-L5 disc herniation. The patients were placed into two groups: with more and less than 12-month duration of preoperative sciatalgia. Disability and pain were measured by Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). Wilcoxon test and Mann-Whitney U test were used for statistical analysis. Results. Total mean duration of preoperative sciatalgia and follow-up period were 13.3 months (range 2 to 65) and 33.7 ± 5.1 months (range 24 to 72), respectively. Comparison between the groups showed that duration of preoperative sciatalgia either less or more than 12 months did not affect the surgical outcomes significantly. Conclusions. More or less than 12-month duration of preoperative sciatalgia may not affect the surgical outcomes of simple lumbar disc herniation in the patients undergoing discectomy. PMID:24616807

  17. Nucleus pulposus cells derived IGF-1 and MCP-1 enhance osteoclastogenesis and vertebrae disruption in lumbar disc herniation

    PubMed Central

    Zhu, Zhongjiao; Huang, Peng; Chong, Yanxue; George, Suraj K; Wen, Bingtao; Han, Na; Liu, Zhiqiang; Kang, Lixin; Lin, Nie

    2014-01-01

    Study design: Chronic strained lumbar disc herniation (LDH) cases were classified into bulging LDH, herniated LDH and prolapse LDH types according to imaging examination, and vertebrae disruptions were evaluated. Cytokines derived from the nucleus pulposus cells were detected, and their effects on osteoclastogenesis, as well as the mechanisms involved, were studied via an in vitro osteoclast differentiation system. Objective: To clarify the mechanisms of lumbar vertebrae resorption induced by lumbar herniation. Summary and background data: Chronic strained lumbar disc herniation induced vertebrae erosion exacerbates quality of patients life and clinical outcome. Although nucleus pulposus cells derived cytokines were reported to play an important role in this pathogenesis, the fundamental mechanisms underlying this process are still unclear. Methods: Chronic strained lumbar disc herniation patients were diagnosed with CT scan and T2-weighted magnetic resonance imaging. RNA was extracted from 192 surgical specimens of the herniated lumbar disc and 29 surgical excisions of the lumbar disc from spinal injury patients. The expressions of osteoclastogenesis related cytokines and chemokines were examined using real time PCR. Monocytes were induced into osteoclast with M-CSF and RANKL in vitro, while the IGF-1 and MCP-1 were added into the differentiation procedure in order to evaluate the effects and explore the molecular mechanisms. Results: Vertebrae erosion had a positive relationship with lumbar disc herniation severity types. In all of the osteoclastogenesis related cytokines, the IGF-1 and MCP-1 were the most highly expressed in the nucleus pulposus cells. IGF-1 enhances activation of NF-kB signaling directly, but MCP-1 upregulated the expression of RANK, so that enhanced cellular sensitivity to RANKL resulted in increasing osteoclastogenesis and activity. Conclusion: Lumbar herniation induced overexpression of IGF-1 and MCP-1 in nucleus pulposus cells aggravated vertebral erosions. Hence, this study suggests that targeting osteoclastogenesis related cytokines has potential clinical significance in the treatment of lumbar disc herniation patients. PMID:25674216

  18. Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function

    PubMed Central

    Kang, Kevin K.; Shen, Michael S.; Zhao, Wenyan; Lurie, Jon D.; Razi, Afshin E.

    2013-01-01

    BACKGROUND CONTEXT The presence of retrolisthesis has been associated with the degenerative changes of the lumbar spine. However, retrolisthesis in patients with L5S1 disc herniation has not been shown to have a significant relationship with worse baseline pain or function. Whether it can affect the outcomes after discectomy, is yet to be established. PURPOSE The purpose of this study was to determine the relationship between retrolisthesis (alone or in combination with other degenerative conditions) and postoperative low back pain, physical function, and quality of life. This study was intended to be a follow-up to a previous investigation that looked at the preoperative assessment of patient function in those with retrolisthesis and lumbar disc herniation. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Patients enrolled in SPORT (Spine Patient Outcomes Research Trial) who had undergone L5S1 discectomy and had a complete magnetic resonance imaging scan available for review (n=125). Individuals with anterolisthesis were excluded. OUTCOME MEASURES Time-weighted averages over 4 years for the Short Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index (ODI), and Sciatica Bothersomeness Index (SBI). METHODS Retrolisthesis was defined as a posterior subluxation of 8% or more. Disc degeneration was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1 to 3 and collectively classified as vertebral end plate degenerative changes. The presence of facet arthropathy and ligamentum flavum hypertrophy was classified jointly as posterior degenerative changes. Longitudinal regression models were used to compare the time-weighted outcomes over 4 years. RESULTS Patients with retrolisthesis did significantly worse with regard to bodily pain and physical function over 4 years. However, there were no significant differences in terms of ODI or SBI. Similarly, retrolisthesis was not a significant factor in the operative time, blood loss, lengths of stay, complications, rate of additional spine surgeries, or recurrent disc herniations. Disc degeneration, modic changes, and posterior degenerative changes did not affect the outcomes. CONCLUSIONS Although retrolisthesis in patients with L5S1 disc herniation did not affect the baseline pain or function, postoperative outcomes appeared to be somewhat worse. It is possible that the contribution of pain or dysfunction related to retrolisthesis became more evident after removal of the disc herniation. PMID:23201024

  19. Comparison of Discectomy versus Sequestrectomy in Lumbar Disc Herniation: A Meta-Analysis of Comparative Studies

    PubMed Central

    Ran, Jisheng; Hu, Yejun; Zheng, Zefeng; Zhu, Ting; Zheng, Huawei; Jing, Yibiao; Xu, Kan

    2015-01-01

    Background Lumbar disc removal is currently the standard treatment for lumbar disc herniation. No consensus has been achieved whether aggressive disc resection with curettage (discectomy) versus conservative removal of the offending disc fragment alone (sequestrectomy) provides better outcomes. This study aims to compare the reherniation rate and clinical outcomes between discectomy and sequestrectomy by literature review and a meta-analysis. Methods A systematic search of PubMed, Medline, Embase and the Cochrane Library was performed up to June 1, 2014. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, recurrent herniation rate and post-operative functional outcomes. Results Twelve eligible trials evaluating discectomy vs sequestrectomy were identified including one randomized controlled study, five prospective and six retrospective comparative studies. By contrast to discectomy, sequestrectomy was associated with significantly less operative time (p<0.001), lower visual analogue scale (VAS) for low back pain (p<0.05), less post-operative analgesic usage (p<0.05) and better patients satisfaction (p<0.05). Recurrent herniation rate, reoperation rate, intraoperative blood loss, hospitalization duration and VAS for sciatica were without significant difference. Conclusions According to our pooled data, sequestrectomy entails equivalent reherniation rate and complications compared with discectomy but maintains a lower incidence of recurrent low back pain and higher satisfactory rate. High-quality prospective randomized controlled trials are needed to firmly assess these two procedures. PMID:25815514

  20. Transforaminal Lumbar Interbody Fusion for Management of Recurrent Lumbar Disc Herniation

    PubMed Central

    2016-01-01

    Study Design Retrospective study. Purpose To study the surgical outcome of transforaminal lumbar interbody fusion (TLIF) combined with trans-pedicular screws fixation for management of selected cases of recurrent lumbar disc herniation. Overview of Literature Recurrent lumbar disc herniation is a major cause of surgical failure, occurring in 5%–11% of cases. The optimal technique for treatment is controversial. Some authors believe that repeated simple discectomy is the treatment of choice, but approach-related complications can be considerable. Other surgeons prefer more removal of posterior elements (as lamina and facet joints) with posterior fusion. Methods The study included 15 patients who presented with symptomatic recurrent lumbar disc herniation who underwent reoperation through posterior trans-pedicular screws and TLIF in our department from April 2008 to May 2010, with a 24-month follow-up. Japanese Orthopedic Association Scale (JOA) was used for low back pain. The results of surgery were also evaluated with the MacNab classification. Results The mean JOA score showed significant improvement, increasing from 9.5 before surgery to 24.0 at the end of follow-up (p<0.001). Clinical outcome was excellent in 7 patients (46% of cases), good in 6 patients (40%) and fair in only 2 patients (14%). There was a significant difference (p<0.05) between patients presenting with recurrent disc at the ipsilateral side and those at the contralateral side. Conclusions In spite of the small number of patients and the short follow-up period, the good clinical and radiological outcome achieved in this study encourage the belief that TLIF is an effective option for the treatment of selected cases of recurrent lumbar disc herniation. PMID:26949458

  1. A history of lumbar disc herniation from Hippocrates to the 1990s.

    PubMed

    Truumees, Eeric

    2015-06-01

    In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with lumbar disc herniation. In this era, use of discectomy surgery increased rapidly. Even patients with very early symptoms were offered surgery. Later work, especially by Weber and Hakelius, showed that many patients with lumbar disc herniation would improve without surgical intervention. In the ensuing decades, the debate over operative indications and timing continued, reaching another pivotal moment with the 2006 publication of the initial results of Spine Patient Outcomes Research Trial. PMID:24752913

  2. Lumbar Disc Herniation Combined with Posterior Apophyseal Ring Separation in a Young Child: A Case Report.

    PubMed

    Kim, Pius; Kim, Seok Won; Ju, Chang Il; Kim, Hyeun Sung

    2015-09-01

    Lumbar disc herniation in children aged 10 years or less is extremely uncommon and posterior apophyseal ring separation is not a common injury that usually occurs in adolescents or young adults after a sports-related microtraumatism. The authors report an unique case of 10-year-old boy who presented with low back pain and radiating pain on both legs. The boy received conservative treatment, which included anti-inflammatory medication, muscle relaxants, and physical therapy, but symptoms were not improved. Computed tomography and magnetic resonance imaging revealed a huge central disc herniation combined with posterior apophyseal ring separation. Microscopic lumbar discectomy with the removal of apophyseal ring separation was performed due to the intractable pain. At six months after surgery, the child was symptom free. PMID:26512269

  3. Single level cervical disc herniation: A questionnaire based study on current surgical practices

    PubMed Central

    Abrishamkar, Saeid; Karimi, Yousef; Safavi, Mohammadreza; Tavakoli, Pouria

    2009-01-01

    Background: Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation) for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons. Materials and Methods: About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed. Results: The mean age of enrolled surgeons was 51 yrs (range 45-73) with mean surgical experience of 16.9 yrs (range 12-40 yrs) on single level cervical disc herniation. Out of 120 surgeons 10(8%) had 15-25 years experience and always preferred fusion with or without instrumentation and six (five per cent with 17-27 yrs experience had never used fusion techniques. However, 104 (87%) surgeons with 12-40 yrs experience had their own criteria based on their experiences for performing fusion with graft and instrumentation (FGI), while. 85 (75%) preferred auto graft with cage. Conclusions: Most of surgeons performed FGI before the age of 40, but for others, patient criteria such as job (heavier job), physical examination (especially myelopathy) and imaging findings (mild degenerative changes on X-ray and signal change in the spinal cord on MRI) were considered significant for performing FGI. PMID:19838345

  4. The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation

    PubMed Central

    Radcliff, Kristen; Hilibrand, Alan; Lurie, Jon D.; Tosteson, Tor D.; Delasotta, Lawrence; Rihn, Jeffrey; Zhao, Wenyan; Vaccaro, Alexander; Albert, Todd J.; Weinstein, James N.

    2012-01-01

    Background: The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of operative versus nonoperative treatment of lumbar intervertebral disc herniation. It has been suggested that epidural steroid injections may help improve patient outcomes and lower the rate of crossover to surgical treatment. Methods: One hundred and fifty-four patients included in the intervertebral disc herniation arm of the SPORT who had received an epidural steroid injection during the first three months of the study and no injection prior to the study (the ESI group) were compared with 453 patients who had not received an injection during the first three months of the study or prior to the study (the No-ESI group). Results: There was a significant difference in the preference for surgery between groups (19% in the ESI group compared with 56% in the No-ESI group, p < 0.001). There was no difference in primary or secondary outcome measures at four years between the groups. A higher percentage of patients changed from surgical to nonsurgical treatment in the ESI group (41% versus 12% in the No-ESI, p < 0.001). Conclusions: Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection. There was a higher prevalence of crossover to nonsurgical treatment among surgically assigned ESI-group patients, although this was confounded by the increased baseline desire to avoid surgery among patients in the ESI group. Given these data, we concluded that more studies are necessary to establish the value of epidural steroid injection for symptomatic lumbar intervertebral disc herniation. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:22739998

  5. The clinical study of percutaneous disc decompression of treating herniation of cervical disc with Nd:YAG laser

    NASA Astrophysics Data System (ADS)

    Zhang, Dianxue; Cheng, Hefu; Wang, Jindong

    2005-07-01

    Objective: The possibility of PLDD (percutaneous laser disc decompression) and an ideal non-operative method which is long everlasting effect for PLDD was investigated. Methods: 159 patients of Cervical Disc Herniation with PLDD were studied. All the herniated discs were irradiated with 1015J/S Nd:YAG laser quantum through optical-fiber under the supervision of C-arm X-ray. Results: All the patients were followed and reexamined CT or MRI after one to six months of PLDD. The result of cured (67.92%), excellent (24.53%), moderation (5.66%), non-effect (1.88%) was got. The excellent rate was 88.24%. The effective rate was 97.65%. Non-effective rate was 2.35%. Conclusion: When irradiated with Nd:YAG laser, the nucleus pulposus was vapouring, charring and coagulating. The volume and inner-pressure of the disc decreased. So the symptoms and signs improved. The main value of this methods were micro-damage, non-operation, no bleeding, no bone injury, good therapy effect, quick recovery, lesser pain, safety and excellent long everlasting effect. It is an ideal non-operative method of treating PLDD.

  6. Comparison of Two Methods of Epidural Steroid Injection in the Treatment of Recurrent Lumbar Disc Herniation

    PubMed Central

    Ebrahimi-Nejad, Ali; Shahsavarani, Shahram; Keikhosravi, Ehsan; Shahba, Mohsen; Ebrahimi, Farzaneh

    2014-01-01

    Study Design Prospective study. Purpose We compared the effects of two methods of epidural steroid injection in patients with recurrent disc herniation. Overview of Literature To our knowledge, there is no previous report of such a comparison in these patients. Methods The study was performed with 30 patients with relapsed lumbar disc herniation whose pain was not relieved by conservative remedies. The patients were divided into two groups, each of 15 patients, and entered the study for caudal or transforaminal injections. The degree of pain, ability to stand and walk, and the Prolo function score were evaluated in both groups before the injection and 2 months and 6 months after the injection. Results The degrees of pain reduction in the caudal injection group in the second and sixth months were 0.6 and 1.63, respectively, and in the transforaminal injection group were 1.33 and 1.56, respectively. The difference between the two methods was not statistically significant. Similarly, no other evaluated criterion showed a significant difference between the methods. Conclusions In the current study, the caudal and transforaminal steroid injection methods showed similar outcomes in the treatment of relapsed lumbar disc herniation. However, more detailed patient categorizing may help in finding possible subgroups with differences. PMID:25346818

  7. Retrolisthesis and Lumbar Disc Herniation: A Pre-operative Assessment of Patient Function

    PubMed Central

    Shen, Michael; Razi, Afshin; Lurie, Jon D.; Hanscom, Brett; Weinstein, Jim

    2008-01-01

    BACKGROUND CONTEXT Retrolisthesis is relatively rare but when present has been associated with increased back pain and impaired back function. Neither the prevalence of this condition in individuals with lumbar disc herniations nor its possible relation to pre-operative back pain and dysfunction has been well studied. PURPOSE The purposes of this study were as follows: 1) to determine the prevalence of retrolisthesis (alone or in combination with other degenerative conditions) in individuals with confirmed L5 S1 disc herniation who later underwent lumbar discectomy; 2) to determine if there is any association between retrolisthesis and degenerative changes within the same vertebral motion segment; and 3) to determine the relation between retrolisthesis (alone or in combination with other degenerative conditions) and pre-operative low back pain, physical function, and quality of life. STUDY DESIGN/SETTING Cross-sectional study. PATIENT SAMPLE A total of 125 individuals were identified for incorporation into this study. All patients had confirmed L5-S1 disc herniation on MRI and later underwent L5-S1 discectomy. All patients were enrolled in the SPORT (Spine Patient Outcomes Research Trial) study; data was obtained from the multi-institutional database comprised of SPORT patients from across the United States. OUTCOME MEASURES Retrolisthesis, Degenerative change on MRI, Modic Changes. METHODS MRI scans of the lumbar spine were assessed at spinal level L5S1 for all 125 patients. Retrolisthesis was defined as posterior subluxation of 8% or more. Disc degeneration was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1 3 and collectively classified as vertebral endplate degenerative changes. The presence of facet arthropathy and ligamentum flavum hypertrophy were classified jointly as posterior degenerative changes. RESULTS The overall incidence of retrolisthesis at L5-S1 in our study was 23.2%. Retrolisthesis combined with posterior degenerative changes, degenerative disc disease, or vertebral endplate changes had incidences of 4.8%, 16%, and 4.8% respectively. The prevalence of retrolisthesis did not vary by sex, age, race, smoking status, or education level when compared to individuals with normal sagittal alignment. However, individuals with retrolisthesis were more likely to be receiving worker compensation than those without retrolisthesis. Increased age was found to be associated with individuals having vertebral endplate degenerative changes (both alone and in conjunction with retrolisthesis) and degenerative disc disease. Individuals who had retrolisthesis with concomitant vertebral endplate degenerative changes were more often smokers and had no insurance. The presence of retrolisthesis was not associated with an increased incidence of having degenerative disc disease, posterior degenerative changes, or vertebral endplate changes. No statistical significance was found between the presence of retrolisthesis on the degree of patient pre-operative low back pain and physical function. Patients with degenerative disc disease were found to have increased leg pain compared to those patients without degenerative disc changes. CONCLUSIONS We found no significant relationship between retrolisthesis in patients with L5-S1 disc herniation and worse baseline pain or function. It is possible that the contribution of pain or dysfunction related to retrolisthesis was far overshadowed by the presence of symptoms due to the concomitant disc herniation. It remains to be seen whether retrolisthesis will affect outcome following discectomy in these patients. PMID:17630138

  8. Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis.

    PubMed

    Huang, Weimin; Han, Zhiwei; Liu, Jiang; Yu, Lili; Yu, Xiuchun

    2016-01-01

    Recurrent lumbar disc herniation (rLDH) is a common complication following primary discectomy. This systematic review aimed to investigate the current evidence on risk factors for rLDH.Cohort or case-control studies addressing risk factors for rLDH were identified by search in Pubmed (Medline), Embase, Web of Science, and Cochrane library from inception to June 2015. Relevant results were pooled to give overall estimates if possible. Heterogeneity among studies was examined and publication bias was also assessed.A total of 17 studies were included in this systematic review. Risk factors that had significant relation with rLDH were smoking (OR 1.99, 95% CI 1.53-2.58), disc protrusion (OR 1.79, 95% CI 1.15-2.79), and diabetes (OR 1.19, 95% CI 1.06-1.32). Gender, BMI, occupational work, level, and side of herniation did not correlate with rLDH significantly.Based on current evidence, smoking, disc protrusion, and diabetes were predictors for rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. More evidence provided by high-quality observational studies is still needed to further investigate risk factors for rLDH. PMID:26765413

  9. Management of Chronic Pain of Cervical Disc Herniation and Radiculitis with Fluoroscopic Cervical Interlaminar Epidural Injections

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A.; Pampati, Vidyasagar; Wargo, Bradley W.; Malla, Yogesh

    2012-01-01

    Study Design: A randomized, double-blind, active controlled trial. Objective: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis. Summary of Background Data: Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature. Methods: One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Primary outcome measure was ? 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight. Results: Significant pain relief and functional status improvement (? 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group. Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis. PMID:22859902

  10. Recurrent lumbar disc herniation: A prospective comparative study of three surgical management procedures

    PubMed Central

    El Shazly, Ayman A.; El Wardany, Mohammed A.; Morsi, Ahmad M.

    2013-01-01

    Context: The optimal surgical treatment of recurrent lumbar disc herniation is controversial. Aim: To compare prospectively the clinical outcomes of surgical treatment of recurrent lumbar disc herniation by three different methods; discectomy alone, discectomy with transforaminal lumbar interbody fusion (TLIF), and diecectomy with posterolateral fusion (PLF), regardless of the postoperative radiological findings. Study Design: This is a prospective, randomized, comparative study. Materials and Methods: This is a prospective, randomized, comparative study on 45 patients with first time recurrent lumbar disc herniation. Patients were evaluated clinically by using the criteria of the Japanese Orthopedic Association's evaluation system for low back pain syndrome (JOA score). The patients were classified into three groups: Group A; patients who had revision discectomy alone, group B; patients who had revision discectomy with TLIF, and group C; patients who had revision discectomy with PLF. The mean follow-up period was 37 (±7.85 STD) months. Results: The mean overall recovery rate was 87.2% (±19.26 STD) and the satisfactory rate was 88.9%. Comparison between the three groups showed no significant difference with regard to the mean total postoperative JOA score, recovery rate, and satisfactory rate. However, the postoperative low back pain was significantly higher in group A than that of group B and C. Two patients in group A required further revision surgery. The incidences of dural tear and postoperative neurological deficit were higher in group A. The intraoperative blood loss and length of operation were significantly less in group A. The total cost of the procedure was significantly different between the three groups, being least in group A and highest in group B. There was no significant difference between the three groups with regard to the length of postoperative hospital stay. Conclusion: Revision discectomy is effective in patients with recurrent lumbar disc herniation. Fusion with revision discectomy improves the postoperative low back pain, decreases the intraoperative risk of dural tear or neural damage and decreases the postoperative incidence of mechanical instability or re-recurrence. TLIF and PLF have comparable results when used with revision discectomy, but PLF has significantly less total cost than TLIF. PMID:24403956

  11. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial

    PubMed Central

    Brouwer, Patrick A; Peul, Wilco C; Brand, Ronald; Arts, Mark P; Koes, Bart W; Berg, Annette A van den; van Buchem, Mark A

    2009-01-01

    Background The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD). This treatment can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. Thus far, no randomized trial into cost-effectiveness of PLDD versus standard surgical procedure has been performed. We present the design of a randomized controlled trial, studying the cost-effectiveness of PLDD versus conventional open discectomy in patients with sciatica from lumbar disc herniation. Methods/design The study is a randomized prospective multi-center trial, in which two treatment strategies are compared in a parallel group design. Patients (age 1870 years) visiting the neurosurgery department of the participating hospitals, are considered for inclusion in the trial when sciatica due to lumbar disc herniation has lasted more than 8 weeks. Patients with disc herniation smaller than 1/3 of the spinal canal diameter, without concomitant lateral recess stenosis or sequestration, are eligible for participation, and are randomized into one of two treatment arms; either Percutaneous Laser Disc Decompression or conventional discectomy. The functional outcome of the patient, as assessed by the Roland Disability Questionnaire for Sciatica at 8 weeks and 1 year after treatment, is the primary outcome measure. The secondary outcome parameters are recovery as perceived by the patient, leg and back pain, incidence of re-intervention, complications, quality of life, medical consumption, absence of work and secondary costs. Discussion Open discectomy is still considered to be the golden standard in the surgical treatment of lumbar disc herniation. Whether Percutaneous Laser Disc Decompression has at least as much efficacy as the standard surgical procedure, and is more cost-effective, will be determined by this trial. Trial registration Current Controlled Trials ISRCTN25884790. PMID:19439098

  12. Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation

    PubMed Central

    Abrishamkar, Saeid; Kouchakzadeh, Masih; Mirhosseini, Ahmad; Tabesh, Homayoun; Rezvani, Majid; Moayednia, Amir; Ganjeifar, Babak; Mahabadi, Amir; Yousefi, Elham; Kooshki, Ali Mehrabi

    2015-01-01

    Background: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. Materials and Methods: This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. Results: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). Conclusion: Our results show that while nucleoplasty is as effective as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty as an effective method of treatment in patients with single-level disc herniation.

  13. Lumbar disc herniation and cauda equina syndrome following spinal manipulative therapy: a review of six court decisions in Canada.

    PubMed

    Boucher, Pierre; Robidoux, Sbastien

    2014-02-01

    The purpose of this review is to expand practitioners' knowledge on areas of liability when treating low back pain patients. Six cases where chiropractors in Canada were sued for allegedly causing or aggravating lumbar disc herniation after spinal manipulative therapy were retrieved using the CANLII search database. The case series involves 4 men and 2 women with an average age of 37.3 years (range, 31-48 years). Trial courts' decisions were rendered between 2000 and 2011. This study highlights the following conclusions from Canadian courts: 1) informed consent is an ongoing process that cannot be entirely delegated to office personnel; 2) when the patient's history reveals risk factors for lumbar disc herniation the chiropractor has the duty to rule out disc pathology as an etiology for the symptoms presented by the patients before beginning anything but conservative palliative treatment; 3) lumbar disc herniation may be triggered by spinal manipulative therapy on vertebral segments distant from the involved herniated disc such as the thoracic spine. PMID:24485443

  14. Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness

    PubMed Central

    Akca, Nezih; Ozdemir, Bulent; Kanat, Ayhan; Batcik, Osman Ersagun; Yazar, Ugur; Zorba, Orhan Unal

    2014-01-01

    Context: Little seems to be known about the sexual dysfunction (SD) in lumbar intervertebral disc herniation. Aims: Investigation of sexual and sphincter dysfunction in patient with lumbar disc hernitions. Settings and Design: A retrospective analysis. Materials and Methods: Sexual and sphincter dysfunction in patients admitted with lumbar disc herniations between September 2012-March 2014. Statistical Analysis Used: Statistical analysis was performed using the Predictive Analytics SoftWare (PASW) Statistics 18.0 for Windows (Statistical Package for the Social Sciences, SPSS Inc., Chicago, Illinois). The statistical significance was set at P < 0.05. The Wilcoxon signed ranks test was used to evaluate the difference between patients. Results: Four patients with sexual and sphincter dysfunction were found, including two women and two men, aged between 20 and 52 years. All of them admitted without low back pain. In addition, on neurological examination, reflex and motor deficit were not found. However, almost all patients had perianal sensory deficit and sexual and sphincter dysfunction. Magnetic resonance imaging (MRI) of three patients displayed a large extruded disc fragment at L5-S1 level on the left side. In fourth patient, there were not prominent disc herniations. There was not statistically significant difference between pre-operative and post-operative sexual function, anal-urethral sphincter function, and perianal sensation score. A syndrome in L5-S1 disc herniation with sexual and sphincter dysfunction without pain and muscle weakness was noted. We think that it is crucial for neurosurgeons to early realise that paralysis of the sphincter and sexual dysfunction are possible in patients with lumbar L5-S1 disc disease. Conclusion: A syndrome with perianal sensory deficit, paralysis of the sphincter, and sexual dysfunction may occur in patients with lumbar L5-S1 disc disease. The improvement of perianal sensory deficit after surgery was counteracted by a trend toward disturbed sexual function. Further researches are needed to explore the extent of this problem. PMID:25558144

  15. Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy

    PubMed Central

    Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil

    2016-01-01

    Abstract Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain. The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was <3. A 32-year-old man was transferred our emergency department with progressive quadriparesis. He had no history of trauma, but had received physical therapy with spinal manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty. Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4–C5 and C5–C6 that caused severe spinal cord compression and surrounding edema. We performed C4–C5–C6 anterior cervical discectomy and fusion. The patient's limb weakness improved rapidly within 1 day postoperatively, and he was discharged 4 weeks later. At his 12-month follow-up, the patient had recovered nearly full muscle power. We presented an extremely rare case of cervical IDH causing progressive quadriparesis after excessive spinal manipulation therapy. The presence of a “halo” and “Y-sign” were useful MRI markers for cervical IDH in this case. PMID:26871842

  16. Treatment of contained lumbar disc herniations using radiofrequency assisted micro-tubular decompression and nucleotomy: four year prospective study results

    PubMed Central

    2014-01-01

    Background Patients with radiculopathy caused by contained disc herniations are less likely to have good outcomes following discectomy surgery than patients with disc herniations that are not contained. The author presents his 4-year results from a prospective trial regarding the efficacy and safety of a tubular transforaminal radiofrequency-assisted manual decompression and annulus modulation of contained disc herniations in 58 patients. Methods Fifty-eight patients with lumbar radiculopathy due to a contained disc herniation were enrolled in a prospective clinical study. Visual analog scores (VAS) for back pain and leg pain, quality of life assessment, Macnab criteria, and SF-12 were collected from patients before treatment, at 2-years and 4-years post-treatment. Results At 4 years, results were obtained from 47 (81%) of patients. Compared to mean pre- treatment assessments, mean 4-year VAS for back pain improved from 8.6 to 2.3 points, and mean VAS for leg pain improved from 7.8 to 2.3. Eighty-three percent of respondents reported that they were “satisfied” or “very satisifed” with their quality of life at 4-years as per SF-12. At 4 years, recurrence was noted in 3 (6.4%) of respondents and no complications were reported. Conclusions The 2-year and 4-year study results are nearly identical, suggesting durable benefit out to 4 years. These results also suggest that in carefully selected patients with sustained contained disc herniations who have failed conservative treatments, manual decompression combined with radiofrequency-assisted decompression and annulus modulation are very likely to have good outcomes 4 years post-treatment. PMID:25694932

  17. Prognostic Factors for Postsurgical Recovery of Deltoid Palsy due to Cervical Disc Herniations

    PubMed Central

    Chung, Jae-Yoon; Chang, Han; Song, Kyung-Jin; Kim, Jin-Hyok; Hong, Chang-Hwa; Lee, Jung Sub; Lee, Sang-Hun; Song, Kwang-Sup; Yang, Jae Jun; Uh, Jae-Hyung; Kim, Young-Tae; Lee, Jae Min

    2015-01-01

    Study Design Retrospective multicenter study. Purpose We aimed to investigate prognostic factors affecting postsurgical recovery of deltoid palsy due to cervical disc herniation (CDH). Overview of Literature Little information is available about prognostic factors affecting postsurgical recovery of deltoid palsy due to CDH. Methods Sixty-one patients with CDH causing deltoid palsy (less than grade 3) were included in this study: 35 soft discs and 26 hard discs. Average duration of preoperative deltoid palsy was 11.9 weeks. Thirty-two patients underwent single-level surgery, 22 two-level, four three-level, and three four-level. Patients with accompanying myelopathy, shoulder diseases, or peripheral neuropathy were excluded from the study. Results Deltoid palsy (2.4 grades vs. 4.5 grades, p<0.001) and radiculopathy (6.4 points vs. 2.1 points, p<0.001) significantly improved after surgery. Thirty-six of 61 patients (59%) achieved full recovery (grade 5) of deltoid palsy, with an average time of 8.4 weeks. Longer duration of preoperative deltoid palsy and more severe radiculopathy negatively affected the degree of improvement in deltoid palsy. Age, gender, number of surgery level, and disc type did not affect the degree of improvement of deltoid palsy. Contrary to our expectations, severity of preoperative deltoid palsy did not affect the degree of improvement. Due to the shorter duration of preoperative deltoid palsy, in the context of rapid referral, early surgical decompression resulted in significant recovery of more severe grades (grade 0 or 1) of deltoid palsy compared to grade 2 or 3 deltoid palsy. Conclusions Early surgical decompression significantly improved deltoid palsy caused by CDH, irrespective of age, gender, number of surgery level, and disc type. However, longer duration of deltoid palsy and more severe intensity of preoperative radiating pain were associated with less improvement of deltoid palsy postoperatively. PMID:26435786

  18. The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation

    PubMed Central

    Rihn, Jeffrey A.; Kurd, Mark; Hilibrand, Alan S.; Lurie, Jon; Zhao, Wenyan; Albert, Todd; Weinstein, James

    2013-01-01

    Background: Questions remain as to the effect that obesity has on patients managed for symptomatic lumbar disc herniation. The purpose of this study was to determine if obesity affects outcomes following the treatment of symptomatic lumbar disc herniation. Methods: An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial for the treatment of lumbar disc herniation. A comparison was made between patients with a body mass index of <30 kg/m2 (nonobese) (n = 854) and those with a body mass index of ?30 kg/m2 (obese) (n = 336). Baseline patient demographic and clinical characteristics were documented. Primary and secondary outcomes were measured at baseline and at regular follow-up time intervals up to four years. The difference in improvement from baseline between operative and nonoperative treatment was determined at each follow-up period for both groups. Results: At the time of the four-year follow-up evaluation, improvements over baseline in primary outcome measures were significantly less for obese patients as compared with nonobese patients in both the operative treatment group (Short Form-36 physical function, 37.3 compared with 47.7 points [p < 0.001], Short Form-36 bodily pain, 44.2 compared with 50.0 points [p = 0.005], and Oswestry Disability Index, ?33.7 compared with ?40.1 points [p < 0.001]) and the nonoperative treatment group (Short Form-36 physical function, 23.1 compared with 32.0 points [p < 0.001] and Oswestry Disability Index, ?21.4 compared with ?26.1 points [p < 0.001]). The one exception was that the change from baseline in terms of the Short Form-36 bodily pain score was statistically similar for obese and nonobese patients in the nonoperative treatment group (30.9 compared with 33.4 points [p = 0.39]). At the time of the four-year follow-up evaluation, when compared with nonobese patients who had been managed operatively, obese patients who had been managed operatively had significantly less improvement in the Sciatica Bothersomeness Index and the Low Back Pain Bothersomeness Index, but had no significant difference in patient satisfaction or self-rated improvement. In the present study, 77.5% of obese patients and 86.9% of nonobese patients who had been managed operatively were working a full or part-time job. No significant differences were observed in the secondary outcome measures between obese and nonobese patients who had been managed nonoperatively. The benefit of surgery over nonoperative treatment was not affected by body mass index. Conclusions: Obese patients realized less clinical benefit from both operative and nonoperative treatment of lumbar disc herniation. Surgery provided similar benefit over nonoperative treatment in obese and nonobese patients. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:23192403

  19. Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients with Lumbar Intervertebral Disc Herniation

    PubMed Central

    Lurie, Jon D.; Moses, Rachel A.; Tosteson, Anna N. A.; Tosteson, Tor D.; Carragee, Eugene J.; Carrino, John A.; Kaiser, Jay A.; Herzog, Richard J.

    2013-01-01

    Study Design A retrospective cohort design Objective To determine if baseline MRI findings including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression are associated with differential surgical treatment effect. Summary of Background Data Intervertebral Disc Herniation (IDH)remains the most common source of lumbar radiculopathy treated either with discectomy or non-operative intervention. Although MRI remains the reliable gold standard for diagnosis, uncertainty surrounds the relationship between MRI findings and treatment outcomes. Methods Three-hundred-and-seven complete images from patients enrolled in a previous trial were de-identified and evaluated by one of 4 independent readers. Findings were compared to outcome measures including the Oswestry Disability Index. Differences in surgery and non-operative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in ODI scores. Results The cohort was comprised of 40% females with an average age of 41.5 (11.6), 61% of which underwent discectomy for IDH. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (?26.4 versus ?39.7 for none and ?39.2 for type 2, p=0.002) and smaller treatment effect (?3.5 versus ?19.3 for none and ?15.7 for type 2, p=0.003). Those with compression >=1/3 showed the greatest improvement within the surgical group (?41.9 for >=1/3 versus ?31.6 for none and ?38.1 for <1/3,p=0.007), and the highest TE (?23 compared to ?11.7 for none and ?15.2 for <1/3, p=0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes(?26.5 versus ?41.1 for displaced and ?38.9 for compressed, p=0.016). Conclusion Among patients with IDH, those with thecal sac compression >=1/3 had greater surgical treatment effect than those with small disc herniations and Modic type I changes. Additionally, patients with nerve root compression and displacement benefit more from surgery than those with minimal nerve-root impingement. PMID:23429684

  20. Percutaneous Disc Coagulation Therapy (PDCT) comparing with Automated Percutaneous Lumbar Discectomy (APLD) in Patients of Herniated Lumbar Disc Disease: Preliminary Report

    PubMed Central

    Park, Cheon Wook; Lee, Joo Yong; Choi, Woo Jin

    2012-01-01

    Objective Percutaneous techniques are rapidly replacing traditional open surgery. This is a randomized controlled trial study of clinical outcomes of Percutaneous Plasma Disc Coagulation Therapy (PDCT) in patients with HLD(herniated lumbar disc) as a new percutaneous access in comparison with Automated Percutaneous Lumbar Discectomy (APLD) in its clinical application and usefulness as a reliable alternative method. Methods The authors analyzed 25 patients who underwent PDCT randomized 1:1 to 25 who underwent APLD between June, 2010 and October, 2011. All patients had herniated lumbar disc diseases. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. Results The age of the patients who underwent PDCT ranged from 29 to 88 years with a mean age of 51.8 years. The age of the APLD undergone patients' population ranged from 30 to 66 with a mean age of 46.0 years. The average preoperative VAS score in PDCT was 7.60 and 1.94 at 7months post-operatively, and in APLD was 7.32, and 3.53 at 7 months post-operatively (p<0.001). In Macnab's criteria, 20 patients (80%) had achieved favorable improvement (excellent and good) in PDCT group. In Macnab's criteria, 16 patients (64%) had achieved favorable improvement in APLD group (p<0.001). Conclusion PDCT can be considered a viable option as a new percutaneous access to herniated lumbar disc. PDCT showed to be more effective than APLD in this study, allowing stable decompression and safe minimally invasive operation to an area desired by the operator in lumbar disc herniation patients, although further long term clinical evaluations are still necessary. PMID:25983808

  1. Characteristics of Lumbar Disc Herniation With Exacerbation of Presentation Due to Spinal Manipulative Therapy

    PubMed Central

    Huang, Sheng-Li; Liu, Yan-Xi; Yuan, Guo-Lian; Zhang, Ji; Yan, Hong-Wei

    2015-01-01

    Abstract The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 415 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24?h. Magnetic resonance imaging showed that L4L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging. PMID:25816037

  2. SPORT: Do outcomes vary across centers for surgery for lumbar disc herniation?

    PubMed Central

    Desai, Atman; Bekelis, Kimon; Ball, Perry A.; Lurie, Jon; Mirza, Sohail K.; Tosteson, Tor D.; Zhao, Wenyan; Weinstein, James N.

    2014-01-01

    Background Lumbar discectomy is the most common procedure performed in spine surgery. Different centers performing this procedure may have different outcomes. Objective To determine whether the choice of academic spine center in which surgery is performed affects outcome after lumbar discectomy. Methods Spine Patient Outcomes Research Trial (SPORT) cohort participants with a confirmed diagnosis of intervertebral disc herniation (IDH) undergoing standard first-time open discectomy were followed from baseline at 6 weeks, and 3, 6, 12 months and yearly thereafter, at 13 spine clinics in 11 US states. Patient data were retrospectively reviewed. As of August 2009, the mean (SD) follow-up among all analyzed IDH patients was 41.3 (14.6) months. The median (range) follow-up time among all analyzed IDH patients was 47.4 (1.3, 95.3) months. Enrollment began in March 2000 and ended in November 2004. Results 792 patients underwent first-time lumbar discectomy. Significant differences were found amongst centers with regard to patient age and race, and in baseline levels of disability and treatment preferences. There were no significant differences among the study centers in other patient characteristics (e.g., sex, body mass index, the prevalence of smoking, diabetes or hypertension), or disease characteristics (herniation level or type). Some short-term outcomes varied significantly among centers, including operative duration and blood loss, the incidence of durotomy and the length of hospital stay. Unadjusted reoperation rates also varied across centers. There were no differences among the various centers in incidence of nerve root injury, post-operative mortality, SF-36 scores of body pain or physical function, or Oswestry Disability Index at 4 years. Conclusions Although mean operative blood loss, risk of durotomy and length of hospital stay vary across academic centers performing lumbar discectomy, there appears to be no difference in long-term functional outcomes. The role of different reoperation rates in producing similar outcomes remains unclear. PMID:22791040

  3. Structural brain alterations in patients with lumbar disc herniation: a preliminary study.

    PubMed

    Luchtmann, Michael; Steinecke, Yvonne; Baecke, Sebastian; Ltzkendorf, Ralf; Bernarding, Johannes; Kohl, Jana; Jllenbeck, Boris; Tempelmann, Claus; Ragert, Patrick; Firsching, Raimund

    2014-01-01

    Chronic pain is one of the most common health complaints in industrial nations. For example, chronic low back pain (cLBP) disables millions of people across the world and generates a tremendous economic burden. While previous studies provided evidence of widespread functional as well as structural brain alterations in chronic pain, little is known about cortical changes in patients suffering from lumbar disc herniation. We investigated morphometric alterations of the gray and white matter of the brain in patients suffering from LDH. The volumes of the gray and white matter of 12 LDH patients were determined in a prospective study and compared to the volumes of healthy controls to distinguish local differences. High-resolution MRI brain images of all participants were performed using a 3 Tesla MRI scanner. Voxel-based morphometry was used to investigate local differences in gray and white matter volume between patients suffering from LDH and healthy controls. LDH patients showed significantly reduced gray matter volume in the right anterolateral prefrontal cortex, the right temporal lobe, the left premotor cortex, the right caudate nucleus, and the right cerebellum as compared to healthy controls. Increased gray matter volume, however, was found in the right dorsal anterior cingulate cortex, the left precuneal cortex, the left fusiform gyrus, and the right brainstem. Additionally, small subcortical decreases of the white matter were found adjacent to the left prefrontal cortex, the right premotor cortex and in the anterior limb of the left internal capsule. We conclude that the lumbar disk herniation can lead to specific local alterations of the gray and white matter in the human brain. The investigation of LDH-induced brain alterations could provide further insight into the underlying nature of the chronification processes and could possibly identify prognostic factors that may improve the conservative as well as the operative treatment of the LDH. PMID:24595036

  4. Subarachnoidal pleural fistula after resection of intradural thoracic disc herniation and multimodal treatment with noninvasive positive pressure ventilation (NPPV).

    PubMed

    Schlag, Holger R; Muquit, Samiul; Hristov, Tanyo B; Morassi, Guiseppe; Boszczyk, Bronek Maximilian; Shafafy, Masood

    2016-01-01

    Subarachnoid pleural fistula (SPF) is a type of cerebrospinal fluid (CSF) fistula that can arise as a complication following transthoracic resection of intervertebral disc herniation in the thoracic spine. It is an abnormal communication between the subarachnoid and pleural space. Negative intrapleural pressure promotes CSF leak due to a suction effect into the pleural cavity, with little chance of spontaneous closure. Due to the risk of severe complications with CSF leak into the thoracic cavity, early diagnosis and treatment are mandatory. However, management can be challenging. We report a case of a 72-year-old woman who underwent anterior thoracic surgery to treat thoracic myelopathy caused by an ossified intradural disc herniation. The postoperative period was complicated by a subarachnoidal pleural fistula. We describe our successful treatment of this using noninvasive positive pressure ventilation and lumbar CSF drainage and review other methods reported in the literature. PMID:26215176

  5. One stage laminoplasty and posterior herniotomy for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation

    PubMed Central

    Yue, Bin; Chen, Bohua; Ma, Xue-Xiao; Xi, Yong-Ming; Xiang, Hong-Fei; Hu, You-Gu; Zhang, Guoqing

    2015-01-01

    The aim of the study was to introduce a method of one stage laminoplasty and posterior herniotomy for myelopathy caused by cervical stenosis with cervical disc herniation and to evaluate the clinical efficacy of this surgery. From 1999 to 2008, 18 patients with myelopathy caused by cervical stenosis with cervical disc herniation who underwent this procedure were included. The average age was 63 years (range 48-74 years), and the average follow-up period was 46 months (range 3-108 months). Neurologic status was evaluated using the JOA scoring system. Neurological symptoms improvement was seen in all patients after surgery. The average JOA score was 14.221.86 by final follow-up, which was higher than preoperative values (P<0.01), and the average improvement in neurological function was 76.63%. Neurologic examination showed that excellent results had been obtained by 10 patients, good results by 8 patients, with no fair or poor results. 2 patients developed cerebrospinal fluid leakage after surgery and recovered during the follow-up period. One patient with cervical disc herniation developed postoperative C5 palsy on the axle side on the third day after surgery. She completely recovered by 1 month after surgery. No other patients experienced postoperative neurologic complications. Complete anterior and posterior decompression of the spinal cord was achieved after surgery. We concluded that one stage laminoplasty and posterior herniotomy is an effective, reliable, and safe procedure for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation. PMID:26309625

  6. Intradural schwannoma complicated by lumbar disc herniation at the same level: A case report and review of the literature

    PubMed Central

    BAEK, SEUNG-WOOK; KIM, CHEOL; CHANG, HAN

    2014-01-01

    Intradural tumours of the spine are usually benign and have a good prognosis, if they are diagnosed and removed early. Lumbar disc herniation is a common cause of chronic, acute, or recurrent lumbar radiculopathy. However, to date, there have been no reports of progressive neurological deficiencies due to the co-existence of two significant pathologies contributing to intradural and extradural compression. The current study reports the rare case of a patient with simultaneous extradural and intradural compression of the nerve root due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. A 71-year-old female suffering from lower back pain and radiating pain of the right lower extremities was admitted to Busan Korea Hospital (Busan, Korea). Magnetic resonance imaging revealed lumbar disc herniation at L45 and a mass occupying the intradural space at the same level of the compressed dural sac. Using the posterior approach, surgical excision of the two pathologies was performed. Pathological diagnosis confirmed schwannoma and the symptoms markedly improved. PMID:25013519

  7. Feasibility and Efficacy of Percutaneous Lateral Lumbar Discectomy in the Treatment of Patients with Lumbar Disc Herniation: A Preliminary Experience

    PubMed Central

    Jiang, Wenjin; Sun, Bolin; Sheng, Qirui; Song, Xuepeng; Zheng, Yanbo; Wang, Ligang

    2015-01-01

    Objective. This study was aimed at evaluating the effectiveness and safety of percutaneous lateral lumbar discectomy (PLLD) in treating patients with lumber disc herniation. Methods. A total of 183 patients with lumbar disc herniation were recruited to receive PLLD surgery from April 2006 to October 2011. All the adverse effects were recorded during the follow-up at 1, 3, 6, and 12 months after PLLD. The clinical outcomes were determined by visual analog scale and Japanese Orthopaedic Association score. Results. The surgery was performed successfully in all patients (102 males and 81 females aged from 21 to 66 years) with a mean 16.6-month follow-up (range from 26 to 65 months). No postoperative complications, including intestinal and vascular complications, nerve injuries, and postoperative infections, were associated with PLLD. At one month after surgery, visual analog scale (3.121.44 versus 6.762.31, P<0.05) was significantly lower than the baseline and was sustained until 24 months after surgery (3.25 1.78 versus 6.762.31, P<0.05). Besides that, Japanese Orthopaedic Association score (25.253.21 versus 11.782.38, P<0.05) was increased when compared to the baseline. Conclusions. PLLD was a promising, mini-invasive, and effective treatment for lumber disc herniation. PMID:25695066

  8. Prognostic factors for non-success in patients with sciatica and disc herniation

    PubMed Central

    2012-01-01

    Background Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2?years of follow-up and to test the prognostic value of surgical treatment for sciatica. Methods The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as MaineSeattle Back Questionnaire score of ?5 (012) (primary outcome) and Sciatica Bothersomeness Index ?7 (024) (secondary outcome). Results Rates of non-success were at 1 and 2?years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1?year was significantly associated with being male (OR 1.70 [95% CI; 1.06???2.73]), smoker (2.06 [1.31???3.25]), more back pain (1.0 [1.01???1.02]), more comorbid subjective health complaints (1.09 [1.03???1.15]), reduced tendon reflex (1.62 [1.03???2.56]), and not treated surgically (2.97 [1.75???5.04]). Further, factors significantly associated with non-success at 2?years were duration of back problems?>;?1?year (1.92 [1.11???3.32]), duration of sciatica?>;?3?months (2.30 [1.40???3.80]), more comorbid subjective health complaints (1.10 [1.03???1.17]) and kinesiophobia (1.04 [1.00???1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2?years. Conclusions The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated. PMID:22999108

  9. A PHASED REHABILITATION PROTOCOL FOR ATHLETES WITH LUMBAR INTERVERTEBRAL DISC HERNIATION

    PubMed Central

    VanGelder, Leonard H.; Vaughn, Daniel W.

    2013-01-01

    Conservative non-surgical management of a herniated lumbar intervertebral disc (HLD) in athletes is a complex task due to the dramatic forces imparted on the spine during sport participation. The demands placed upon the athlete during rehabilitation and return to sport are unique not only from a sport specific perspective, but also regarding return to the sport strength and conditioning programs utilized for sport preparation. Many prescriptions fail to address postural and motor control faults specific to athletic development, which may prevent full return to sport after suffering a HLD or predispose the athlete to future exacerbations of a HLD. Strength exercises involving squatting, deadlifting, and Olympic power lifts are large components of the typical athlete's conditioning program, therefore some progressions are provided to address potential underlying problems in the athlete's technique that may have contributed to their HLD in the first place. The purpose of this clinical commentary is to propose a framework for rehabilitation that is built around the phases of healing of the disc. Phase I: Non-Rotational/Non-Flexion Phase (Acute Inflammatory Phase), Phase II: Counter rotation/Flexion Phase (Repair Phase), Phase III: Rotational Phase/Power development (Remodeling Phase), and Phase IV: Full return to sport. This clinical commentary provides a theoretical basis for these phases based on available literature as well as reviewing many popular current practice trends in the management of an HLD. The authors recognize the limits of any general exercise rehabilitation recommendation with regard to return to sport, as well as any general strength and conditioning program. It is vital that an individual assessment and prescription is made for every athlete which reviews and addresses movement in all planes of motion under all necessary extrinsic and intrinsic demands to that athlete. Level of Evidence: 5 PMID:24175134

  10. Brain herniation

    MedlinePLUS

    ... herniation; Uncal herniation; Subfalcine herniation; Tonsillar herniation; Herniation - brain ... Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most ...

  11. Efficacy of Transforaminal Endoscopic Spine System (TESSYS) Technique in Treating Lumbar Disc Herniation.

    PubMed

    Pan, Zhimin; Ha, Yoon; Yi, Seong; Cao, Kai

    2016-01-01

    BACKGROUND To compare efficacy and safety of percutaneous transforaminal endoscopic spine system (TESSYS) and traditional fenestration discectomy (FD) in treatment of lumbar disc herniation (LDH). MATERIAL AND METHODS A total of 106 LDH patients were divided into TESSYS group (n=48) and FD group (n=58). Visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and modified MacNab criteria were used for efficacy evaluation. Post-operative responses were compared by enzyme-linked immunosorbent assay (ELISA) based on detection of serum IL-6, CRP, and CPK levels. RESULTS In the TESSYS group, compared with the FD group, we observed, shorter incision length, less blood loss, shorter hospital stay, lower hospitalization cost, shorter recovery time, lower complication rate (all P<0.001), and lower VAS scores of lumbago and skelalgia at 3 days and 1, 3, and 6 months postoperatively (all P<0.05). At 24 and 48 h postoperatively, CRP level was remarkably higher in the FD group compared to the TESSYS group (P<0.001). Further, comparison of IL-6 levels at 6, 12, 24, and 48 h postoperatively revealed significantly higher levels in the FD group than in the FESSYS group (all P<0.001). CONCLUSIONS TESSYS had clinical advantages over FD and entails less trauma and quicker postoperative recovery, suggesting that TESSYS is well tolerated by patients and is a better approach than FD in surgical treatment of LDH. PMID:26887645

  12. Clinical Effect of Acupotomy Combined with Korean Medicine: A Case Series of a Herniated Intervertebral Disc.

    PubMed

    Kim, Hyun-Ji; Jeon, Ju-Hyun; Kim, Young-Il

    2016-02-01

    The aim of this study is to evaluate the effect of acupotomy for treating patients with a herniated intervertebral disc (HIVD). This case series includes five HIVD patients who were treated at the Department of Acupuncture and Moxibustion, Daejeon University Dunsan Korean Hospital, Daejeon, Korea, from January 2015 to April 2015. Acupotomy was performed three times over a 2-week period, along with Korean medical treatment. The outcomes were evaluated by using a numeric rating scale (NRS), physical examination, the Oswestry Low Back Pain Disability Index (ODI), the Short-Form 36-Item Health Survey (SF-36), and the Surgical Safety Checklist. The NRS and physical examination results, as well as the ODI scores, were improved in all cases. No significant differences were noted on the SF-36. No patients had any adverse effects. This study, with its findings of encouraging responses in reducing low back pain and radiating pain and in recovering the kinetic state of soft tissue, supports the potential use of acupotomy for the treatment of patients suffering from HIVD. PMID:26896075

  13. Estimates of success in patients with sciatica due to lumbar disc herniation depend upon outcome measure.

    PubMed

    Haugen, Anne Julsrud; Grvle, Lars; Brox, Jens Ivar; Natvig, Brd; Keller, Anne; Soldal, Dag; Grotle, Margreth

    2011-10-01

    The objectives were to estimate the cut-off points for success on different sciatica outcome measures and to determine the success rate after an episode of sciatica by using these cut-offs. A 12-month multicenter observational study was conducted on 466 patients with sciatica and lumbar disc herniation. The cut-off values were estimated by ROC curve analyses using Completely recovered or Much better on a 7-point global change scale as external criterion for success. The cut-off values (references in brackets) at 12 months were leg pain VAS 17.5 (0-100), back pain VAS 22.5 (0-100), Sciatica Bothersomeness Index 6.5 (0-24), Maine-Seattle Back Questionnaire 4.5 (0-12), and the SF-36 subscales bodily pain 51.5, and physical functioning 81.7 (0-100, higher values indicate better health). In conclusion, the success rates at 12 months varied from 49 to 58% depending on the measure used. The proposed cut-offs may facilitate the comparison of success rates across studies. PMID:21516463

  14. Efficacy of Transforaminal Endoscopic Spine System (TESSYS) Technique in Treating Lumbar Disc Herniation

    PubMed Central

    Pan, Zhimin; Ha, Yoon; Yi, Seong; Cao, Kai

    2016-01-01

    Background To compare efficacy and safety of percutaneous transforaminal endoscopic spine system (TESSYS) and traditional fenestration discectomy (FD) in treatment of lumbar disc herniation (LDH). Material/Methods A total of 106 LDH patients were divided into TESSYS group (n=48) and FD group (n=58). Visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and modified MacNab criteria were used for efficacy evaluation. Post-operative responses were compared by enzyme-linked immunosorbent assay (ELISA) based on detection of serum IL-6, CRP, and CPK levels. Results In the TESSYS group, compared with the FD group, we observed, shorter incision length, less blood loss, shorter hospital stay, lower hospitalization cost, shorter recovery time, lower complication rate (all P<0.001), and lower VAS scores of lumbago and skelalgia at 3 days and 1, 3, and 6 months postoperatively (all P<0.05). At 24 and 48 h postoperatively, CRP level was remarkably higher in the FD group compared to the TESSYS group (P<0.001). Further, comparison of IL-6 levels at 6, 12, 24, and 48 h postoperatively revealed significantly higher levels in the FD group than in the FESSYS group (all P<0.001). Conclusions TESSYS had clinical advantages over FD and entails less trauma and quicker postoperative recovery, suggesting that TESSYS is well tolerated by patients and is a better approach than FD in surgical treatment of LDH. PMID:26887645

  15. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

    PubMed Central

    Yi, Ji Sook; Han, Jong Kyu; Kim, Hyun-Joo

    2015-01-01

    Objective To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Materials and Methods Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. Results The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Conclusion Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI. PMID:26175589

  16. Clinical and Magnetic Resonance Imaging Factors Which May Predict the Need for Surgery in Lumbar Disc Herniation

    PubMed Central

    Motiei-Langroudi, Rouzbeh; Sadeghian, Homa

    2014-01-01

    Study Design Case-control. Purpose Evaluate clinical and imaging factors which may predict the risk of failure of medical therapy in patients with lumbar disc herniation (LDH). Overview of Literature LDH is a common cause of low back pain and radicular leg pain, with a generally favorable natural course. At present, however, it is not possible to identify patients who may be candidates for surgery in an early stage of their disease by means of clinical signs or diagnostic imaging criteria. Methods We designed a study investigating patients with untreated low back pain to assess the predictive value of demographic, clinical or imaging findings in identifying patients who finally would meet the classic current criteria for surgery. Results Among 134 patients, 80.6% were successfully treated with conservative therapy and 19.4% finally underwent surgery. Sex, occupation, involved root level, presence of Modic changes, osteophytes or annular tears were not significantly different between the 2 groups, while cerebrospinal fluid block, Pfirrmann's grade, location of herniation with regard to the midline, and type of herniation were significantly different. Anteroposterior fragment size was significantly higher and intervertebral foramen height and thecal sac diameters were significantly lower in the surgical group. Conclusions Although it is strongly recommended to practice conservative management at first for patients with LDH symptoms, the results of this study shows that higher Pfirrmann's grade, more laterally located discs, extrusion and protrusion herniation types, and larger fragments could predict the risk of conservative treatment failure. This way, unnecessarily prolonged conservative management (beyond 4-8 weeks) may be precluded. PMID:25187861

  17. Postoperative Clinical Outcome and Risk Factors for Poor Outcome of Foraminal and Extraforaminal Lumbar Disc Herniation

    PubMed Central

    Bae, Jung Sik; Kang, Kyung Hee; Park, Jeong Hyun; Lim, Jae Hyeon

    2016-01-01

    Objective We evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes. Methods A total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS). Results Paramedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0–79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000). Conclusion This study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes. PMID:26962420

  18. Outcome of surgical treatment of lumbar disc herniation in young individuals.

    PubMed

    Strmqvist, F; Strmqvist, B; Jnsson, B; Gerdhem, P; Karlsson, M K

    2015-12-01

    Lumbar disc herniation (LDH) is uncommon in youth and few cases are treated surgically. Very few outcome studies exist for LDH surgery in this age group. Our aim was to explore differences in gender in pre-operative level of disability and outcome of surgery for LDH in patients aged ? 20 years using prospectively collected data. From the national Swedish SweSpine register we identified 180 patients with one-year and 108 with two-year follow-up data ? 20 years of age, who between the years 2000 and 2010 had a primary operation for LDH. Both male and female patients reported pronounced impairment before the operation in all patient reported outcome measures, with female patients experiencing significantly greater back pain, having greater analgesic requirements and reporting significantly inferior scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects of Short Form-36 and Oswestry Disabilities Index, when compared with male patients. Surgery conferred a statistically significant improvement in all registered parameters, with few gender discrepancies. Quality of life at one year following surgery normalised in both males and females and only eight patients (4.5%) were dissatisfied with the outcome. Virtually all parameters were stable between the one- and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in both male and female patients aged 20 years or younger, who failed to recover after non-operative management. Cite this article: Bone Joint J 2015;97-B:1675-82. PMID:26637684

  19. Surgical management of recurrent lumbar disc herniation and the role of fusion.

    PubMed

    Dower, Ashraf; Chatterji, Robindro; Swart, Alexander; Winder, Mark J

    2016-01-01

    This systematic review was performed to evaluate the various operative management strategies for recurrent lumbar disc herniation (RLDH), including the efficacy of instrumented spinal fusion (ISF) at repeat discectomy, and whether the operative approach for repeat discectomy, minimally invasive (MID) or conventional open discectomy (CD), affected the outcomes. RLDH is one of the most common complications of lumbar discectomies. Whilst repeat discectomy is the standard procedure performed, the routine addition of ISF has been advocated to improve outcomes and prevent reherniation. A comprehensive search of the MEDLINE, EMBASE, CINAHL and Cochrane databases was performed. The measured outcomes included the rate of satisfactory clinical outcome, improvement in leg and back pain, Japanese Orthopaedic Association (JOA) recovery score, and complication rates. In total, 37 studies met our inclusion criteria, with 1483 patients. The rate of satisfactory outcomes was found to be statistically similar between the patients undergoing a discectomy with or without fusion (77.8% with ISF versus 79.5% without ISF; p=0.665). Back pain and JOA scores showed greater improvements in the patients undergoing discectomy and fusion, compared to discectomy alone. The rate of satisfactory outcomes was marginally higher in the patients undergoing MID compared to CD (MID 81.2% versus CD 77.5%; p=0.248). However, the leg pain improvement was similar. The postoperative back pain improvement was greater in the MID group (52.5% MID versus 36.3% CD), but with lower complication rates, specifically durotomies (MID 5.2% versus CD 15.3%; p<0.001). There is no evidence to recommend the routine addition of ISF in the management of RLDH. The data suggest that MID has lower complication rates than CD in the setting of RLDH, yet unequivocal evidence is lacking. PMID:26282154

  20. Instrumented transforaminal lumbar interbody fusion in surgical treatment of recurrent disc herniation

    PubMed Central

    Omidi-Kashani, Farzad; Ghayem Hasankhani, Ebrahim; Noroozi, Hamid Reza

    2014-01-01

    Background: The incidence of recurrence in patients undergoing primary discectomy due to lumbar disc herniation (LDH), is regularly reported as 5-15%. In this study we aimed to evaluate surgical outcome of instrumented transforaminal lumbar interbody fusion (TLIF) in the patients suffering from recurrent LDH. Methods: We retrospectively studied 51 patients (30 female, 21 male) from August 2007 to October 2011. The mean age and follow-up of the patients was 46.4±14.8 (ranged; 29-77 years old) and 31.4±6.8 (ranged; 25-50 months), respectively. Clinical improvement was assessed by Oswestry Disability Index (ODI), visual analogue scale (VAS), and subjective satisfaction rate, while fusion was appraised radiologically. Data analysis was by one sample Kolmogorov-Smirnov, paired t, and Mann-Whitney tests. Results: Surgery could significantly improve mean leg and lumbar VAS and ODI from preoperative 7.4±2.5, 7.8±3.1, and 72.1±21.5 to postoperative 3.4±3.6, 3.5±2.6, and 27.5±18.0, respectively at the last follow-up visit. Subjective satisfaction rate was excellent in 24 patients (47.1%), good in 14 (27.5%), fair 11 (21.6%), and poor in two (3.9%). We had one patient with iatrogenic partial L5 nerve root injury and one with unknown late onset refractory postoperative back pain. Fusion rate was 100% and instrument failure was nil. Conclusion: In surgical treatment of the patients with recurrent LDH, bilaterally instrumented TLIF is a relatively safe and effective procedure and can be associated with least instrument failure and highest fusion rate while no postoperative bracing is also needed. PMID:25679003

  1. Prognostic Value of Impaired Preoperative Ankle Reflex in Surgical Outcome of Lumbar Disc Herniation

    PubMed Central

    Omidi-Kashani, Farzad; EG, Hasankhani; Zare, Atefe

    2016-01-01

    Background: Several prognostic factors exist influencing the outcome of surgical discectomy in the patients with lumbar disc herniation (LDH). The aim of this study is to evaluate the relationship between severity of preoperative impaired ankle reflex and outcomes of lumbar discectomy in the patients with L5-S1 LDH. Methods: We retrospectively evaluated 181 patients (108 male and 73 female) who underwent simple discectomy in our orthopedic department from April 2009 to April 2013 and followed them up for more than one year. The mean age of the patients was 35.38.9 years old. Severity of reflex impairment was graded from 0 to 4+ and radicular pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaires, respectively. Subjective satisfaction was also evaluated at the last follow-up visit. Chi-square and Kruskal-Wallis tests were used to compare qualitative variables. Results: Reflex impairment existed in 44.8% preoperatively that improved to 10% at the last follow-up visit. Statistical analyses could not find a significant relationship between the severity of impaired ankle reflex and sex or age (P=0.538 and P=0.709, respectively). There was a remarkable relationship between severity of reflex impairment and preoperative radicular pain or disability (P=0.012 and P=0.002, respectively). Kruskal-Wallis test showed that a more severity in ankle reflex impairment was associated with not only less improvement in postoperative pain and disability but also less satisfaction rate (P<0.001 in all three). Conclusions: In the patients with L5-S1 LDH, more severe ankle reflex impairment is associated with less improvement in postoperative pain, disability, and subjective satisfaction. PMID:26894219

  2. Early neuromuscular customized training after surgery for lumbar disc herniation: a prospective controlled study

    PubMed Central

    Strmqvist, Bjrn

    2006-01-01

    A prospective and controlled study of training after surgery for lumbar disc herniation (LDH). The objective was to determine the effect of early neuromuscular customized training after LDH surgery. No consensus exists on the type and timing of physical rehabilitation after LDH surgery. Patients aged 1550 years, disc prolapse at L4L5 or L5S1. Before surgery, at 6 weeks, 4, and 12 months postoperatively, the following evaluations were performed: low back pain and leg pain estimated on a visual analog scale, disability according to the RolandMorris questionnaire (RMQ) and disability rating index (DRI). Clinical examination, including the SLR test, was performed using a single blind method. Consumption of analgesics was registered. Twenty-five patients started neuromuscular customized training 2 weeks after surgery (early training group=ETG). Thirty-one patients formed a control group (CG) and started traditional training after 6 weeks. There was no significant difference in pain and disability between the two training groups before surgery. Median preoperative leg pain was 63mm in ETG and 70mm in the CG. Preoperative median disability according to RMQ was 14 in the ETG and 14.5 in the CG. Disability according to DRI (33/56 patients) was 5.3 in the ETG vs. 4.6 in the CG. At 6 weeks, 4 months, and 12 months, pain was significantly reduced in both groups, to the same extent. Disability scores were lower in the ETG at all follow-ups, and after 12 months, the difference was significant (RMQ P=.034, DRI P=.015). The results of the present study show early neuromuscular customized training to have a superior effect on disability, with a significant difference compared to traditional training at a follow-up 12 months after surgery. No adverse effects of the early training were seen. A prospective, randomized study with a larger patient sample is warranted to ultimately demonstrate that early training as described is beneficial for patients undergoing LDH surgery. PMID:16421747

  3. Efficacy of Epidural Neuroplasty Versus Transforaminal Epidural Steroid Injection for the Radiating Pain Caused by a Herniated Lumbar Disc

    PubMed Central

    Kim, Hae Jong; Rim, Byeong Cheol; Lim, Jeong-Wook; Park, Noh Kyoung; Kang, Tae-Wook; Sohn, Min Kyun; Beom, Jaewon

    2013-01-01

    Objective To compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc. Methods Thirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment. Results In the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.001.52, 4.291.20, 2.640.93, 1.430.51 and those of FRI were 23.573.84, 16.503.48, 11.432.44, 7.002.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.222.05, 4.281.67, 2.561.04, 1.330.49 and those of FRI were 22.006.64, 16.225.07, 11.564.18, 8.061.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (p<0.05) after the treatment. But there were no significant differences between the two groups statistically. Conclusion Epidural NP and TFESI are equally effective treatments for the reduction of radiating pain and for improvement of function in patients with a herniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP. PMID:24466517

  4. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar

    2012-01-01

    Background Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. Methods A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1) and the other group did (group 2). There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment. Results Significant pain relief and functional status improvement (primary outcome) defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months. Conclusion Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis. PMID:23091395

  5. Return to play after conservative treatment in athletes with symptomatic lumbar disc herniation: a practice-based observational study

    PubMed Central

    Iwamoto, Jun; Sato, Yoshihiro; Takeda, Tsuyoshi; Matsumoto, Hideo

    2011-01-01

    The purpose of the study was to confirm the short-term outcome of conservative treatment in terms of the ability to return to play and factors influencing return to play in athletes with symptomatic lumbar disc herniation. A total of 100 consecutive athletes (72 male and 28 female) who consulted our sports medicine clinic during the 16-year period between September 1993 and October 2009 because of severe low back pain and/or leg pain/numbness due to lumbar disc herniation were studied. The mean age of the subjects was 23 years. All of them were conservatively treated by being advised to discontinue their sporting activities with/without short-term medication. After the subjective symptoms had reduced by more than 80%, individual training was started in order to allow the athletes to return to play. Seventy-nine athletes (79.0%) returned to play at an average of 4.8 months (range 1–12 months) after the start of treatment and were able to sustain the activities for at least 6 months, the minimum duration of follow-up in the study. The outcome of the conservative treatment was not influenced by the intensity of the sporting activity. Multiple logistic regression analyses showed that the severity of the symptoms prior to the start of treatment was the factor influencing the ability of the athletes to return to play. The present study confirmed the satisfactory short-term outcome of conservative treatment in athletes with symptomatic lumbar disc herniation regarding return to play and revealed that subjective symptoms prior to the start of treatment appeared to be a key factor in return to play after conservative treatment. PMID:24198567

  6. Comparison of Clinical Efficacy Between Interlaminar and Transforaminal Epidural Injection in Patients With Axial Pain due to Cervical Disc Herniation.

    PubMed

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-01-01

    Transforaminal (TF) approach is preferred by physician to interlaminar (IL) approach because it can deliver injectates directly around nerve root and dorsal root ganglion, which is regarded as main pain sources. Axial neck pain is originated from sinuvertebral nerve located in ventral epidural spaces, which has been described to be related to central or paramedian disc herniation. It is very questionable that TF injection is also more effective than IL injection in the patients with axial neck or interscapular pain. This study was to evaluate clinical efficacy of cervical epidural injection in patients with axial pain due to cervical disc herniation and to compare the clinical outcomes between TF and IL approaches. Fifty-six and 52 patients who underwent IL and TF epidural injections, respectively, for axial neck/interscapular pain due to central or paramedian cervical disc herniation were included. Numeric Rating Scale (NRS) and Neck Disability Index (NDI) were compared between both groups at 2 and 8 weeks after treatment. Successful pain relief was defined if a 50% or more reduction of NRS score was achieved in comparison with pretreatment one. Successful functional improvement was defined if at least a 40% reduction of NDI was obtained. Overall, 79 (73.1%) and 57 (52.8%) among 108 patients showed successful pain relief at 2 and 8 weeks, respectively. Seventy-six (70.4%) and 52 (48.1%) had successful functional improvement at 2 and 8 weeks, respectively. The IL and TF groups showed no significant difference in proportion of successful results of NRS 2 weeks (73.2% vs 67.3%) and 8 weeks (48.2% vs 48.1%). Also, no significant difference was obtained in proportion of successful NDI between 2 groups at 2 weeks (75.0% vs 71.2%) and 8 weeks (53.6% vs 51.9%). Cervical epidural injection showed favorable results in 2 weeks and moderate results in 8 weeks in patients with axial pain due to cervical disc herniation. IL and TF showed no significant difference in clinical efficacy. Considering TF was relevant to more serious side effects, IL was more recommendable in these patients. PMID:26825899

  7. Use of Magnetic Resonance Imaging to Identify Outcome Predictors of Caudal Epidural Steroid Injections for Lower Lumbar Radicular Pain Caused by a Herniated Disc

    PubMed Central

    Cha, Sung Oh; Jang, Chul Hoon; Hong, Jin Oh; Park, Joon Sang

    2014-01-01

    Objective We used lumbar magnetic resonance image (MRI) findings to determine possible outcome predictors of a caudal epidural steroid injection (CESI) for radicular pain caused by a herniated lumbar disc (HLD). Methods Ninety-one patients with radicular pain whose MRI indicated a HLD were enrolled between September 2010 and July 2013. The CESIs were performed using ultrasound (US). A responder was defined as having complete relief or at least a 50% reduction of pain as assessed by the visual analog scale (VAS) and functional status on the Roland Morris Disability Questionnaire (RMDQ); responder (VAS n=61, RMDQ n=51), and non-responder (VAS n=30, RMDQ n=40). MRI findings were analyzed and compared between the two groups with regard to HLD level, HLD type (protrusion or exclusion), HLD zone (central, subarticular, foraminal, and extraforaminal), HLD volume (mild, moderate, or severe), relationship between HLD and nerve root (no contact, contact, displaced, or compressed), disc height loss (none, less than half, or more than half ), and disc degeneration grade (homogeneous disc structure or inhomogeneous disc structure-clear nucleus and height of intervertebral disc). Results A centrally located herniated disc was more common in the responder group than that in the non-responder group. Treatment of centrally located herniated discs showed satisfactory results. (VAS p=0.025, RMDQ p=0.040). Other factors, such as HLD level, HLD type, HLD volume, relationship to nerve root, disc height loss, and disc degeneration grade, were not critical. Conclusion The HLD zone was significant for pain reduction after CESI. A centrally located herniated disc was a predictor of a good clinical outcome. PMID:25566478

  8. A Modified Approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for Far Lateral Disc Herniation at L5-S1 with Foot Drop.

    PubMed

    Chun, Eun Hee; Park, Hahck Soo

    2016-01-01

    Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy. PMID:26839673

  9. A Modified Approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for Far Lateral Disc Herniation at L5-S1 with Foot Drop

    PubMed Central

    Chun, Eun Hee

    2016-01-01

    Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy. PMID:26839673

  10. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546

    PubMed Central

    Arts, Mark P; Peul, Wilco C; Brand, Ronald; Koes, Bart W; Thomeer, Ralph TWM

    2006-01-01

    Background Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows early ambulation, short hospital stay and quick resumption of daily activities. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in patients with lumbar disc herniation. Methods/Design Patients (age 1870 years) presenting with sciatica due to lumbar disc herniation lasting more than 68 weeks are included. Patients with disc herniation larger than 1/3 of the spinal canal diameter, or disc herniation less than 1/3 of the spinal canal diameter with concomitant lateral recess stenosis or sequestration, are eliglible for participation. Randomisation into microendoscopic discectomy or conventional unilateral transflaval discectomy will take place in the operating room after induction of anesthesia. The length of skin incision is equal in both groups. The primary outcome measure is the functional assessment of the patient, measured by the Roland Disability Questionnaire for Sciatica, at 8 weeks and 1 year after surgery. We will also evaluate several other outcome parameters, including perceived recovery, leg and back pain, incidence of re-operations, complications, serum creatine kinase, quality of life, medical consumption, absenteeism and costs. The study is a randomised prospective multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 2 years. Discussion Currently, open discectomy is the golden standard in the surgical treatment of lumbar disc herniation. Whether microendoscopic discectomy is more cost-effective than unilateral transflaval discectomy has to be determined by this trial. PMID:16696861

  11. Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series.

    PubMed

    Gadjradj, Pravesh S; van Tulder, Maurits W; Dirven, Clemens M F; Peul, Wilco C; Sanjay Harhangi, B

    2016-02-01

    OBJECTIVE Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies describing its safety and short- and long-term efficacy are scarce. In this study the authors aimed to evaluate the clinical outcomes and safety in patients undergoing PTED for LDH. METHODS Patients who underwent PTED for LDH between January 2009 and December 2012 were prospectively followed. The primary outcomes were the visual analog scale (VAS) score for leg pain and the score on the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes were the perceived experience with the local anesthesia used and satisfaction with the results after 1 year using Likert-type scales. The pretreatment means were compared with the means obtained 6 and 52 weeks after surgery using paired t-tests. RESULTS A total of 166 patients underwent surgery for a total of 167 LDHs. The mean duration of surgery ( SD) was 51.0 9.0 minutes. The 1-year follow-up rate was 95.2%. The mean reported scores on the VAS and QBPDS were 82.5 17.3 mm and 60.0 18.4 at baseline, respectively. Six weeks after surgery, the scores on the VAS and QBPDS were significantly reduced to 28.8 24.5 mm and 26.7 20.6, respectively (p < 0.001). After 52 weeks of follow-up, the scores were further reduced compared with baseline scores (p < 0.001) to 19.6 23.5 mm on the VAS and 20.2 18.1 on the QBPDS. A total of 4 complications were observed, namely 1 dural tear, 1 deficit of ankle dorsiflexion, and 2 cases of transient paresis in the foot due to the use of local anesthetics. CONCLUSIONS PTED appears to be a safe and effective intervention for LDH and has similar clinical outcomes compared to conventional open microdiscectomy. High-quality randomized controlled trials are required to study the efficacy and cost-effectiveness of PTED. PMID:26828884

  12. A new technique for the treatment of lumbar far lateral disc herniation: technical note and preliminary results.

    PubMed

    Greiner-Perth, R; Bhm, H; Allam, Y

    2003-06-01

    A newly designed technique for a minimally invasive approach to the laterally herniated disc is presented. Fifteen patients suffering from far lateral disc herniation (extraforaminal) were operated according to this technique. Through a small skin incision (1.5 cm), the paraspinal muscles are spread by dilators, until a working channel of 9 mm inner diameter and 11 mm outer diameter can be placed. The next steps are done through this channel using the surgical microscope. No bone resections are necessary and the facet joints are left untouched. However, partial resection of the intertransverse ligament may be necessary. The mean follow-up period for these 15 patients was 11.5 months, and they were evaluated by using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The average surgical time was 43 min. The ODI improved from 30.6 (preoperative) to 14.3 (postoperative). The VAS of leg pain improved from 7 (preoperative) to 3.6 (postoperative), which represented a statistically significant improvement at the significance level of (P<0.01). No intra-operative or early postoperative complications occurred. However, one recurrence did occur, which was treated by the same technique. This technique combines the advantages of three-dimensional visual control (operating microscope) with the minimal surgical trauma of endoscopic techniques, while avoiding some of the shortcomings of both the microsurgical and endoscopic techniques. PMID:12800006

  13. What were the advantages of microendoscopic discectomy for lumbar disc herniation comparing with open discectomy: a meta-analysis?

    PubMed Central

    Mu, Xiaoping; Wei, Jianxun; Li, Peifeng

    2015-01-01

    The purpose of this study was to compare the safety and efficacy of micro-endoscopic discectomy (MED) and open discectomy (OD) for lubmar disc herniation (LDH). Randomised controlled trials (RCTs) comparing MED with OD for LDH were searched comprehensively in PubMed, EMBASE, the Cochrane Library. Relevant studies retrieved, data extracted and the quality of included studies were independently performed by two authors. RevMan software (Version 5.2.0) was used to analyse and synthesis relevant data of the included studies. Nine RCTs involving 774 patients were obtained and reported the relevant outcome measures. Compared with OD group, there were significant difference in the general operation indicators including operation time, blood loss, site of incision, hospital stay and time of return to work, biochemical indexes including C-reactive protein (CRP) and interleukin-6 (IL-6) in MED group. Meanwhile, there were no difference in effective rate, complication including total complications, dural leaks occurred and recurrence of the disc herniation, compared MED group with OD group. MED had slighter trauma, milder blood loss and shorter healing time than OD. The results demonstrated MED has great efficacy and safety comparable to OD. So we think that MED can be used routinely for LDH patients, especially the patients of old and intolerable major surgery. Meanwhile, it is necessary for surgeon to master indication and contraindication of MED and improve the operative technique.

  14. Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Malla, Yogesh

    2012-01-01

    Background While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Methods A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain. Results One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1) or local anesthetic mixed with nonparticulate betamethasone (group 2). The primary outcome of significant pain relief and improvement in functional status (?50%) was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 3739 weeks in the successful group over a period of 52 weeks. Conclusion Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain. PMID:22826642

  15. Survivorship analysis of 150 consecutive patients with DIAM implantation for surgery of lumbar spinal stenosis and disc herniation

    PubMed Central

    Sur, Yoo-Joon; Kong, Chae-Gwan

    2010-01-01

    Recently, the Device for Intervertebral Assisted Motion (DIAM) has been introduced for surgery of degenerative lumbar disc diseases. The authors performed the current study to determine the survivorship of DIAM implantation for degenerative lumbar disc diseases and risk factors for reoperation. One hundred and fifty consecutive patients underwent laminectomy or discectomy with DIAM implantation for primary lumbar spinal stenosis or disc herniation. The characteristics of the 150 patients included the following: 84 males and 66 females; mean age at the time of surgery, 46.5years; median value of follow-up, 23months (range 148months); 96 spinal stenosis and 54 disc herniations; and 146 one-level (115, L45; 31, L56) and 4 two-level (L45 and L56). In the current study, due to lumbosacral transitional vertebra (LSTV) L6 meant lumbarization of S1 and this had a prominent spinous process so that the DIAM was implanted at L56. Reoperations due to any reasons of the DIAM implantation level or adjacent levels were defined as a failure and used as the end point for determining survivorship. The cumulative reoperation rate and survival time were determined via KaplanMeier analysis. The log-rank test and Cox regression model were used to evaluate the effect of age, gender, diagnosis, location, and level of DIAM implantation on the reoperation rate. During a 4-year follow-up, seven patients (two males and five female) underwent reoperation at the DIAM implantation level, giving a reoperation rate of 4.7%. However, no patients underwent reoperation for adjacent level complications. The causes of reoperation were recurrent spinal stenosis (n=3), recurrent disc herniation (n=2), post-laminectomy spondylolisthesis (n=1), and delayed deep wound infection (n=1). The mean time between primary operation and reoperation was 13.4months (range 229months). KaplanMeier analysis predicted an 8% cumulative reoperation rate 4years post-operatively. Survival time was predicted to be 45.60.9months (meanstandard deviation). Based on the log-rank test, the reoperation rate was higher at L56 (p=0.002) and two-level (p=0.01) DIAM implantation compared with L45 and one-level DIAM implantation. However, gender (p=0.16), age (p=0.41), and diagnosis (p=0.67) did not significantly affect the reoperation rate of DIAM implantation. Based on a Cox regression model, L56 [hazard ratio (HR), 10.3; 95% CI, 1.763.0; p=0.01] and two-level (HR, 10.4; 95% CI, 1.290.2; p=0.04) DIAM implantation were also significant variables associated with a higher reoperation rate. Survival time was significantly lower in L56 (47 vs. 22months, p=0.002) and two-level DIAM implantation (46 vs. 18months, p=0.01) compared with L45 and one-level DIAM implantation. The current results suggest that 8% of the patients who have a DIAM implantation for primary lumbar spinal stenosis or disc herniation are expected to undergo reoperation at the same level within 4years after surgery. Based on the limited data set, DIAM implantation at L56 and two-level in patients with LSTV are significant risk factors for reoperation. PMID:20953966

  16. Long-Term Outcomes of Patients with Lumbar Disc Herniation Treated with Percutaneous Discectomy: Comparative Study with Microendoscopic Discectomy

    SciTech Connect

    Liu Wengui; Wu Xiaotao; Guo Jinhe; Zhuang Suyang; Teng Gaojun

    2010-08-15

    We assessed the long-term outcomes of patients with lumbar disc herniation treated with percutaneous lumbar discectomy (PLD) or microendoscopic discectomy (MED). A retrospective study was performed in consecutive patients with lumbar disc herniation treated with PLD (n = 129) or MED (n = 101) in a single hospital from January 2000 to March 2002. All patients were followed up with MacNab criteria and self-evaluation questionnaires comprising the Oswestry Disability Index and Medical Outcomes Study 36-Item Short-Form Health Survey. Several statistical methods were used for analyses of the data, and a p value of <0.05 was considered to be statistically significant. A total of 104 patients (80.62%) with PLD and 82 patients (81.19%) with MED were eligible for analyses, with a mean follow-up period of 6.64 {+-} 0.67 years and 6.42 {+-} 0.51 years, respectively. There were no significant differences between the two groups in age, number of lesions, major symptoms and physical signs, and radiological findings. According to the MacNab criteria, 75.96% in the PLD group and 84.15% in the MED group achieved excellent or good results, respectively, this was statistically significant (p = 0.0402). With the Oswestry Disability Index questionnaires, the average scores and minimal disability, respectively, were 6.97 and 71.15% in the PLD group and 4.89 and 79.27% in the MED group. Total average scores of Medical Outcomes Study 36-Item Short-Form Health Survey were 75.88 vs. 81.86 in PLD group vs. MED group (p = 0.0582). The cost and length of hospitalization were higher or longer in MED group, a statistically significant difference (both p < 0.0001). Long-term complications were observed in two patients (2.44%) in the MED group, no such complications were observed in the PLD group. Both PLD and MED show an acceptable long-term efficacy for treatment of lumbar disc herniation. Compared with MED patients, long-term satisfaction is slightly lower in the PLD patients; complications, hospitalization duration, and costs in PLD group are also lower.

  17. Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy: A Case Report and Literature Review.

    PubMed

    Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil

    2016-02-01

    Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain.The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was <3.A 32-year-old man was transferred our emergency department with progressive quadriparesis. He had no history of trauma, but had received physical therapy with spinal manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty.Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4-C5 and C5-C6 that caused severe spinal cord compression and surrounding edema. We performed C4-C5-C6 anterior cervical discectomy and fusion.The patient's limb weakness improved rapidly within 1 day postoperatively, and he was discharged 4 weeks later. At his 12-month follow-up, the patient had recovered nearly full muscle power.We presented an extremely rare case of cervical IDH causing progressive quadriparesis after excessive spinal manipulation therapy. The presence of a "halo" and "Y-sign" were useful MRI markers for cervical IDH in this case. PMID:26871842

  18. The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach

    PubMed Central

    Scott, David L.; Han, Xiao; Yacob, Alem

    2014-01-01

    Background Surgery for same level multi-focal extruded lumbar disc herniations is technically challenging and the optimal method controversial. The subarticular disc herniation may pose the most challenging subtype requiring partial or complete facetectomy with or without fusion. The far-lateral disc herniation, often treated using a Wiltse approach, can also be difficult to access especially in the obese patient. When both the subarticular and far-lateral subtypes are simultaneously present at the same level with or without a paracentral disc herniation, a total facetectomy and interbody fusion (TLIF) or a total disc replacement (TDR) may be necessary. Endoscopic surgical techniques may reduce the need for these more invasive methods. Methods Fifteen patients (6 male and 9 female) who had same level multi-focal (subarticular as well as far-lateral and/or paracentral) extruded disc herniations underwent single incision unilateral endoscopic disc excision by the same surgeon at a single institution. Patients were prospectively followed for an average of 15.3 months (range 14-18 months) and outcomes were evaluated radiographically and clinically (Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results The mean operative time was 52 minutes with minimal blood loss in all cases. Fourteen of the 15 patients were discharged to home on the day of their surgery. The mean ODI and leg VAS scores improved from 22.9 3.2 to 12.9 2.7 (p < 0.005), and from 8.6 1.6 to 2.1 + 0.4 (p < 0.005), respectively. Conclusions After an average of 15.3 months of follow-up, the clinical and radiographic results of full endoscopic surgical treatment of single level multi-focal (subarticular as well as far-lateral and/or paracentral) disc herniations are excellent. This study is a case series with mid-term follow-up (Level IV). Clinical Relevance Foraminal and extra-foraminal full endoscopic decompression appears to offer a safe minimally invasive solution to a complex pathologic problem. PMID:25694941

  19. Recurrent Lumbar Disc Herniation: Results of Revision Surgery and Assessment of Factors that May Affect the Outcome. A Non-Concurrent Prospective Study

    PubMed Central

    Arockiaraj, Justin; Amritanand, Rohit; Venkatesh, Krishnan; David, Kenny Samuel

    2015-01-01

    Study Design Non-concurrent prospective study. Purpose To determine the functional outcome after open 'fragment' discectomy for recurrent lumbar disc herniation, and to analyze the factors that may affect the outcome. Overview of Literature Literature search revealed only four studies where the factors affecting the outcome of a revision surgery for recurrent disc herniation have been evaluated. None of these studies analyzed for diabetes, disc degeneration and facet arthropathy. We have analyzed these features, in addition to the demographic and clinical factors. Methods Thirty-four patients who underwent the procedure were followed up for an average period of 27.1 months. The Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were used to assess the functional outcome. Age, gender, smoking, diabetic status, duration of recurrent symptoms, the side of leg pain, level and type of disc herniation, degree of disc degeneration on magnetic resonance imaging, and facet joint arthritis before first and second surgeries, were analyzed as factors affecting the outcome. Results The average Hirabayashi improvement in JOA was 56.4%. The mean preoperative ODI was 74.5% and the mean ODI at final follow-up was 32.2%, the difference being statistically significant (p<0.01). Patients with diabetes, all of whom had poor long term glycemic control, were found to have a poor outcome in terms of ODI improvement (p=0.03). Conclusions Open fragment discectomy is a safe and effective surgical technique for the treatment of recurrent disc herniation. However, patients with uncontrolled diabetes may have a less favorable outcome. PMID:26435791

  20. Prevalence and Geographic Distribution of Herniated Intervertebral Disc in Korean 19-Year-Old Male from 2008 to 2009: A Study Based on Korean Conscription -National and Geographic Prevalence of Herniated Intervertebral Disc in Korean 19YO Male-

    PubMed Central

    Lee, Sang Hun; Oh, Chang Hyun; Park, Hyeong-chun; Park, Chong Oon

    2013-01-01

    Purpose This study was to determine the prevalence of herniated intervertebral disc (HIVD) among Korean 19-year-old male in a large national sample and to compare the prevalence across geographic regions based on the data of conscription. Materials and Methods We analyzed the conscription data of 615508 cases who were 19-year-old male, given an examination for conscription at nationwide Korean Military Manpower Administration from January 2008 to December 2009. Prevalence was determined by dividing the number of cases by the number of persons enrolled for 2 years. The analyses included of a cross-tabulations and nonparametric chi-square to compare the prevalence according to geographic region, disc severity, and conscription year. Results The prevalence of HIVD among 19-year-old male was 0.47%. Seoul had the highest prevalence of HIVD (total HIVD was 0.60%, and severe HIVD was 0.44%). The prevalence of HIVD was lower in Jeollabuk-do and Jeollanam-do (total HIVD was 0.25-0.27%, and severe HIVD was 0.16-0.17%). Annual prevalence of HIVD was slightly decreased in 2009, but geographic distribution annually was not different. Conclusion In Korean 19-year-old male, the national prevalence of adolescent HIVD was 0.60%, but different geographic distribution was observed. It is quite possible that secondary contributing factor(s) interfere with the different geographic prevalence of HIVD. PMID:23918557

  1. Can clinical and radiological findings predict surgery for lumbar disc herniation? A systematic literature review

    PubMed Central

    White, Andrew P.; Harrop, James; Dettori, Joseph R.

    2012-01-01

    Study design:?Systematic review. Objective or clinical question:?What clinical and radiological findings in patients with lumbar-herniated nucleus pulposus can serve as predictors of surgical intervention? Methods:?Articles published between January 1975 and August 2011 were systematically reviewed using Pubmed, Cochrane, National Guideline Clearinghouse Databases, and bibliographies of key articles. Each article was subject to quality rating and was analyzed by two independent reviewers. Results:?From 123 citations, 21 underwent full-text review. Four studies met inclusion criteria. Only baseline disability as measured by the Roland Disability Index (RDI) or the Oswestry Disability Index (ODI) was consistently associated with a greater likelihood of having discectomy surgery across multiple studies. With the current literature, we were not able to find an association between surgery and several characteristics including smoking status, body mass index, neurological deficit, positive straight leg testing, and level of herniation. Conclusions:?From the limited data available, it appears that individual radiographic and clinical features are not able to predict the likelihood of surgical intervention. Higher baseline disability measurements (Oswestry and Roland) did correlate, however, with surgical treatment. PMID:23236305

  2. Evaluation of the Clinical Curative Effect of an O2-O3 mixture to Treat Lumbar Disc Herniation with Different Treatment Sessions

    PubMed Central

    Xu, L.; Li, Z-L.; He, X-F.; Xiang, D-C.; Ma, J.; Hong, C-J.; He, J-X.; Yang, L.; Gong, Z-H.; Qiu, J.

    2009-01-01

    Summary To compare the effective rates among one week, two week and four week treatment sessions of ozone therapy for lumbar disc herniation to provide a foundation for clinical decision-making. One hundred and eighty-seven lumbar disc herniation patients were divided into three groups, 103 cases for one week, 61 cases for two week and 23 cases for four week treatment sessions. The clinical curative effective rates in the three groups were 82.52%, 85.24% and 95.65% respectively. The effective rate among the three groups showed no significant difference at statistical analysis. Considering the cost-effectiveness of ozone therapy, increasing the treatment course does not enhance the curative effect. PMID:20465893

  3. Comparison of the Efficacy of Caudal, Interlaminar, and Transforaminal Epidural Injections in Managing Lumbar Disc Herniation: Is One Method Superior to the Other?

    PubMed Central

    Singh, Vijay; Pampati, Vidyasagar; Falco, Frank JE; Hirsch, Joshua A.

    2015-01-01

    Background Epidural injections are performed utilizing 3 approaches in the lumbar spine: caudal, interlaminar, and transforaminal. The literature on the efficacy of epidural injections has been sporadic. There are few high-quality randomized trials performed under fluoroscopy in managing disc herniation that have a long-term follow-up and appropriate outcome parameters. There is also a lack of literature comparing the efficacy of these 3 approaches. Methods This manuscript analyzes data from 3 randomized controlled trials that assessed a total of 360 patients with lumbar disc herniation. There were 120 patients per trial either receiving local anesthetic alone (60 patients) or local anesthetic with steroids (60 patients). Results Analysis showed similar efficacy for caudal, interlaminar, and transforaminal approaches in managing chronic pain and disability from disc herniation. The analysis of caudal epidural injections showed the potential superiority of steroids compared with local anesthetic alone a 2-year follow-up, based on the average relief per procedure. In the interlaminar group, results were somewhat superior for pain relief in the steroid group at 6 months and functional status at 12 months. Interlaminar epidurals provided improvement in a significantly higher proportion of patients. The proportion of patients nonresponsive to initial injections was also lower in the group for local anesthetic with steroid in the interlaminar trial. Conclusions The results of this assessment show significant improvement in patients suffering from chronic lumbar disc herniation with 3 lumbar epidural approaches with local anesthetic alone, or using steroids with long-term follow-up of up to 2 years, in a contemporary interventional pain management setting. PMID:25589942

  4. Trends in inpatient setting laminectomy for excision of herniated intervertebral disc: Population-based estimates from the US nationwide inpatient sample

    PubMed Central

    Walcott, Brian P.; Hanak, Brian W.; Caracci, James R.; Redjal, Navid; Nahed, Brian V.; Kahle, Kristopher T.; Coumans, Jean-Valery C.E.

    2011-01-01

    Background: Herniated intervertebral discs can result in pain and neurological compromise. Treatment for this condition is categorized as surgical or non-surgical. We sought to identify trends in inpatient surgical management of herniated intervertebral discs using a national database. Methods: Patient discharges identified with a principal procedure relating to laminectomy for excision of herniated intervertebral disc were selected from the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project - Agency for Healthcare Research and Quality, Rockville, MD), under the auspices of a data user agreement. These surgical patients did not undergo instrumented fusion. To account for the Nationwide Inpatient Sample weighting schema, design-adjusted analyses were used. The estimates of standard errors were calculated using SUDAAN software (Research Triangle International, NC, USA). This software is based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM); a uniform and standardized coding system. Results: Using International Classification of Disease 9th Revision clinical modifier (ICD-9 CM) procedure code 80.51, we were able to identify disc excision, in part or whole, by laminotomy or hemilaminectomy. The incidence of laminectomy for the excision of herniated intervertebral disc has decreased dramatically from 1993 where 266,152 cases were reported [CI = 22,342]. In 2007, only 123,398 cases were identified [CI = 12,438]. The average length of stay in 1993 was 4 days [CI = 0.17], and in 2007 it decreased to just 2 days [CI = 0.17]. Both these comparisons were significantly different at P < 0.001. The average inflation adjusted (2007 buying power) charge of the procedure in 1993 was 14,790.87 USD [CI = 916.85]. This value rose in 2007 to 24,639 USD [CI = 1,485.51]. This difference was significant at P < 0.001. Conclusions: National estimates indicate that the incidence of inpatient laminectomy for the excision of herniated intervertebral disc has decreased significantly. This trend is multifactorial and is likely related to developments in outcomes research, the growing popularity of alternative procedures (intervertebral instrumented fusion), and transition to an ambulatory setting of surgical care. PMID:21297929

  5. Clinical Case Report of Expansive Laminoplasty for Cervical Myelopathy Due to Both Disc Herniation and Developmental Cervical Spinal Canal Stenosis in Older Adolescents.

    PubMed

    Zhou, Hua; Sun, Yu; Zhang, Fengshan; Dang, Gengting; Liu, Zhongjun

    2016-02-01

    Reports on adolescent patients with cervical myelopathy who underwent anterior cervical discectomy and fusion are scarce. However, to our knowledge, no cases of expansive laminoplasty for cervical myelopathy associated with progressive neurological deficit after a series of conservative treatment, caused by both disc herniation and developmental cervical spinal canal stenosis, have been reported.From January 2006 to July 2012, we retrospectively studied 3 patients in late adolescence presenting with cervical myelopathy who underwent expansive unilateral open-door laminoplasty at our hospital. The outcomes after the surgery were evaluated according to the Japanese Orthopedic Association scores.Symptoms presented by these patients were due to both disc herniation and developmental cervical spinal canal stenosis. No major complications occurred after the surgical procedures. The median follow-up time was 66 months (range 36-112 months). The Japanese Orthopedic Association scores after surgery showed a significant increase. Long-term outcomes after surgery were satisfactory according to the evaluation criteria for the Japanese Orthopedic Association scores. However, the ranges of motion of the cervical spine decreased, especially the ranges of motion on flexion after surgery showed a significant decrease.Expansive laminoplasty is helpful for older adolescent patients with cervical myelopathy due to both disc herniation and developmental cervical spinal canal stenosis, presenting with progressive neurological deficit after long conservative treatment. PMID:26937923

  6. Clinical Case Report of Expansive Laminoplasty for Cervical Myelopathy Due to Both Disc Herniation and Developmental Cervical Spinal Canal Stenosis in Older Adolescents

    PubMed Central

    Zhou, Hua; Sun, Yu; Zhang, Fengshan; Dang, Gengting; Liu, Zhongjun

    2016-01-01

    Abstract Reports on adolescent patients with cervical myelopathy who underwent anterior cervical discectomy and fusion are scarce. However, to our knowledge, no cases of expansive laminoplasty for cervical myelopathy associated with progressive neurological deficit after a series of conservative treatment, caused by both disc herniation and developmental cervical spinal canal stenosis, have been reported. From January 2006 to July 2012, we retrospectively studied 3 patients in late adolescence presenting with cervical myelopathy who underwent expansive unilateral open-door laminoplasty at our hospital. The outcomes after the surgery were evaluated according to the Japanese Orthopedic Association scores. Symptoms presented by these patients were due to both disc herniation and developmental cervical spinal canal stenosis. No major complications occurred after the surgical procedures. The median follow-up time was 66 months (range 36–112 months). The Japanese Orthopedic Association scores after surgery showed a significant increase. Long-term outcomes after surgery were satisfactory according to the evaluation criteria for the Japanese Orthopedic Association scores. However, the ranges of motion of the cervical spine decreased, especially the ranges of motion on flexion after surgery showed a significant decrease. Expansive laminoplasty is helpful for older adolescent patients with cervical myelopathy due to both disc herniation and developmental cervical spinal canal stenosis, presenting with progressive neurological deficit after long conservative treatment. PMID:26937923

  7. A Minimally Invasive Treatment for Lumbar Disc Herniation: DiscoGel Chemonucleolysis in Patients Unresponsive to Chemonucleolysis with Oxygen-Ozone

    PubMed Central

    Stagni, S.; de Santis, F.; Cirillo, L.; DallOlio, M.; Princiotta, C.; Simonetti, L.; Stafa, A.; Leonardi, M.

    2012-01-01

    Summary A multitude of therapies is available to treat disc herniation, ranging from conservative methods (medication and physical therapy) to minimally invasive (percutaneous) treatments and surgery. O2-O3 chemonucleolysis (O2-O3 therapy) is one of the minimally invasive treatments with the best cost/benefit ratio and lowest complication rate. Another substance recently made available exploiting the chemical properties of pure ethanol is DiscoGel, a radiopaque gelified ethanol more viscous than absolute alcohol8,9. The present study aimed to assess the therapeutic outcome of DiscoGel chemonucleolysis in patients with lumbar disc herniation unresponsive to O2-O3 therapy. Thirty-two patients aged between 20 and 79 years were treated by DiscoGel chemonucleolysis between December 2008 and January 2010. The treatment was successful (improvement in pain) in 24 out of 32 patients. DiscoGel is safe and easy to handle and there were no complications related to product diffusivity outside the treatment site. The therapeutic success rate of DiscoGel chemonucleolysis in patients unresponsive to O2-O3 therapy was satisfactory. Among other methods used to treat lumbar disc herniation, DiscoGel chemonucleolysis can be deemed an intermediate procedure bridging conservative medical treatments and surgery. PMID:22440607

  8. Comparative analysis of the influence of FructusLigustriLucidi on a rat lumbar disc herniation model.

    PubMed

    Han, Ya-Xin; Liang, Dong; Han, Xiao-Rui; Liang, De-Yong

    2015-07-01

    Lumbar disc herniation (LDH) is a term used for a group of conditions, including back pain, femoral nerve pain and sciatica. Currently available treatments and surgical options are insufficient for patients with LDH. Fructus Ligustri Lucidi (FLL) is a herb that is used for treating age-associated diseases. The results of the present study suggested that FLL may be used for treatment of patients with LDH. In the present study, matrix metalloproteinase-1, -3, -8 and -9 (MMP-1, -3, -8 and -9) protein and mRNA expression downregulation was observed in patients with LDH according to western blotting and reverse transcription-quantitative polymerase chain reaction. By contrast, upregulation of interleukin-2 (IL-2), IL-6, IL-8 and tumor necrosis factor-? (TNF-?) expression was observed in patients with LDH, according to an enzyme-linked immunosorbent assay. Mechanical allodynia was observed in rats with LDH not treated with FLL; however, not in FLL?treated rats. IL-2, IL-6, IL-8 and TNF-? expression levels in the serum from untreated rats were significantly higher than that of the FLL?treated rat models. Protein expression levels of MMPs in FLL-treated rats were lower than those in untreated rats. However, the mechanisms underlying the association between FLL and protein expression levels require further investigation. PMID:25816023

  9. Integrative TCM Conservative Therapy for Low Back Pain due to Lumbar Disc Herniation: A Randomized Controlled Clinical Trial

    PubMed Central

    Yuan, Wei An; Huang, Shi Rong; Guo, Kai; Sun, Wu Quan; Xi, Xiao Bing; Zhang, Ming Cai; Kong, Ling Jun; Lu, Hua; Zhan, Hong Sheng; Cheng, Ying Wu

    2013-01-01

    Low back pain due to lumbar disc herniation (LDH) is very common in clinic. This randomized controlled trial was designed to investigate the effects of integrative TCM conservative therapy for low back pain due to LDH. A total of 408 patients with low back pain due to LDH were randomly assigned to an experimental group with integrative TCM therapy and a control group with normal conservative treatment by the ratio of 3?:?1. The primary outcome was the pain by the visual analogue scale (VAS). The secondary outcome was the low back functional activities by Chinese Short Form Oswestry Disability Index (C-SFODI). Immediately after treatment, patients in the experimental group experienced significant improvements in VAS and C-SFODI compared with the control group (between-group difference in mean change from baseline, ?16.62 points, P < 0.001 in VAS; ?15.55 points, P < 0.001 in C-SFODI). The difference remained at one-month followup, but it is only significant in C-SFODI at six-month followup (?7.68 points, P < 0.001). No serious adverse events were observed. These findings suggest that integrative TCM therapy may be a beneficial complementary and alternative therapy for patients with low back pain due to LDH. PMID:23864883

  10. The prognostic value of cerebrospinal fluid characteristics in dogs without deep pain perception due to thoracolumbar disc herniation.

    PubMed

    Chamisha, Y; Aroch, I; Kuzi, S; Srugo, I; Bdolah-Abram, T; Chai, O; Christopher, M M; Merbl, Y; Rothwell, K; Shamir, M H

    2015-06-01

    Providing a pre-operative prognosis for dogs presented with absent deep pain perception (DPP) is extremely challenging, as the overall recovery rates widely vary. This study assesses the possible correlation between the severity of spinal cord injury and CSF cytology in 31 paraplegic dogs presented with absent DPP due to acute thoracolumbar intervertebral disc herniation (TL-IVDH). All dogs underwent surgical decompression immediately following diagnosis. CSF TNCC, macrophage percentage and macrophage to monocyte (M?:M) ratio were significantly higher in dogs that failed to regain DPP within 10 days post-operatively and in dogs that failed to regain ambulation at the end of the study period (P

  11. Assessing the Effect of Spaceflight on the Propensity for Astronauts to Develop Disc Herniation

    NASA Technical Reports Server (NTRS)

    Feiveson, A.; Mendez, C.; Somers, J.

    2015-01-01

    A previous study reported that the instantaneous risk of developing a Herniated Nucleus Pulposus (HNP) was higher in astronauts who had flown at least one mission, as compared with those in the corps who had not yet flown. However, the study only analyzed time to HNP after the first mission (if any) and did not account for the possible effects of multiple missions. While many HNPs occurred well into astronauts' careers or in somecases years after retirement, the higher incidence of HNPs relatively soon after completion of space missions appears to indicate that spaceflight may lead to an increased risk of HNP. In addition, when an HNP occurs after spaceflight, is it related to previous spaceflight exposure? The purpose of this study was to investigate whether multiple missions, sex, age, vehicle landing dynamics, and flight duration affect the risk of developing an HNP usinga competing risks model. The outcome of the study will inform the Human System Risk Board assessment of back pain, inform the risk of injury due to dynamic loads, and update the previous dataset, which contained events up to December 31, 2006.

  12. Effects of acupuncture, core-stability exercises, and treadmill walking exercises in treating a patient with postsurgical lumbar disc herniation: a clinical case report.

    PubMed

    Ganiyu, Sokunbi Oluwaleke; Gujba, Kachalla Fatimah

    2015-02-01

    The objective of this study is to investigate the effects of acupuncture, core-stability exercises, and treadmill 12-minute walking exercises in treating patients with postsurgical lumbar disc herniation. A 34-year-old woman with a history lumbar disc prolapse who had undergone lumbar disc surgery on two different occasions was treated using acupuncture, core-stability exercises, and treadmill walking exercises three times per week for 12 weeks. The outcome measures used in this study were pain intensity, spinal range of movement, and general health. After 12 weeks of treatment, the patient had made improvement in terms of pain, which was reduced from 9/10 to 1/10. In a similar vein, the patient's general health showed improvement of >100% after 12 weeks of treatment. Pre-treatment scores of spinal flexion and left-side flexion, which measured 20cm and 12cm, respectively, increased to 25cm and 16cm after 12 weeks of treatment. This study showed that acupuncture, core-stability exercises, and treadmill walking exercises were useful in relieving pain, increasing spinal range of movement, and improving the health of a patient with postsurgical lumbar disc herniation. PMID:25660445

  13. Factors Predicting Patient Dissatisfaction 2 Years After Discectomy for Lumbar Disc Herniation in a Chinese Older Cohort

    PubMed Central

    Wang, Hui; Zhang, Di; Ma, Lei; Shen, Yong; Ding, Wenyuan

    2015-01-01

    Abstract We aim to identify factors predicting patient dissatisfaction 2 years after discectomy for lumbar disc herniation (LDH) in a Chinese older cohort. Preoperative and 2-year follow-up data for 843 patients were analyzed. After 2 years of discectomy, the patients rated their satisfaction by Patient Satisfaction Index (PSI), with response of 1 or 2 defining satisfaction and a PSI response of 3 or 4 defining dissatisfaction. Associations between perioperative variables and satisfaction with the results of surgery were examined in univariate and multivariate analysis. Six hundred fifty-seven patients had a PSI of 1 or 2 and were enrolled as satisfied group, 186 patients had a PSI of 3 or 4 and were enrolled as dissatisfied group. At baseline, no significant differences were found between the 2 groups in age, occupation, Oswestry Disability Index (ODI), Visual Analog Scale (VAS)-leg, and VAS-back. Compared to satisfied group, dissatisfied group had a significantly higher BMI and a higher incidence of depression. Two years after discectomy, no significant differences were found between the 2 groups in decrease of ODI, decrease of VAS-back, decrease of VAS-leg, surgery complications. Compared to satisfied group, dissatisfied group experienced higher incidence of symptom recurrence and depression. Logistic regression analysis showed that obesity, pre- and postoperative depression, symptom recurrence were independently associated with patient dissatisfaction 2 years after discectomy. In conclusion, more than 70% patients expressed satisfaction with discectomy for LDH. Two factors could predict patient dissatisfaction and be assessed before surgery: obesity and preoperative depression. Symptom recurrence and postoperative depression are also associated with diminished patient satisfaction. PMID:26448005

  14. The Factors Associated With the Successful Outcomes of Percutaneous Disc Decompression in Patients With Lumbar Herniated Nucleus Pulposus

    PubMed Central

    Lee, Sang Heon; Kim, Nack Hwan; Park, Hyeun Jun; Yoo, Hyun-Joon; Jo, Soo Yung

    2015-01-01

    Objective To determine clinical and radiological factors that predict the successful outcome of percutaneous disc decompression (PDD) in patients with lumbar herniated nucleus pulposus (HNP). Methods We retrospectively reviewed the clinical and radiological features of patients who underwent lumbar PDD from April 2009 to March 2013. Sixty-nine patients with lumbar HNP were studied. Clinical outcome was assessed by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Multivariate logistic regression analysis was performed to assess relationship among clinical and radiological factors and the successful outcome of the PDD. Results The VAS and the ODI decreased significantly at 1 year follow-up (p<0.01). One year after PDD, the reduction of the VAS (?VAS) was significantly greater in the patients with pain for <6 months (p=0.03) and subarticular HNP (p=0.015). The reduction of the ODI (?ODI) was significantly greater in the patients with high intensity zone (p=0.04). Multivariate logistic regression analysis revealed the following 5 factors that were associated with the successful outcome after PDD: pain duration for <6 months (odds ratio [OR]=14.036; p=0.006), positive straight leg raising test (OR=8.425, p=0.014), the extruded HNP (OR=0.106, p=0.04), the sequestrated HNP (OR=0.037, p=0.026), and the subarticular HNP (OR=10.876, p=0.012). Conclusion PDD provided significant improvement of pain and disability of patients. The results of the analysis indicated that the duration of pain <6 months, positive straight leg raising test, the subarticular HNP, and the protruded HNP were predicting factors associated with the successful response of PDD in patients with lumbar HNP. PMID:26605171

  15. The Impact of Workers' Compensation on Outcomes of Surgical and Nonoperative Therapy for Patients with a Lumbar Disc Herniation SPORT

    PubMed Central

    Atlas, Steven J.; Tosteson, Tor D.; Blood, Emily A.; Skinner, Jonathan S.; Pransky, Glenn S.; Weinstein, James N.

    2010-01-01

    Study Design Prospective randomized and observational cohorts. Objective To compare outcomes of patients with and without workers' compensation who had surgical and nonoperative treatment for a lumbar intervertebral disc herniation (IDH). Summary of Background Data Few studies have examined the association between worker's compensation and outcomes of surgical and nonoperative treatment. Methods Patients with at least 6 weeks of sciatica and a lumbar IDH were enrolled in either a randomized trial or observational cohort at 13 US spine centers. Patients were categorized as workers' compensation or nonworkers' compensation based on baseline disability compensation and work status. Treatment was usual nonoperative care or surgical discectomy. Outcomes included pain, functional impairment, satisfaction and work/disability status at 6 weeks, 3, 6, 12, and 24 months. Results Combining randomized and observational cohorts, 113 patients with workers' compensation and 811 patients without were followed for 2 years. There were significant improvements in pain, function, and satisfaction with both surgical and nonoperative treatment in both groups. In the nonworkers' compensation group, there was a clinically and statistically significant advantage for surgery at 3 months that remained significant at 2 years. However, in the workers' compensation group, the benefit of surgery diminished with time; at 2 years no significant advantage was seen for surgery in any outcome (treatment difference for SF-36 bodily pain [?5.9; 95% CI: ?16.74.9] and physical function [5.0; 95% CI: ?4.915]). Surgical treatment was not associated with better work or disability outcomes in either group. Conclusion Patients with a lumbar IDH improved substantially with both surgical and nonoperative treatment. However, there was no added benefit associated with surgical treatment for patients with workers' compensation at 2 years while those in the nonworkers' compensation group had significantly greater improvement with surgical treatment. PMID:20023603

  16. Outcomes of Microendoscopic Discectomy and Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation: A Comparative Retrospective Study

    PubMed Central

    Sinkemani, Arjun; Hong, Xin; Gao, Zeng-Xin; Zhuang, Su-Yang; Jiang, Zan-Li; Zhang, Shao-Dong; Bao, Jun-Ping; Zhu, Lei; Zhang, Pei; Xie, Xin-Hui; Wang, Feng

    2015-01-01

    Study Design Retrospective, case control evaluation of 86 patients who underwent microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) for the treatment of lumbar disc herniation (LDH). Purpose To evaluate the safety and the outcomes of MED and PTED for the treatment of LDH. Overview of Literature MED and PTED are minimally invasive surgical techniques for lower back pain. Studies to date have shown that MED and PTED are safe and effective treatment modalities for LDH. Methods A retrospective study was performed in patients with LDH treated with MED (n=50) and transforaminal endoscopic discectomy (PTED; n=36) in our hospital. All patients were followed-up with self-evaluation questionnaires, Oswestry disability index (ODI), medical outcomes study 36-item short form health survey and MacNab criteria. All the patients in both groups were followed up to 12 months after the operation. Results ODI questionnaire responses were not statistically different between the MED and PTED groups (53.00 vs. 48.72) before treatment. Average scores and minimal disability after 5 days to 12 months of follow-up were 4.96 in the MED group and 3.61 in the PTED group. According to MacNab criteria, 92.0% of the MED group and 94.4% of the PTED group had excellent or good results with no significant difference. Conclusions There was no significant difference between MED and PTED outcomes. Further large-scale, randomized studies with long-term follow-up are needed. PMID:26713113

  17. Changes in the Expressions of Iba1 and Calcitonin Gene-Related Peptide in Adjacent Lumbar Spinal Segments after Lumbar Disc Herniation in a Rat Model.

    PubMed

    Cho, Hee Kyung; Ahn, Sang Ho; Kim, So-Yeon; Choi, Mi-Jung; Hwang, Se Jin; Cho, Yun Woo

    2015-12-01

    Lumbar disc herniation is commonly encountered in clinical practice and can induce sciatica due to mechanical and/or chemical irritation and the release of proinflammatory cytokines. However, symptoms are not confined to the affected spinal cord segment. The purpose of this study was to determine whether multisegmental molecular changes exist between adjacent lumbar spinal segments using a rat model of lumbar disc herniation. Twenty-nine male Sprague-Dawley rats were randomly assigned to either a sham-operated group (n=10) or a nucleus pulposus (NP)-exposed group (n=19). Rats in the NP-exposed group were further subdivided into a significant pain subgroup (n=12) and a no significant pain subgroup (n=7) using mechanical pain thresholds determined von Frey filaments. Immunohistochemical stainings of microglia (ionized calcium-binding adapter molecule 1; Iba1), astrocytes (glial fibrillary acidic protein; GFAP), calcitonin gene-related peptide (CGRP), and transient receptor potential vanilloid 1 (TRPV1) was performed in spinal dorsal horns and dorsal root ganglions (DRGs) at 10 days after surgery. It was found immunoreactivity for Iba1-positive microglia was higher in the L5 (P=0.004) dorsal horn and in the ipsilateral L4 (P=0.009), L6 (P=0.002), and S1 (P=0.002) dorsal horns in the NP-exposed group than in the sham-operated group. The expression of CGRP was also significantly higher in ipsilateral L3, L4, L6, and S1 segments and in L5 DRGs at 10 days after surgery in the NP-exposed group than in the sham-operated group (P<0.001). Our results indicate that lumbar disc herniation upregulates microglial activity and CGRP expression in many adjacent and ipsilateral lumbar spinal segments. PMID:26713069

  18. Changes in the Expressions of Iba1 and Calcitonin Gene-Related Peptide in Adjacent Lumbar Spinal Segments after Lumbar Disc Herniation in a Rat Model

    PubMed Central

    2015-01-01

    Lumbar disc herniation is commonly encountered in clinical practice and can induce sciatica due to mechanical and/or chemical irritation and the release of proinflammatory cytokines. However, symptoms are not confined to the affected spinal cord segment. The purpose of this study was to determine whether multisegmental molecular changes exist between adjacent lumbar spinal segments using a rat model of lumbar disc herniation. Twenty-nine male Sprague-Dawley rats were randomly assigned to either a sham-operated group (n=10) or a nucleus pulposus (NP)-exposed group (n=19). Rats in the NP-exposed group were further subdivided into a significant pain subgroup (n=12) and a no significant pain subgroup (n=7) using mechanical pain thresholds determined von Frey filaments. Immunohistochemical stainings of microglia (ionized calcium-binding adapter molecule 1; Iba1), astrocytes (glial fibrillary acidic protein; GFAP), calcitonin gene-related peptide (CGRP), and transient receptor potential vanilloid 1 (TRPV1) was performed in spinal dorsal horns and dorsal root ganglions (DRGs) at 10 days after surgery. It was found immunoreactivity for Iba1-positive microglia was higher in the L5 (P=0.004) dorsal horn and in the ipsilateral L4 (P=0.009), L6 (P=0.002), and S1 (P=0.002) dorsal horns in the NP-exposed group than in the sham-operated group. The expression of CGRP was also significantly higher in ipsilateral L3, L4, L6, and S1 segments and in L5 DRGs at 10 days after surgery in the NP-exposed group than in the sham-operated group (P<0.001). Our results indicate that lumbar disc herniation upregulates microglial activity and CGRP expression in many adjacent and ipsilateral lumbar spinal segments. PMID:26713069

  19. The Effect of GCSB-5 a New Herbal Medicine on Changes in Pain Behavior and Neuroglial Activation in a Rat Model of Lumbar Disc Herniation

    PubMed Central

    Cho, Hee Kyung; Kim, So-Yeon; Choi, Mi Jung; Baek, Seung Ok; Kwak, Sang Gyu

    2016-01-01

    Objective Lumbar disc herniation can induce sciatica by mechanical compression and/or chemical irritation. The aim of this study was to compare the effects of GCSB-5 (Shinbaro®) and NSAIDs on pain-related behavior and on the expressions of microglia, astrocytes, CGRP, TRPV1, IL-6, and CX3CL1 in a rat model of lumbar disc herniation. Methods 112 male Sprague-Dawley rats underwent implantation of nucleus pulposus to a dorsal root ganglion (DRG). Rats were divided into five groups as follows; a saline group (the vehicle control group) (n=27), a 10 mg/kg aceclofenac group (the aceclofenac group) (n=22), and 100, 300 or 600 mg/kg GCSB-5 groups (the GCSB-5 100, 300, or 600 groups) (n=21 for each group). Rats were tested for mechanical allodynia at 3 days after surgery and at 1 day, 3 days, 7 days, 14 days, 21 days, 28 days, 35 days, 42 days, 49 days, and 56 days after treatment commencement. Immunohistochemical staining of microglia (Iba1), astrocytes (GFAP), CGRP, and TRPV1, and PCR for IL-6 and CX3CL1 were performed on spinal dorsal horns and DRGs at 56 days after medication commencement. Results After 56 days of GCSB-5 300 administration, mechanical withdrawal thresholds were significantly increased (p<0.05), and immunohisto-chemical expressions of Iba1, GFAP, CGRP, and TRPV1 were reduced than other groups, but this difference was not statistically significant. Conclusion These results indicate GCSB-5 reduces mechanical allodynia and downregulates neuroglial activity and the expressions of CGRP and TRPV1 in the spinal segments of a rat model of lumbar disc herniation. PMID:26962414

  20. Surgical versus Non-Operative Treatment for Lumbar Disc Herniation: Four-Year Results for the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Weinstein, James N.; Lurie, Jon D.; Tosteson, Tor D.; Tosteson, Anna N. A.; Blood, Emily; Abdu, William A.; Herkowitz, Harry; Hilibrand, Alan; Albert, Todd; Fischgrund, Jeffrey

    2009-01-01

    Study Design Concurrent prospective randomized and observational cohort study. Objectives To assess the 4-year outcomes of surgery vs. non-operative care. Background Although randomized trials have demonstrated small short-term differences in favor of surgery, long-term outcomes comparing surgical to non-operative treatment remain controversial. Methods Surgical candidates with imaging-confirmed lumbar intervertebral disc herniation meeting SPORT eligibility criteria enrolled into prospective randomized (501 participants) and observational cohorts (743 participants) at 13 spine clinics in 11 US states. Interventions were standard open discectomy versus usual non-operative care. Main outcome measures were changes from baseline in the SF-36 Bodily Pain (BP) and Physical Function (PF) scales and the modified Oswestry Disability Index (ODI - AAOS/Modems version) assessed at 6 weeks, 3 and 6 months, and annually thereafter. Results Non-adherence to treatment assignment caused the intent-to-treat analyses to underestimate the treatment effects. In the 4-year combined as-treated analysis, those receiving surgery demonstrated significantly greater improvement in all the primary outcome measures (mean change Surgery vs. Non-operative; treatment effect; 95% CI): BP (45.6 vs. 30.7; 15.0; 11.8 to 18.1), PF (44.6 vs. 29.7; 14.9; 12.0 to 17.8) and ODI (?38.1 vs. ?24.9; ?13.2; ?15.6 to ?10.9). The percent working was similar between the surgery and non-operative groups, 84.4% vs. 78.4% respectively. Conclusion In a combined as-treated analysis at 4 years, patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients in all primary and secondary outcomes except work status. Trial Registration Spine Patient Outcomes Research Trial (SPORT): Intervertebral Disc Herniation; #NCT00000410; http://www.clinicaltrials.gov/ct/show/NCT00000410?order=2 PMID:19018250

  1. Comparative analysis of serum proteomes: Identification of proteins associated with sciatica due to lumbar intervertebral disc herniation

    PubMed Central

    XIE, PEIGEN; LIU, BIN; CHEN, RUIQIANG; YANG, BU; DONG, JIANWEN; RONG, LIMIN

    2014-01-01

    Lumbar intervertebral disc herniation (LDH) is one of the most common orthopedic conditions that can cause lower back pain and sciatica. However, the pathogenesis of LDH is poorly understood. The aim of the present study was to use proteomic analysis of blood samples to establish whether there are serum proteins associated with LDH, which may be useful in elucidating LDH pathogenesis. The ultimate aim was to develop a simple technique for the diagnosis of LDH based on the blood samples of patients with sciatica. The study used comparative analysis of serum proteomes associated with sciatica due to LDH. A total of 30 LDH patients with sciatica, receiving treatment between August and December 2007, were selected as the experimental group (or LDH group). A total of 2 ml of blood was obtained from each of the 30 patients in the LDH group and from 30 healthy volunteers, who constituted the control group. Two-dimensional electrophoresis of the blood samples was conducted, distinct protein spots were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and proteins associated with LDH were detected. An enzyme-linked immunosorbent assay (ELISA) was developed to screen for the LDH proteins and was tested on the sera of a second test and control group that included 10 patients with LDH and 10 healthy subjects, respectively. Based on signal intensity, the expression levels of 6 proteins on the dielectrophoretogram were found to be significantly associated with LDH. The identities of the LDH proteins were upregulated apolipoprotein-L1 (APO-L1) and two types of serum albumin precursors, and downregulated apolipoprotein M (APO-M), tetranectin (TN) and immunoglobulin light chain (IGL). Further ELISA experiments confirmed that there were increased serum levels of 4 out of the 6 proteins in patients with sciatica due to LDH, which was statistically different compared to the healthy subjects. In conclusion, these results suggest that serum APO-L1, TN, APO-M and IGL may serve as LDH biomarkers. PMID:25054013

  2. Comparative analysis of serum proteomes: Identification of proteins associated with sciatica due to lumbar intervertebral disc herniation.

    PubMed

    Xie, Peigen; Liu, Bin; Chen, Ruiqiang; Yang, Bu; Dong, Jianwen; Rong, Limin

    2014-09-01

    Lumbar intervertebral disc herniation (LDH) is one of the most common orthopedic conditions that can cause lower back pain and sciatica. However, the pathogenesis of LDH is poorly understood. The aim of the present study was to use proteomic analysis of blood samples to establish whether there are serum proteins associated with LDH, which may be useful in elucidating LDH pathogenesis. The ultimate aim was to develop a simple technique for the diagnosis of LDH based on the blood samples of patients with sciatica. The study used comparative analysis of serum proteomes associated with sciatica due to LDH. A total of 30 LDH patients with sciatica, receiving treatment between August and December 2007, were selected as the experimental group (or LDH group). A total of 2 ml of blood was obtained from each of the 30 patients in the LDH group and from 30 healthy volunteers, who constituted the control group. Two-dimensional electrophoresis of the blood samples was conducted, distinct protein spots were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and proteins associated with LDH were detected. An enzyme-linked immunosorbent assay (ELISA) was developed to screen for the LDH proteins and was tested on the sera of a second test and control group that included 10 patients with LDH and 10 healthy subjects, respectively. Based on signal intensity, the expression levels of 6 proteins on the dielectrophoretogram were found to be significantly associated with LDH. The identities of the LDH proteins were upregulated apolipoprotein-L1 (APO-L1) and two types of serum albumin precursors, and downregulated apolipoprotein M (APO-M), tetranectin (TN) and immunoglobulin light chain (IGL). Further ELISA experiments confirmed that there were increased serum levels of 4 out of the 6 proteins in patients with sciatica due to LDH, which was statistically different compared to the healthy subjects. In conclusion, these results suggest that serum APO-L1, TN, APO-M and IGL may serve as LDH biomarkers. PMID:25054013

  3. Microdiscectomy for the Treatment of Lumbar Disc Herniation: An Evaluation of Reoperations and Long-Term Outcomes

    PubMed Central

    Aichmair, Alexander; Du, Jerry Y.; Shue, Jennifer; Evangelisti, Gisberto; Sama, Andrew A.; Hughes, Alexander P.; Lebl, Darren R.; Burket, Jayme C.; Cammisa, Frank P.; Girardi, Federico P.

    2014-01-01

    Design?Retrospective case series. Objective?The objective of this study was to assess the reoperation rate after microdiscectomy for the treatment of lumbar disc herniation (LDH) in patients with???5-year follow-up and identify demographic, perioperative, and outcome-related differences between patients with and without a reoperation. Methods?The medical records, operative reports, and office notes of patients who had undergone microdiscectomy at a single institution between March 1994 and December 2007 were reviewed and long-term follow-up was assessed via a telephone questionnaire. Results?Forty patients (M:24, F:16) with an average age at surgery of 39.9??12.5 years (range: 1880) underwent microdiscectomy at the levels L5S1 (n?=?28, 70%), L4-L5 (n?=?9, 22.5%), L3L4 (n?=?2, 5.0%), and L1L2 (n?=?1, 2.5%). After an average of 40.4??40.1 months (range: 1128), 25% of patients (10/40) required further spine surgery related to the initial microdiscectomy. At an average postoperative follow-up of 11.1??4.0 years (range: 519), additional symptoms apart from back and leg pain were reported more frequently by patients who underwent a reoperation (p?=?0.005). Patient satisfaction was significantly higher in patients who did not undergo a reoperation (p?=?0.041). For the Oswestry disability index, pain intensity (p?=?0.036), and pain-related sleep disturbances (p?=?0.006) were reported to be more severe in the reoperation group. Conclusions?Microdiscectomy for the treatment of LDH results in a favorable long-term outcome in the majority of cases. The reoperation rate was higher in our series than reported in previous investigations with shorter follow-up. Although there were no statistically significant pre-/perioperative differences between patients with and without reoperation, our findings suggest a difference in self-reported long-term outcome measures. PMID:25278881

  4. Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation

    PubMed Central

    Choi, Jioun; Lee, Sangyong; Hwangbo, Gak

    2015-01-01

    [Purpose] The purpose of this study was to identify how spinal decompression therapy and general traction therapy influence the pain, disability, and straight leg raise (SLR) ability of patients with intervertebral disc herniation. [Subjects] The subjects were 30 patients with chronic lumbar pain who were divided into a spinal decompression therapy group (SDTG, n=15), and a general traction therapy group (GTTG, n=15). [Methods] The SDTG used a spinal decompression device, and the GTTG used a lumbar traction device. Both groups received conservative physical therapy three times a week for four weeks. A visual analog scale (VAS) was used to measure the degree of pain the patients with chronic lumbar pain. The Oswestry Disability Index (ODI) was used to measure the degree of functional disability. A goniometer was used to measure the patients SLR ability. [Results] Both SDTG and GTTG showed statistically significant decreases in VAS and ODI scores and a statistically significant increase in SLR angle. A comparison of the two groups found no statistically significant differences. [Conclusion] Spinal decompression therapy and general traction therapy are effective at improving the pain, disability, and SLR of patients with intervertebral disc herniation. Thus, selective treatment may be required. PMID:25729196

  5. Risk factors for back pain-related loss of working time after surgery for lumbar disc herniation: a 5-year follow-up study.

    PubMed

    Puolakka, K; Ylinen, J; Neva, M H; Kautiainen, H; Hkkinen, A

    2008-03-01

    The aim of this study is to explore the occurrence and the risk factors of back-related loss of working time in patients undergoing surgery for lumbar disc herniation. One hundred and fifty-two gainfully employed patients underwent surgery for lumbar disc herniation. Two months postoperatively, those patients completed a self-report questionnaire including queries on back and leg pain (VAS), functional capacity (Oswestry disability index--ODI, version 1.0), and motivation to work. After 5 years, lost working time was evaluated by means of a postal questionnaire about sick leave and disability pensions. The cumulative number of back pain-related days-off work was calculated for each patient. All 152 patients, 86 men and 66 women, were prescribed sick leave for the first 2 months. Thereafter, 80 (53%) of them reported back pain-related sick leave or early retirement. A permanent work disability pension due to back problems was awarded to 15 (10%) patients, 5 men (6%) and 10 women (15%). Median number of all work disability days per year was 11 (interquartile range [IQR] 9-37); it was 9 days (IQR 9-22) in patients with minimal disability (ODI score 0-20) at 2 months postoperatively and 67 days (IQR 9-352) in those with moderate or severe disability (ODI > 20; P < 0.001). The respective means were 61, 29, and 140 days/year. Multivariate analysis showed ODI > 20, leg pain, and poor motivation to work to be the risk factors for extension of work disability. Results of the present study show that after the lumbar disc surgery, poor outcome in questionnaire measures the physical functioning (ODI) and leg pain at 2 months postoperatively, as well as poor motivation to work, are associated with the loss of working time. Patients with unfavourable prognosis should be directed to rehabilitation before the loss of employment. PMID:18038161

  6. Percutaneous laser disc decompression.

    PubMed

    Choy, D S

    1995-06-01

    Herniated disc disease has an incidence of 1.7% in the U.S. Heretofore, open operative procedures were the rule for this condition when conservative measures were ineffective. Choy and Ascher introduced this new technique in February 1986 using a Nd:YAG laser introduced into the disc through an optical fiber in a needle. Percutaneous laser disc decompression is based on the principle that in an enclosed hydraulic space, such as an intact disc, a small reduction in volume is associated with a disproportionate fall in pressure. In the disc, this partial vacuum causes the herniated portion to move away from the nerve root back toward the center of the disc. This technique has been taught worldwide and is being performed in most of Europe, Japan, the United States, and Korea. In this special issue devoted to percutaneous laser disc decompression (PLDD), we will set forth the basic science of PLDD, patient selection, use of the holmium:YAG, and the Nd:YAG lasers, operative technique, and results. PMID:10150634

  7. Pain intensity the first year after lumbar disc herniation is associated with the A118G polymorphism in the opioid receptor mu 1 gene: evidence of a sex and genotype interaction.

    PubMed

    Olsen, Maria Belland; Jacobsen, Line Mel; Schistad, Elina Iordanova; Pedersen, Linda Margareth; Rygh, Lars Jrgen; Re, Cecilie; Gjerstad, Johannes

    2012-07-18

    Earlier studies have shown that the single nucleotide polymorphism (SNP) A118G (rs1799971) in the opioid receptor mu 1 (OPRM1) gene may affect pain sensitivity. In the present study we investigated whether the A118G SNP could predict clinical outcome regarding progression of pain intensity and disability in patients with low back pain and sciatica after lumbar disc herniation. Patients (n = 258) with lumbar disc herniation and sciatic pain, all European-Caucasian, were recruited from two hospitals in Norway. Pain and disability were rated on a visual analog scale (VAS), by McGill Sensory Questionnaire and by Oswestry Disability Index (ODI) over a 12 months period. The data revealed a significant interaction between sex and A118G genotype regarding the pain intensity during the 12 months (VAS, p = 0.002; McGill, p = 0.021; ODI, p = 0.205, repeated-measures ANOVA). We found that */G women had a slower recovery rate than the */G men. Actually, the */G women had 2.3 times as much pain as the */G men 12 months after the disc herniation (VAS, p = 0.043, one-way ANOVA; p = 0.035, Tukey HSD). In contrast, the A/A women and A/A men seemed to have almost exactly the same recovery rate. The present data suggest that OPRM1 G allele increases the pain intensity in women, but has a protective effect in men the first year after disc herniation. PMID:22815498

  8. Local Irrigation of the Surgical Field with Antibiotics in the End of Procedure Reduces the Infection Rate in Herniated Lumbar Disc Surgery

    PubMed Central

    Krveshi, Armend; Halili, Nehat; Kastrati, Bujar; Qosja, Faik; Kabashi, Serbeze; Muaj, Sefedin

    2014-01-01

    Introduction: Reported rate of infections after lumbar discectomy is 1%15 %. This complication may result in disability or even the death. Aim The aim of the study is to assess the rate of infection associated with lumbar discectomies when combined systemic and local antibiotic prophylaxis was employed. Patients and methods: In this retrospective study we analyzed all patients operated for herniated lumbar disc from 2009 -2012 in our institute. Beside of receiving systemic prophylaxis with 2g of Cefazoline, all patients had their operative field irrigated at the end of operation with Amikacin sulfate injection. Wound was considered infected when local and systemic signs of infection were revealed and were associated with elevated ESR, leukocytosis and elevated CRP. Assessment of infection is done by neurosurgeon during the hospitalization and later at outpatients clinic along postoperative course of three months. Results: A total of 604 patients were operated, of those 285 patients (47.2 %) females and 319 males (52.8 %), 12 patients were operated on two levels (1.98 %). Average patient age was 32.5 years (range 2065 years) Localization of herniated disc was: in L/2-L/3 20 patients or 3.3 %, the L/3-L/4 level 42 patients or 7 % , the L/4 -L /5 262 patients or 43.3 % at the level L/V- S/1 280 patients or 46.3 %. Three patients (0.49%) developed wound infection, two of them superficial infection only with local signs: local pain, redness and leakage. They were treated with oral antibiotics. One with deep wound infection. He presented with local and systemic signs and treated with i.v antibiotics. All the cultures from wound swab revealed staphylococcus aureus. Conclusion: Prophylaxis with systemic antibiotic (Cefazoline 2.0) intravenous administration 30 minutes before the incision and irrigation of operative field with local antibiotic Amikacine sulfate at the end of procedure reduces the infection rate in patients operated for herniated lumbar disc when compared with systemic antibiotic prophylaxis only. PMID:25685087

  9. A case of an 18-year-old male rugby union forward with a C5/C6 central disc herniation.

    PubMed

    Broughton, Henare Renata

    2009-01-01

    The patient was an 18-year-old front row forward rugby player who had a history of episodic neck pain for over 2 years following playing games of rugby. The initial event of April 2005 for which the symptoms manifested was a scrum collapse; he continued playing until a front-on tackle occurred when the symptoms dictated that he leave the field and be taken to the local hospital. A diagnosis of a cervical sprain was made and conservative management ensued. During the selections held on January 2008, a medical assessment was made and an MRI found that he had a central disc herniation at C5/C6. He was referred to a spinal orthopaedic surgeon for further treatment. The risks to cervical spinal injuries are illustrated in this case, in a scrum and in the tackle. The prevention of such an injury is discussed. PMID:21686741

  10. Surgical management of recurrent disc herniations with microdiscectomy and long-term results on life quality: Detailed analysis of 70 cases

    PubMed Central

    Albayrak, Serdal; Ozturk, Sait; Durdag, Emre; Ayden, mer

    2016-01-01

    Background: Aim of this paper is to recall the surgical technique used in the recurrent lumbar disc herniations (LDHs) and to share our experiences. Materials and Methods: Out of series of 1115 patients who underwent operations for LDH between 2006 and 2013, 70 patients underwent re-operations, which were included in this study. During surgery, lateral decompression performed over the medial facet joint to the superior facet joint border was seen after widening the laminectomy defect, and microdiscectomy was performed. The demographic findings of the patients, their complaints in admission to hospital, the level of operation, the condition of dural injury, the first admission in the prospective analysis, and their quality of life were evaluated through the Oswestry scoring during their postoperative 1st, 3rd, 6th-month and 1st, 3rd, 5th and 7th-year follow-up. In the statical analysis, Friedman test was performed for the comparison of the Oswestry scores and Siegel Castellan test was used for the paired nonparametrical data. A P < 0.05 was considered statistically significant. Results: Considering the Oswestry Index during the follow-ups, the values in the postoperative early period and follow-ups were seen to be significantly lower than those at the time of admission to hospital (P < 0.05). None of the patients, who re-operated by microdiscectomy, presented with iatrogenic instability in 7 years follow-up period. Conclusion: Microdiscectomy performed through a proper technique in the re-operation of recurrent disc herniations eases complaints and improves the quality of life. Long-term follow-ups are required for more accurate results. PMID:26933352

  11. Diffusion-Weighted Imaging for Pretreatment Evaluation and Prediction of Treatment Effect in Patients Undergoing CT-Guided Injection for Lumbar Disc Herniation

    PubMed Central

    Niu, Xiang-Ke; Bhetuwal, Anup

    2015-01-01

    Objective To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O2-O3) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. Materials and Methods A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O2-O3 mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O2-O3 therapy was determined. Results Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. Conclusion This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O2-O3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. PMID:26175588

  12. Surgical versus Non-Operative Treatment for Lumbar Disc Herniation: Eight-Year Results for the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Lurie, Jon D.; Tosteson, Tor D.; Tosteson, Anna N. A.; Zhao, Wenyan; Morgan, Tamara S.; Abdu, William A.; Herkowitz, Harry; Weinstein, James N.

    2014-01-01

    Study Design Concurrent prospective randomized and observational cohort studies. Objective To assess the 8-year outcomes of surgery vs. non-operative care. Summary of Background Data Although randomized trials have demonstrated small short-term differences in favor of surgery, long-term outcomes comparing surgical to non-operative treatment remain controversial. Methods Surgical candidates with imaging-confirmed lumbar intervertebral disc herniation meeting SPORT eligibility criteria enrolled into prospective randomized (501 participants) and observational cohorts (743 participants) at 13 spine clinics in 11 US states. Interventions were standard open discectomy versus usual non-operative care. Main outcome measures were changes from baseline in the SF-36 Bodily Pain (BP) and Physical Function (PF) scales and the modified Oswestry Disability Index (ODI - AAOS/Modems version) assessed at 6 weeks, 3 and 6 months, and annually thereafter. Results Advantages were seen for surgery in intent-to-treat analyses for the randomized cohort for all primary and secondary outcomes other than work status; however, with extensive non-adherence to treatment assignment (49% patients assigned to non-operative therapy receiving surgery versus 60% of patients assigned to surgery) these observed effects were relatively small and not statistically significant for primary outcomes (BP, PF, ODI). Importantly, the overall comparison of secondary outcomes was significantly greater with surgery in the intent-to-treat analysis (sciatica bothersomeness [p > 0.005], satisfaction with symptoms [p > 0.013], and self-rated improvement [p > 0.013]) in long-term follow-up. An as-treated analysis showed clinically meaningful surgical treatment effects for primary outcome measures (mean change Surgery vs. Non-operative; treatment effect; 95% CI): BP (45.3 vs. 34.4; 10.9; 7.7 to 14); PF (42.2 vs. 31.5; 10.6; 7.7 to 13.5) and ODI (?36.2 vs. ?24.8; ?11.2; ?13.6 to ?9.1). Conclusion Carefully selected patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients; there was little to no degradation of outcomes in either group (operative and non-operative) from 4 to 8 years. PMID:24153171

  13. Descriptive Epidemiology and Prior Healthcare Utilization of Patients in the Spine Patient Outcomes Research Trial’s (SPORT) Three Observational Cohorts: Disc Herniation, Spinal Stenosis and Degenerative Spondylolisthesis

    PubMed Central

    Cummins, Justin; Lurie, Jon D.; Tosteson, Tor; Hanscom, Brett; Abdu, William A.; Birkmeyer, Nancy J. O.; Herkowitz, Harry; Weinstein, James

    2009-01-01

    Study Design Prospective Observational Cohorts Objective To describe sociodemographic and clinical features, and non-operative (medical) resource utilization prior to enrollment, in patients who are candidates for surgical intervention for intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS) according to SPORT criteria. Summary of Background Data Intervertebral disc herniation, spinal stenosis, and degenerative spondylolisthesis with stenosis are the three most common diagnoses of low back and leg symptoms for which surgery is performed. There is a paucity of descriptive literature examining large patient cohorts for the relationships among baseline characteristics and medical resource utilization with these three diagnoses. Methods The Spine Patient Outcomes Research Trial (SPORT) conducts three randomized and three observational cohort studies of surgical and non-surgical treatments for patients with IDH, SPS, and DS. Baseline data include demographic information, prior treatments received, and functional status measured by SF-36 and the Oswestry Disability Index (ODI-AAOS/Modems version). The data presented represents all 1,417 patients (745 IDH, 368 SpS, 304 DS) enrolled in the SPORT observational cohorts. Multiple logistic regression was used to generate independent predictors of utilization adjusted for sociodemographic variables, diagnosis, and duration of symptoms. Results The average age was 41 years for the IDH group, 64 years for the SPS group, and 66 years for the DS group. At enrollment, IDH patients presented with the most pain as reported on the SF-36 (BP 26.2 vs 33 SPS and 33.7 DS) and were the most impaired (ODI 51 vs 42.3 SPS and 41.5 DS). IDH patients utilized more chiropractic treatment (42% vs 33% SPS and 26% DS); had more Emergency Department (ED) visits (21% vs 7 % SPS and 4% DS); and used more opiate analgesics (50% vs 29% SPS and 28% DS). After adjusting for age, gender, diagnosis, education, race, duration of symptoms, and compensation, Medicaid patients used significantly more opiate analgesics (58% Medicaid vs 41% no insurance, 42% employer, 33% Medicare, and 32% private) and had more ED visits compared to other insurance types. (31% Medicaid vs 22% no insurance, 16% employer, 3% Medicare, and 11% private). Conclusion IDH patients appear to have differences in sociodemographics, resource utilization, and functional impairment when compared to the SpS/DS patients. In addition, the differences in resource utilization for Medicaid patients may reflect differences in access to care. The data provided from these observational cohorts will serve as an important comparison to the SPORT randomized cohorts in the future. PMID:16582855

  14. Transarticular Laser Discal Fragmentectomy. A New Minimally Invasive Surgical Approach for Challenging Disc Herniations in the Elderly

    PubMed Central

    Bonaldi, Giuseppe; Brembilla, Carlo; Foresti, Camillo; Cianfoni, Alessandro

    2014-01-01

    Summary This report describes two elderly patients with large disc fragments extruded into lumbar radicular recesses not treatable by any conventional conservative, minimally invasive or surgical approach. Direct access to the disc fragments was obtained crossing the articular zygapophyseal cavity instead of the interlaminar space and spinal canal, using a small needle through which a laser fibre was inserted to deliver energy for tissue ablation. The procedures obtained regression of both symptoms and the bulk of the fragments at early and late clinical and MR follow-ups. PMID:25363258

  15. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154

    PubMed Central

    Peul, Wilco C; van Houwelingen, Hans C; van der Hout, Wilbert B; Brand, Ronald; Eekhof, Just AH; Tans, Joseph ThJ; Thomeer, Ralph TWM; Koes, Bart W

    2005-01-01

    Background The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the diagnosis and surgical indication MRI scanning is performed. If a distinct disc herniation is discerned which in addition covers the clinically expected site the patient is eligible for randomization. Depending on the outcome of the randomization scheme the patient will either be submitted to prolonged conservative care or surgery. Surgery will be carried out according to the guidelines and between six and twelve weeks after onset of complaints. The experimental therapy consists of a prolonged conservative treatment under supervision of the general practitioner, which may be followed by surgical intervention in case of persisting or progressive disability. The main primary outcome measure is the disease specific disability of daily functioning. Other primary outcome measures are perceived recovery and intensity of legpain. Secondary outcome measures encompass severity of complaints, quality of life, medical consumption, absenteeism, costs and preference. The main research question will be answered at 12 months after randomization. The total follow-up period covers two years. Discussion Evidence is lacking concerning the optimal treatment of lumbar disc induced sciatica. This pragmatic randomized trial, focusses on the 'timing' of intervention, and will contribute to the decision of the general practictioner and neurologist, regarding referral of patients for surgery. PMID:15707491

  16. Plasma metabonomic profiling of lumbar disc herniation and its traditional Chinese medicine subtypes in patients by using gas chromatography coupled with mass spectrometry.

    PubMed

    Shan, Letian; Liao, Fei; Jin, Hongting; Ye, Fusheng; Tong, Peijian; Xiao, Luwei; Zhou, Jia; Wu, Chengliang

    2014-11-01

    Lumbar disc herniation (LDH) is a commonly occurring disease, threatening human health and life quality. Lack of a gold standard of diagnosis has hindered the efficiency and efficacy of clinical therapy against LDH. Traditional Chinese medicine (TCM) has provided an experience-based but subjective diagnosis system for LDH, demanding objective evidence and explanation. In this study, we adopted a metabonomics approach using gas chromatography-mass spectrometry (GC-MS) to profile metabolic characteristics of LDH and its TCM subtypes. Plasma samples of 41 LDH patients and 25 healthy controls were collected. LDH patients were classified into two main subtypes, the reality syndrome and deficiency syndrome, according to TCM theory. By using multivariate statistical analysis and metabolism network analysis, we found diverse perturbations of metabolites in amino acid metabolism and carbohydrate metabolism, in which the amino acids (glutamic acid, aspartic acid, glycine, etc.) were up-regulated and a key carbohydrate metabolite (glucose 1-phosphate) was down-regulated. Few differences were found between the two TCM subtypes. Our findings reveal the metabolic disorders of LDH for the first time and demonstrate the feasibility of the metabonomics approach for LDH research but not for its TCM subtypes. PMID:25144444

  17. Herniated Disk

    MedlinePLUS

    ... disk. Herniated disks are most common in the lumbar spine -- the lower part of your backbone, between the bottom of your ribs and your hips. Symptoms What are the signs of a herniated disk? When part of a disk presses on a nerve, it can cause pain in the back and the legs. The location ...

  18. Combination of serum phosphorylated neurofilament heavy subunit and hyperintensity of intramedullary T2W on magnetic resonance imaging provides better prognostic value of canine thoracolumbar intervertebral disc herniation

    PubMed Central

    MASHITA, Tadahisa; KAMISHINA, Hiroaki; NAKAMOTO, Yuya; AKAGI, Yosuke; NAKANISHI, Ataru; HARASAKI, Yusuke; OZAWA, Tsuyoshi; UEMURA, Takashi; KOBATAKE, Yui; SHIMAMURA, Shunsuke; KITAMURA, Naoki; MAEDA, Sadatoshi; UZUKA, Yuji; SHAW, Gerry; YASUDA, Jun

    2014-01-01

    The aim of this study was to evaluate the prognostic value of concurrent measurement of serum phosphorylated neurofilament heavy subunit (pNF-H) concentration and intramedullary T2W hyperintensity in paraplegic to paraplegic dogs. Our hypothesis was that concurrent measurement of these would provide a more accurate prediction of functional outcome in dogs with thoracolumbar intervertebral disc herniation (IVDH). A prospective case-control clinical study was designed using 94 dogs with acute onset of thoracolumbar IVDH. The association of serum pNF-H concentration, T2W hyperintensity on sagittal MRI (T2H/L2), deep pain perception and surgical outcome were evaluated with logistic regression analysis after three months for all 94 surgically treated dogs. Sensitivity to predict non-ambulatory outcome was compared among pNF-H and T2H/L2 and combination of both. Logistic regression analysis indicated that serum pNF-H concentration and T2H/L2 were significantly correlated with surgical outcome (P<0.05); however, deep pain perception was not (P=0.41). The results of logistic regression analysis indicated that the odds ratios of unsuccessful long-term outcome were 2.6 for serum pNF-H concentration, 1.9 for T2H/L2 and 2.3 for deep pain sensation. The sensitivity and specificity to predict non-ambulatory outcome for using serum parameter pNF-H>2.6 ng/ml, using T2H/L2 value of>0.84 and using both serum pNF-H and T2H/L2, were 95% and 75.7%, 65% and 86.5%, and 90.0% and 97.5%, respectively. Therefore, combined measurements of serum pNF-H and T2H/L2 might be useful for predicting long-term outcome in dogs with thoracolumbar IVDH. PMID:25650056

  19. Comparison of lumbar spine stabilization exercise versus general exercise in young male patients with lumbar disc herniation after 1 year of follow-up

    PubMed Central

    Ye, Chaoqun; Ren, Jixin; Zhang, Jianzheng; Wang, Chongwei; Liu, Zhi; Li, Fang; Sun, Tiansheng

    2015-01-01

    Objective: The safest and most effective conservative treatment for patients with lumbar disc herniation (LDH) has not been established. The purpose of this study was to evaluate the effect of lumbar spine stabilization exercise (LSSE) and general exercise (GE) on pain intensity and functional capacity in young male patients with LDH. Methods: Sixty-three young male adults aged 20 to 29 years with the diagnosis of LDH were enrolled and divided into an LSSE group (n=30) and a GE group (n=33). Patients in both groups received low-power laser (LPL) therapy during the first week of the onset of LDH. Patients in the GE group underwent a GE program. Patients in the LSSE group followed an LSSE program for 3 months. All of the patients were subjected to pain intensity and functional capacity evaluations four times: at pre-and post-LPL therapy, and at 3 months and 1 year post-exercise. Pain intensity of the lower back and legs was evaluated with the visual analogue scale (VAS), and functional capacity was evaluated with the Oswestry Disability Index (ODI). Results: Both groups showed a significant reduction in VAS and ODI scores at 3 and 12 months post-exercise compared with before treatment (P<0.001). The LSSE group showed a significant reduction in the average score of the VAS for low back pain (P=0.012) and the ODI (P=0.003) at 12 months post-exercise compared with the GE group. Conclusions: LSSE and GE are considered as effective interventions for young male patients with LDH. Moreover, LSSE is more effective than GE, and physical therapy, such as LPL, is required during acute LDH. PMID:26309670

  20. A posterior ring apophyseal fracture and disc herniation in a 21-year-old competitive basketball player: a case report

    PubMed Central

    Deleo, Trevor; Merotto, Samuel; Smith, Colyn; D’Angelo, Kevin

    2015-01-01

    Objective: To describe the diagnosis and management of a competitive male basketball player with discogenic low back pain and presence of an old posterior ring apophyseal fracture (PRAF). This case will highlight the importance of early recognition and considerations regarding patient management for this differential of radiating low back pain. Clinical Features: A 21-year-old provincial basketball player presented with recurrent radiating low back pain into the left groin and lower limb. After several weeks of persistent symptoms including pain, muscle weakness, and changes in the Achilles deep tendon reflex, imaging was obtained that revealed a large disc extrusion with an old posterior ring apophyseal fracture. In collaboration with a spine surgeon and family physician, the patient was treated using a conservative, multimodal approach. Treatment consisted of graded mobilizations, spinal manipulative therapy, interferential current, and soft tissue therapy to the lumbar spine. Rehabilitation exercises focused on centralizing symptoms and improving strength, proprioception and function of the lower limb. After a period of 8 weeks, the patient was able to complete all activities of daily living without pain in addition to returning to basketball practice. Summary: PRAF is a unique condition in the immature spine and recent evidence suggests that those involved in sports requiring repetitive motion of the lumbar spine may be at increased risk. The astute clinician must consider this differential in young populations presenting with discogenic low back pain, as a timely diagnosis and necessary referral may allow for effective conservative management to reduce symptoms. Equally as important, one must be aware of the complications from PRAF as a contributing source of low back pain and dysfunction into adulthood. Knowing when to refer for advanced imaging and/or a surgical consult given the variable clinical presentation and prognosis is an essential component to care. PMID:26816414

  1. Psychometric properties of the Polish language version of the Chronic Pain Coping Inventory-42 for patients treated surgically due to herniated lumbar discs and spondylotic changes

    PubMed Central

    Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej

    2014-01-01

    Background The development of a pain-management program tailored to the specific needs of patients with chronic low back pain (CLBP) requires the proper assessment of psychosocial factors affecting each individual. The Chronic Pain Coping Inventory-42 (CPCI-42) refers to coping strategies, which are commonly defined as the cognitive and behavioral techniques an individual may resort to in stressful or demanding situations. Evidence from a number of sources suggests that differences in pain coping strategies may significantly affect how an individual deals with chronic pain. We aimed to adapt the CPCI-42 to Polish cultural conditions (PL-CPCI-42) and then verify its psychometric properties based on a group of patients treated surgically due to herniated lumbar discs and coexisting spondylotic changes. Material/Methods The average age of the study participants (n=90) was 43.47 years (SD 10.21). The average duration of chronic low back pain (CLBP) was 49.37 months (SD 64.71). Lumbosacral spine X-rays and magnetic resonance imaging scans were performed and all patients completed the PL-CPCI-42 and the Polish versions of the Numeric Pain Rating Scale (NPRS-PL) twice. Internal consistency of the PL-CPCI-42, floor and ceiling effects, test-retest reliability, and criterion validity were analyzed. Results Resting, guarding, and coping self-statements were frequently used as coping strategies both in the test and in the retest, in contrast to relaxation and exercise/stretch. The NPRS-PL result was 5.70 cm in the test and 5.66 in the retest. Cronbach’s alpha values were recorded for the asking for assistance, coping self-statements, and seeking social support domains (0.83, 0.80, 0.83, respectively). Test-retest reliability of the PL-CPCI-42 varied from 0.53 (relaxation domain) to 0.84 (asking for assistance and coping self-statements domains). Conclusions The present study provides evidence of the validity of the PL-CPCI-42 and supports its usefulness in assessing chronic pain coping strategies, which are especially important to pain adjustment and in the creation of multidisciplinary pain management programs for patients with severe CLBP. PMID:24824781

  2. The long-term course of patients undergoing alternative and integrative therapy for lumbar disc herniation: 3-year results of a prospective observational study

    PubMed Central

    Shin, Joon-Shik; Lee, Jinho; Kim, Me-riong; Shin, Byung-Cheul; Lee, Myeong Soo; Ha, In-Hyuk

    2014-01-01

    Objectives This study aimed to assess the efficacy and safety of an integrative complementary and alternative medicine (CAM) approach in the management of lumbar herniated disc (LHD) with sciatic pain and investigate pain relapse, use of medical care and surgery rates in patients who actively chose non-surgical CAM treatment for LHD. Study design/Setting This prospective observational study was undertaken at a Korean medicine hospital outpatient setting in Korea. Participants A total of 128 consecutive patients with LHD with a numeric rating scale for leg pain of ?5 completed 6?months of CAM treatment after recruitment from November 2006, and 73/128 participants (57%) attended follow-up 3?years later. Interventions 6?months of CAM treatment (herbal medicine, acupuncture, bee venom pharmacopuncture, and Chuna manipulation). Primary outcome measures Visual analogue scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI), and Short Form (SF)-36 Health Survey. Secondary outcome measures Neurological impairment (muscular weakness, sensory loss, Straight Leg Raise test), MRIs, recurrence of low back pain and/or radiating pain, and use of medical care. Results 92 patients could be assessed for surgical state, of whom 4 replied that they had received surgery. 73 patients attended the 3-year follow-up. The baseline VAS of back pain (4.372.70) decreased after treatment (0.901.01; p<0.001) and was maintained at 3?years (1.121.64; p=0.19). The baseline VAS of leg pain (7.571.40) also decreased on treatment (0.821.18; p<0.001) and was sustained at 3?years (0.991.58; p=0.34). ODI scores declined from 40.7416.15 to 9.849.67 (p<0.001), then decreased further to 6.307.19 (p<0.01). SF-36 scores increased from 34.9613.30 to 69.2014.96 (p<0.001), reaching 76.1914.45 (p<0.001) at 3?years. 37 patients reported recurrence of pain and most chose CAM treatment for management of relapse symptoms. Conclusions Although the absence of a control group prevents validation of effectiveness, many patients showed favourable long-term outcomes. Trial registration number ClinicalTrials.gov Identifier: NCT01989403.

  3. Serum levels of the pro-inflammatory interleukins 6 (IL-6) and -8 (IL-8) in patients with lumbar radicular pain due to disc herniation: A 12-month prospective study.

    PubMed

    Pedersen, Linda Margareth; Schistad, Elina; Jacobsen, Line Mel; Re, Cecile; Gjerstad, Johannes

    2015-05-01

    Earlier studies indicate that lumbar radicular pain after disc herniation may be associated with a local inflammation induced by leakage of nucleus pulposus (NP) into the spinal canal and neuroforamen. In the present study we addressed the role of two interleukins, IL-6 and IL-8 in such long-lasting lumbar radicular pain. All 127 patients were recruited from Oslo University Hospital, Ullevl, Norway. At inclusion, 6weeks and 12months, serum concentrations of IL-6 and IL-8 were analyzed by enzyme-linked immunosorbent assay (ELISA) and pain intensity was reported on a 0-10cm visual analog scale (VAS). Significantly higher levels of IL-6 and IL-8 in serum were found in patients with VAS ?3 at 12months, than in patient with VAS <3 at 12months (p?0.01, test of between-subjects effect, repeated measures ANOVA, covariates for IL-6: age, smoking; covariates for IL-8: smoking, treatment). For the first time we show that chronic lumbar radicular pain may be associated with a persistent increase of the pro-inflammatory substances IL-6 and IL-8 in serum after disc herniation. PMID:25653193

  4. Electroburning of few-layer graphene flakes, epitaxial graphene, and turbostratic graphene discs in air and under vacuum

    PubMed Central

    Richter, Nils; Convertino, Domenica; Coletti, Camilla; Balestro, Franck; Wernsdorfer, Wolfgang; Kläui, Mathias; Affronte, Marco

    2015-01-01

    Summary Graphene-based electrodes are very promising for molecular electronics and spintronics. Here we report a systematic characterization of the electroburning (EB) process, leading to the formation of nanometer-spaced gaps, on different types of few-layer graphene (namely mechanically exfoliated graphene on SiO2, graphene epitaxially grown on the C-face of SiC and turbostratic graphene discs deposited on SiO2) under air and vacuum conditions. The EB process is found to depend on both the graphene type and on the ambient conditions. For the mechanically exfoliated graphene, performing EB under vacuum leads to a higher yield of nanometer-gap formation than working in air. Conversely, for graphene on SiC the EB process is not successful under vacuum. Finally, the EB is possible with turbostratic graphene discs only after the creation of a constriction in the sample using lithographic patterning. PMID:25821711

  5. Subjective health complaints in patients with lumbar radicular pain and disc herniation are associated with a sex - OPRM1 A118G polymorphism interaction: a prospective 1-year observational study

    PubMed Central

    2014-01-01

    Background Earlier observations show that development of persistent pain may be associated with the genetic variability in the gene encoding for the ?-opioid receptor 1, the OPRM1 A118G (rs1799971). The aim of this study was to investigate the association between OPRM1 genotype and subjective health complaints in patients with radicular pain and disc herniation. Methods A prospective, 1-year observational study was conducted at a hospital back clinic, including 118 Caucasian patients with lumbar radicular pain and MRI confirmed disc herniation. Single nucleotide polymorphism genotyping regarding the OPRM1 A118G was performed. The data of individuals with AA versus AG or GG were analysed separately by linear mixed models. The Subjective Health Complaints Inventory (0-81) including 27 common complaints experienced the previous month on a scale from not at all (0) to severe (3) was used as outcome. Pain, prior duration of leg pain, age, smoking status, and lumbar disc surgery were considered as covariates. Results In total 23 of 118 patients were carriers of the OPRM1 G-allele. All patients except female carriers of the G-allele reported a decrease in pain from baseline to 1year. Female carriers of the G-allele reported significantly higher subjective health complaints score during the study time span than male carriers of the G-allele when controlling for pain and pain duration. Conclusion The present data indicate that, when controlling for pain intensity and duration, subjective health complaints are associated with a sex - OPRM1 A118G polymorphism interaction in patients with radicular pain. PMID:24884878

  6. A prospective study of the interrelationship between subjective and objective measures of disability before and 2 months after lumbar decompression surgery for disc herniation.

    PubMed

    Mannion, Anne F; Dvorak, Jiri; Müntener, Markus; Grob, Dieter

    2005-06-01

    The value of range of motion (ROM) as an indicator of impairment associated with spinal problems, and in monitoring changes in response to treatment, is a controversial issue. The aim of this study was to examine the interrelationship between subjective disability (Roland-Morris scores) and objectively measured impairment (ROM), both before and in response to spinal decompression surgery, in an older group of patients with herniated lumbar disc (DH). Seventy-six individuals took part in the study: 33 patients (mean age 57 years, SD 9 years) presenting with DH and for whom decompression surgery was planned, and 43 controls (mean age 57 years, SD 7 years), with no history of back pain requiring medical treatment. In the patient group, pain intensity (leg and back; visual analog score), self-rated disability (Roland-Morris score), certain psychological attributes, and ROM of the spine (Spinal Mouse) were measured before and 2 months after decompression surgery. In addition, the patients rated the success of surgery on a 1-5 Likert scale. The pain-free control group performed only the tests of spinal mobility. Before surgery, compared with matched controls, significantly lower values were observed in the DH patients for standing lumbar lordosis (p=0.01), and for range of flexion of the lumbar spine (ROF(lumbar)) (p=0.0006), but not of the hips (ROF(hip)) (p=0.14). Roland-Morris Disability scores correlated significantly with ROF(lumbar) (r=0.61, p=0.0002), but less well with ROF(hip)(r=0.43, p=0.01). Two months after surgery, there were significant reductions in back pain and leg pain (p=0.0001) and in Roland-Morris Disability scores (p=0.019). There was also a significant decrease in the group mean values for lumbar lordosis angle (i.e., a "flatter" spine after surgery, p=0.002) and ROF(lumbar) (p=0.038). ROF(hip) showed a (nonsignificant) tendency to increase (p=0.08) towards normal control values. As a result of these two opposing changes, the range of total trunk flexion showed no significant changes from pre-surgery to 2 months post-surgery (p=0.60). On an individual basis, there was a highly significant relationship between the change in self-rated disability scores and the change in ROF(lumbar), pre-surgery- to 2 months post-surgery (r= -0.82; p<0.0001). Changes in ROF(hip) showed no such relationship (r= -0.30, p=0.10). The patients in the "poor" outcome group ("surgery didn't help"; 9%) had a significantly greater reduction in ROF(lumbar) post-surgery compared with the "good" outcome group ("surgery helped"; 91%) (p=0.04). In stepwise linear regression, the change in ROF(lumbar) was the only variable accounting for the change in self-rated disability pre-surgery to post-surgery (variables not included: pain intensity, psychological factors). The pivotal role of lumbar mobility in explaining disability emphasizes the importance of measuring lumbar and hip ranges of motion separately, as opposed to "global trunk motion." In the patient group examined, the determination of lumbar spinal mobility provides a valid, objective measure of function, that shows differences from normal matched controls, that correlates well with self-rated disability, and the changes in which correlate extremely well with subjective changes in disability following surgery. PMID:15830214

  7. Comparison of Posterior Lumbar Interbody Fusion and Posterolateral Lumbar Fusion in Monosegmental Vacuum Phenomenon within an Intervertebral Disc

    PubMed Central

    An, Ki-Chan; Kong, Gyu-Min; Park, Dae-Hyun; Youn, Ji-Hong; Lee, Woon-Seong

    2016-01-01

    Study Design Retrospective. Purpose To compare the clinical and radiological outcomes of posterolateral lumbar interbody fusion (PLIF) and posterolateral lumbar fusion (PLF) in monosegmental vacuum phenomenon within an intervertebral disc. Overview of Literature The vacuum phenomenon within an intervertebral disc is a serious form of degenerative disease that destabilizes the intervertebral body. Outcomes of PLIF and PLF in monosegmental vacuum phenomenon are unclear. Methods Monosegmental instrumented PLIF and PLF was performed on 84 degenerative lumbar disease patients with monosegmental vacuum phenomenon (PLIF, n=38; PLF, n=46). Minimum follow-up was 24 months. Clinical outcomes of leg and back pain were assessed using visual analogue scales for leg pain (LVAS) and back pain (BVAS), and the Oswestry disability index (ODI). The radiographic outcome was the estimated bony union rate. Results LVAS, BVAS, and ODI improved in both groups. There was no significant difference in the degree of these improvements between PLIF and PLF patients (p>0.05). Radiological union rate was 91.1% in PLIF group and 89.4% in PLF group at postoperative 24 months (p>0.05). Conclusions No significant differences in clinical results and union rates were found between PLIF and PLF patients. Selection of the operation technique will reflect the surgeon's preferences and patient condition. PMID:26949464

  8. The Effect and Feasibility Study of Transforaminal Percutaneous Endoscopic Lumbar Discectomy Via Superior Border of Inferior Pedicle Approach for Down-Migrated Intracanal Disc Herniations

    PubMed Central

    Ying, Jinwei; Huang, Kelun; Zhu, Minyu; Zhou, Beibei; Wang, Yu; Chen, Bi; Teng, Honglin

    2016-01-01

    Abstract Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is gradually regarded as an effective alternative to posterior open surgery. However, migrated herniations bring a great technical challenge even for experienced surgeons due to the absence of the appropriate approaching guideline. We aimed to describe a safe and effective approaching technique for the removal of down-migrations on the basis of the clinical outcomes and complications compared with the conventional approaching method. A total of 45 patients recommended to single-level PELD with foraminoplasty were randomly divided into 2 groups, group A received foraminoplasty via upper border of inferior pedicle, group B was approached through the common transforaminal route. The clinical outcomes were evaluated by Visual Analog Scale (VAS) for leg pain and Oswestry Disability Index (ODI) scores. Then participants were classified into 2 types of migrations (high-grade and low-grade) based on the extent of migration presented on preoperative magnetic resonance imaging (MRI). The various comparisons between the 2 surgical techniques were analyzed. The postoperative VAS and ODI scores significantly decreased in both of the 2 groups after surgery (P < 0.001). The follow-up continued 1 year. With increasing length of follow-up, the disparities in clinical outcomes between the 2 groups were gradually narrowing and there was no significant difference at the end of follow-up (P = 0.32; P = 0.46). There were no differences in the operation time and duration of hospital stay (P = 0.36; P = 0.08). The highly migration group in group B showed a significant longer operation time (P = 0.02), but the extent of migration did not have a significant influence on the operation time in group A with the modified approach (P = 0.19). There were no apparent approach-related complications in group A during the procedure and follow-up period. Foraminoplastic-PELD via upper border of inferior pedicle can serve as a safe and effective minimally invasive technique for removal of down-migrated herniations. Furthermore, it is essential to identify the radiologic characteristics so as to choose the most appropriate approaching technique. PMID:26937930

  9. Idiopathic spinal cord herniation.

    PubMed

    Miura, Y; Mimatsu, K; Matsuyama, Y; Yoneda, M; Iwata, H

    1996-02-01

    Idiopathic spinal cord herniation is a rare disease, few cases having been reported. We encountered a case of idiopathic spinal cord herniation presenting with severe spasticity in the right leg and urinary dysfunction. The spinal cord was herniated into a cavity created by duplication of the dura mater and resection of the inner layer improved the neurological deficits. MRI, myelography, and CT myelography were useful for diagnosing this disease. Four radiological signs of spinal cord herniation are described. PMID:8692428

  10. Quantitative Discomanometry: Correlation of Intradiscal Pressure Values to Pain Reduction in Patients With Intervertebral Disc Herniation Treated With Percutaneous, Minimally Invasive, Image-Guided Techniques

    SciTech Connect

    Filippiadis, Dimitrios K. Mazioti, A. Papakonstantinou, O. Brountzos, E.; Gouliamos, A.; Kelekis, N. Kelekis, A.

    2012-10-15

    Purpose: To illustrate quantitative discomanometry's (QD) diagnostic efficacy and predictive value in discogenic-pain evaluation in a prospective study correlating intradiscal pressure values with pain reduction after percutaneous image-guided technique (i.e., percutaneous decompression, PD). Materials and Methods: During the last 3 years, 36 patients [21 male and 15 female (mean age 36 {+-} 5.8 years)] with intervertebral disc hernia underwent QD before PD. Under absolute sterilization and fluoroscopy, a mixture of contrast medium and normal saline (3:1 ratio) was injected. A discmonitor performed a constant rate injection and recorded pressure and volume values, thus producing the relative pressure-volume curve. PD was then performed. Pain reduction and improved mobility were recorded at 3, 12, and 24 months after PD using clinical evaluation and a numeric visual scale (NVS; 0 to 10 units). Results: Mean pain values of 7.5 {+-} 1.9 (range 4 to 8) NVS units were recorded before PD; these decreased to 2.9 {+-} 2.44 at 3 months, 1.0 {+-} 1.9 at 12 months, and 1.0 {+-} 1.9 NVS units at 24 months after PD. Recorded correlations (pressure, volume, significant pain-reduction values) with bilateral statistical significance included a maximum injected volume of 2.4 ml (p = 0.045), P{sub o} < 14 psi [initial pressure required to inject 0.1 ml of the mixture inside the disc (p = 0.05)], P{sub max} {<=} 65 psi [greatest pressure value on the curve (p = 0.018)], and P{sub max} - P{sub o} {<=} 47 psi (p = 0.038). Patients meeting these pressure or volume cut-off points, either independently or as a total, had significant pain reduction (>4 NVS units) after PD. No complications were noted. Conclusions: QD is an efficient technique that may have predictive value for discogenic pain evaluation. It might serve as a useful tool for patient selection for intervertebral disc therapies.

  11. Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control

    PubMed Central

    Misterska, Ewa; Jankowski, Roman; G?owacki, Maciej

    2013-01-01

    Background Pain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes. Material/Methods The average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish versions of the Chronic Pain Coping Inventory-42 (PL-CPCI-42), Beck Depression Inventory (BDI-PL), Coping Strategies Questionnaire (CSQ-PL), Beliefs about Pain Control Questionnaire (BPCQ-PL), and Roland-Morris Disability Questionnaire (RMQ-PL). Results In the PL-CPCI-42 results, resting, guarding and coping self-statements were frequently used as coping strategies (3.96 SD 1.97; 3.72 SD 1.72; 3.47 SD 2.02, respectively). In the CSQ-PL domains, catastrophizing and praying/hoping were frequently used as coping strategies (3.62 SD 1.19). The mean score obtained from the BDI-PL was 11.86 SD 7.23, and 12.70 SD 5.49 from the RMDQ-PL. BPCQ-PL results indicate that the highest score was in the subscale measuring beliefs that powerful others can control pain (4.36 SD 0.97). Exercise correlated significantly with beliefs about internal control of pain (rs=0.22). We identified associations between radiating pain and guarding (p=0.038) and between sports recreation and guarding (p=0.013) and task persistence (p=0.041). Conclusions Back pain characteristics, depressive mood, disability, and beliefs about personal control of pain are related to chronic LBP coping styles. Most of the variables related to advancement of degenerative changes were not associated with coping efforts. PMID:24370564

  12. [Effects of 3-hydroxypyridine and succinic acid derivatives on the dynamics of dorsalgia and affective disorders after surgical treatment of disc herniation].

    PubMed

    Volchegorski?, I A; Mester, K M

    2010-01-01

    A prospective, placebo-controlled randomized study of the effects of 3-hydropxypyridine and succinic acid derivatives (emoxipine, reamberin and mexi the early dynamics of dorsalgia and the corresponding affective disorders has been performed in 136 patients after surgical treatment of lumbal disc hen It is established that a two-week administration of all preparations reduced the manifestations of depression during 3.5 months after spinal surgery. The course of emoxipine (150 mg, i.v., daily) produced an antidepressant effect without any changes in the dynamics of dorsalgia, psychological dysada (PD), and quality of life (QL). The 14-day administration of reamberin (400 ml, i.v., daily) significantly reduced in the manifestations of depression and pathic pain, without any effect upon nociceptive pain, PD, and QL dynamics. The two-week course of mexidol (300 mg, i.v., daily) led to the most pron antidepressant effect, which was accompanied by the attenuation of both nociceptive and neuropathic pain, a decrease in PD, and appreciable increase in ter the surgical treatment. PMID:20184287

  13. Can Prevention of a Reherniation Be Investigated? Establishment of a Herniation Model and Experiments With an Anular Closure Device

    PubMed Central

    Wilke, Hans-Joachim; Ressel, Lena; Heuer, Frank; Graf, Nicolas; Rath, Stefan

    2013-01-01

    Study Design. Biomechanical in vitro study. Objective. To establish a reliable in vitro herniation model with human cadaver spines that enables evaluation of anular closure devices. Summary of Background Data. Biomechanically, it is desirable to close anulus defects after disc herniation to preserve as much nucleus as possible. Multiple anular closure options exist to prevent reherniation. A reliable test procedure is needed to evaluate the efficacy and reliability of these implants. Methods. Two groups of human lumbar segments (n = 6 per group) were tested under cyclic loading until herniation occurred or 100,000 load cycles were applied. One group contained moderate/severe degenerated discs. A second group had mild degenerated discs. Intradiscal pressure was measured in the intact state to confirm disc quality. If herniation occurred, the extruded material was reinserted into the disc and the anulus defect was treated with the Barricaid anular closure device (Intrinsic Therapeutics, Inc., Woburn, MA). Disc height and 3-dimensional flexibility of the specimens in the intact, defect, and implanted states were measured under pure moments in each principal motion plane. Afterwards, provocation of reherniation was attempted with additional 100,000 load cycles. Results. Likelihood of herniation was strongly linked to disc degeneration and supported by the magnitude of intradiscal pressure. In moderate/severe degenerated discs, only 1 herniation was created. In mild degenerated discs, herniations were reliably created in all specimens. Using this worst-case model, herniation caused a significant reduction of disc height, which was nearly restored with the implant. In no case was reherniation or implant migration visible after 100,000 load cycles after Barricaid implantation. Conclusion. We established a human herniation model that reliably produced nucleus extrusion during cyclic loading by selecting specimens with low disc degeneration. The Barricaid seems to prevent nucleus from reherniating. The reliability of this method suggests the opportunity to investigate other anulus closure devices and nucleus replacement techniques critically. PMID:23429676

  14. Spontaneous Regression of a Large Lumbar Disc Extrusion

    PubMed Central

    Ryu, Sung-Joo

    2010-01-01

    Although the spontaneous disappearance or decrease in size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of a spontaneous regression of a large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow up MRI study 6 months later. The literature is reviewed and the possible mechanisms of spontaneous disc regression are discussed. PMID:21082061

  15. Atypical Presentation of a Sequestered Posterolateral Disc Fragment

    PubMed Central

    Shoakazemi, Alireza; Tubbs, R. Shane; Moisi, Marc; Rostad, Steven; Newell, David W.

    2016-01-01

    Sequestered disc fragments typically occur ventrally but can also migrate dorsally or intradurally. At times, atypical disc herniations can be misinterpreted on imaging as other lesions, such as neoplasms, hematomas, or abscesses. We present an uncommon case of a patient presenting with cauda equina syndrome secondary to an enhancing sequestered disc fragment mimicking a tumor. PMID:27014536

  16. MRI Evaluation of Lumbar Disc Degenerative Disease

    PubMed Central

    Patel, Rupal; Mehta, Chetan; Patel, Narrotam

    2015-01-01

    Introduction: Lower back pain secondary to degenerative disc disease is a condition that affects young to middle-aged persons with peak incidence at approximately 40 y. MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes. Aims and Objective: To evaluate the characterization, extent, and changes associated with the degenerative lumbar disc disease by Magnetic Resonance Imaging. Study Design: Cross-sectional and observational study. Materials and Methods: A total 109 patients of the lumbar disc degeneration with age group between 17 to 80 y were diagnosed & studied on 1.5 Tesla Magnetic Resonance Imaging machine. MRI findings like lumbar lordosis, Schmorls nodes, decreased disc height, disc annular tear, disc herniation, disc bulge, disc protrusion and disc extrusion were observed. Narrowing of the spinal canal, lateral recess and neural foramen with compression of nerve roots observed. Ligamentum flavum thickening and facetal arthropathy was observed. Result: Males were more commonly affected in Degenerative Spinal Disease & most of the patients show loss of lumbar lordosis. Decreased disc height was common at L5-S1 level. More than one disc involvement was seen per person. L4 L5 disc was the most commonly involved. Annular disc tear, disc herniation, disc extrusion, narrowing of spinal canal, narrowing of lateral recess, compression of neural foramen, ligamentum flavum thickening and facetal arthropathy was common at the L4 L5 disc level. Disc buldge was common at L3 L4 & L4 L5 disc level. Posterior osteophytes are common at L3 - L4 & L5 S1 disc level. L1- L2 disc involvement and spondylolisthesis are less common. Conclusion: Lumbar disc degeneration is the most common cause of low back pain. Plain radiograph can be helpful in visualizing gross anatomic changes in the intervertebral disc. But, MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes. PMID:26023617

  17. SPORT Lumbar Intervertebral Disk Herniation and Back Pain

    PubMed Central

    Pearson, Adam M.; Blood, Emily A.; Frymoyer, John W.; Herkowitz, Harry; Abdu, William A.; Woodward, Randy; Longley, Michael; Emery, Sanford E.; Lurie, Jon D.; Tosteson, Tor D.; Weinstein, James N.

    2009-01-01

    Study Design Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort. Objective This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes. Summary of Background Data Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes. Methods Patients underwent diskectomy or received usual nonoperative care. Data from the randomized cohort and observational cohort were combined in an as-treated analysis. Low back pain was recorded on a 0 to 6 point scale, and changes in low back pain were compared between the surgical and nonoperative treatment groups. The effects of herniation location and morphology on back pain outcomes were determined. Results The combined analysis included 1191 patients with 775 undergoing surgery within 2 years, whereas 416 remained nonoperative. Overall, leg pain improved more than back pain in both treatment groups. Back pain improved in both surgical and nonoperative patients, but surgical patients improved significantly more (treatment effect favoring surgery -0.9 at 3 months, -0.5 at 2 years, P < 0.001). Patients who underwent surgery were more likely to report no back pain than nonoperative patients at each follow-up period (28.0% vs. 12.0% at 3 months, P < 0.001, 25.5% vs. 17.6% at 2 years, P = 0.009). At baseline, central herniations were associated with more severe back pain than more lateral herniations (4.3 vs. 3.9, P = 0.012). Patients with central herniations and protrusions had a beneficial treatment effect from surgery similar to the overall surgical group. Conclusion Diskectomy resulted in greater improvement in back pain than nonoperative treatment, and this difference was maintained at 2 years for all herniation locations and morphologies. PMID:18277876

  18. Herniated Disk in the Lower Back

    MedlinePLUS

    ... lives. A high percentage of people will have low back and leg pain caused by a herniated disk. Although a herniated ... pressure against the outer ring may cause lower back pain. If the disk is very worn or injured, ...

  19. Diaphragmatic herniation after penetrating trauma.

    PubMed

    Degiannis, E; Levy, R D; Sofianos, C; Potokar, T; Florizoone, M G; Saadia, R

    1996-01-01

    A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury. PMID:8653376

  20. Assessing the Risk of Disc Heniation Related to Landing Impact Following Long-duration Spacecraft

    NASA Technical Reports Server (NTRS)

    Somers, J. T.; Newby, N..; Wells, J.

    2014-01-01

    Previous research has shown that crewmembers returning on the Space Shuttle have an increased incidence of herniated nucleus pulposus after spaceflight. This increased risk is thought to be related to disc volume expansion due to unloading and prolonged exposure to microgravity. Although there is an increased risk of disc herniation in Space Shuttle astronauts, it is unknown if dynamic landing loads further contribute to the risk of herniation. To determine if dynamic loads increase the risk of incidence, data from crewmembers (excluding cosmonauts) returning on the Soyuz spacecraft will be compared to Space Shuttle astronauts. These data will be obtained from the Lifetime Surveillance of Astronaut Health (LSAH) Project at NASA. Severity and incidence after spaceflight will be mined from the data, and statistical analyses will be used to determine if Soyuz crewmembers have a higher incidence of disc herniation than Space Shuttle crewmembers. The results are expected to show no difference between Space Shuttle and Soyuz crewmembers, indicating that higher dynamic loads on landing and long-duration spaceflight do not significantly increase the risk of disc herniation. If no difference is shown between the two crewmember populations, then disc volume expansion due to microgravity does not significantly increase the risk of injury due to dynamic loads for deconditioned crewmembers. Any risk associated with deconditioning would be primarily due to bone structure changes and resulting bone strength changes. This study is an important first step in determining whether the spinal disc plays a role in injury due to dynamic loads.

  1. Chronic herniation of the hindbrain

    PubMed Central

    Williams, Bernard

    1981-01-01

    Herniation of the hindbrain occurs when the lowest parts of the cerebellum and sometimes part of the medulla are moved downwards through the foramen magnum, a pressure difference acting across the foramen magnum moulding the tissues into a plug. It is suggested that the clinical course in both adults and babies with spina bifida may be explained by the hindbrain hernia acting as a valve. The term 'Chiari Type I deformity' is commonly used for an abnormality in which the tonsils and lowermost parts of the cerebellar hemispheres are prolapsed through a normal foramen magnum. Acute herniation may occur as a result of space-occupying lesions. Chronic herniation may be morphologically identical although it tends to be more severe. Sometimes it will produce few symptoms which often may be delayed so that the original causative lesion may not be apparent. Causes include bone softening, tumour, or previous meningitis. Birth injury is probably the commonest cause of the deformity, which presents clinically in adults. In infants with severe forms of spina bifida a hindbrain herniation is present. This abnormality may be called 'Chiari Type II deformity' or ArnoldChiari deformity and is an intra-uterine abnormality in which the fourth ventricle and medulla are grotesquely herniated before they are properly developed and the foramen magnum is enlarged. The commonest clinical presentation of Chiari Type I deformity is syringomyelia, which is usually not diagnosed until adult life. Other presentations include syringobulbia, headache, oscillopsia, attacks of giddiness, lower cranial nerve palsies, and ataxia. Particularly characteristic are cough headache and cough syncope. Syringomyelia and syringobulbia in particular may be irreversible by the time they are diagnosed. Nevertheless, surgical decompression may be successful in relieving symptoms of headache, cough syncope, and long-tract compression; most cases of syringomyelia show some improvement and in others progression of the disease is arrested. Operative techniques for hindbrain herniation are discussed. Chiari Type II deformity is probably responsible for the progression of hydrocephalus after birth in the majority of babies with spina bifida. Measurement of pressure in the cerebrospinal fluid above and below the foramen magnum shows that intermittent pressure difference is commonly present at times of neurological deterioration. Surgical decompression of the hernia in adults allows correction of the valvular effect, which may be monitored by pressure measurements. In babies the associated hydrocephalus is usually so gross that it requires separate treatment, but pressure monitoring may be of value in assessing the state of the disease. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:7018351

  2. Mesh reconstruction preventing sacral herniation.

    PubMed

    Junge, K; Krones, C J; Rosch, R; Fackeldey, V; Schumpelick, V

    2003-12-01

    Sacral hernias are uncommon defects developing through the pelvic floor after partial or total sacrectomy. We report on a 29-year-old woman, who has been under our care with a cystic formation after perineosacral resection of a rhabdomyosarcoma and partial sacrectomy. The cystic tumor was resected and a mesh repair performed to prevent sacral herniation. The current literature is summarized; etiology and management recommendations of this rare complication are discussed. PMID:12884083

  3. Percutaneous laser discectomy of cervical discs: preliminary clinical results.

    PubMed

    Siebert, W

    1995-06-01

    Thirty-one patients with herniated cervical discs were treated with PLDD from 1991 to 1993. In 1990, a few of these patients were treated with the Nd:YAG laser with no complications. Since 1991 we have used the holmium:YAG laser; 28 of the 31 patients experienced pain relief in a 6-week follow-up. PLDD for the cervical discs is a viable therapy. PMID:10150647

  4. Cerebellopontine angle empyema after lumbar disc herniation surgery

    PubMed Central

    Nascimento, Clarissa Gambara; Brock, Roger Schmidt; Morais, Barbara Albuquerque; Tavares, Wagner Malag; Teixeira, Manoel Jacobsen; Paiva, Wellingson Silva

    2015-01-01

    Background: Lumbar discectomy is still one of the most common spinal surgeries performed today. Nevertheless, there are few publications considering severe complications. Case Description: We report a case with severe complication, without any previous report, a brain empyema after cerebrospinal fluid leak with good outcome afterword. A 45 years old man, returned six days after surgery, presenting cerebrospinal fluid leak, which after clinical and laboratory deterioration was reoperated. In the 14th postoperative facing worsening level of consciousness was diagnosed empyema in cerebellopontine angle and hydrocephalus underwent emergency surgery. Evolved with hemiplegia in the first postoperative attributed to vasculitis, completely recovered after 5 days. Conclusions: Although infrequent, lumbar discectomy is subject to severe complications, which as the case presented, can be dramatic. In surgeries must be careful to avoid cerebrospinal fluid leak e infectious complications. PMID:26131253

  5. Percutaneous diode laser disc nucleoplasty

    NASA Astrophysics Data System (ADS)

    Menchetti, P. P.; Longo, Leonardo

    2004-09-01

    The treatment of herniated disc disease (HNP) over the years involved different miniinvasive surgical options. The classical microsurgical approach has been substituted over the years both by endoscopic approach in which is possible to practice via endoscopy a laser thermo-discoplasty, both by percutaneous laser disc nucleoplasty. In the last ten years, the percutaneous laser disc nucleoplasty have been done worldwide in more than 40000 cases of HNP. Because water is the major component of the intervertebral disc, and in HNP pain is caused by the disc protrusion pressing against the nerve root, a 980 nm Diode laser introduced via a 22G needle under X-ray guidance and local anesthesia, vaporizes a small amount of nucleous polposus with a disc shrinkage and a relief of pressure on nerve root. Most patients get off the table pain free and are back to work in 5 to 7 days. Material and method: to date, 130 patients (155 cases) suffering for relevant symptoms therapy-resistant 6 months on average before consulting our department, have been treated. Eightyfour (72%) males and 46 (28%) females had a percutaneous laser disc nucleoplasty. The average age of patients operated was 48 years (22 - 69). The level of disc removal was L3/L4 in 12 cases, L4/L5 in 87 cases and L5/S1 in 56 cases. Two different levels were treated at the same time in 25 patients. Results: the success rate at a minimum follow-up of 6 months was 88% with a complication rate of 0.5%.

  6. Transconjunctival herniation of orbital fat.

    PubMed

    Monner, J; Benito, J R; Zayuelas, J; Paloma, V; Castro, V; Serra, J M

    1998-12-01

    The authors present 3 patients with subconjunctival fat prolapse treated at their oculoplastic unit. Albeit rare, orbital fat is a well-recognized entity, and is described in the literature as being associated with trauma and surgery. The 3 patients reported herein, however, presented with no history of trauma or surgery. This condition is produced by herniation of the intraconal fat between the conjunctiva and the sclera, presumably due to dehiscence of the Tenon's capsule. Differential diagnosis should be made with lacrimal gland ptosis, lacrimal gland tumors, and lymphoid tumors. PMID:9869141

  7. Repeated microendoscopic discectomy for recurrent lumbar disk herniation

    PubMed Central

    Hou, Tianyong; Zhou, Qiang; Dai, Fei; Luo, Fei; He, Qingyi; Zhang, Jinsong; Xu, Jianzhong

    2015-01-01

    OBJECTIVES: To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect. METHODS: A consecutive series of 25 patients who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations. RESULTS: Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4 1.5, whereas it decreased to 2.10.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.510.0, whereas it was 26.08.5 at 7 days after surgery. CONCLUSION: In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery. PMID:25789521

  8. Accretion discs

    NASA Astrophysics Data System (ADS)

    Abramowicz, Marek A.; Straub, Odele

    2014-08-01

    Accretion discs are flattened astronomical objects made of rapidly rotating gas which slowly spirals onto a central gravitating body. The gravitational energy of infalling matter extracted in accretion discs powers stellar binaries, active galactic nuclei, proto-planetary discs and some gamma-ray bursts. The black hole accretion in quasars is the most powerful and efficient stationary engine known in the universe. In accretion discs the high angular momentum of rotating matter is gradually transported outwards by stresses (related to turbulence, viscosity, shear and magnetic fields). This gradual loss of angular momentum allows matter to progressively move inwards, towards the centre of gravity. The gravitational energy of the gaseous matter is thereby converted to heat. A fraction of the heat is converted into radiation, which partially escapes and cools down the accretion disc. Accretion disc physics is thus governed by a non-linear combination of many processes, includ! ing gravity, hydrodynamics, viscosity, radiation and magnetic fields.

  9. Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology: Early results

    PubMed Central

    Kumar, Aravind; Siddharth M, Shah; Sambhav P, Shah; Tan, Justin

    2014-01-01

    Background Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. A number of minimally invasive procedures have also been developed in the recent past for its management. Disc-FX is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification. Literature on its role in the management of lumbar disc pathology is scarce. Methods We included 24 consecutive patients who underwent the Disc-FX for back pain due to lumbar disc pathology non-responsive to non-operative treatment for a period of at least 6 months. Based on Magnetic Resonance Imaging (MRI) these patients fell into 2 groups those with degenerative disc disease (DDD) (n = 12) and those with a contained lumbar disc herniation (CLDH)(n = 12). They were evaluated using the Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preoperatively and postoperatively. Results The mean age was 37.9 years (21-53 years). There were 17 males and 7 females. One patient in each subgroup was excluded from the final evaluation. Significant improvement was seen in all outcome measures. The overall rate of reintervention for persistent symptoms was 18.18% (4/22); in the CLDH subgroup, it was 36.36% (4/11). Conclusions and level of evidence Early results after the Disc-FX procedure suggest that it s a reasonable treatment option for patients with back pain due to lumbar disc disease, especially for those with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement. This study presents Level IV evidence. Clinical relevance We feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD. However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH. PMID:25694914

  10. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 2 2014-10-01 2014-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING MARINE PORTABLE TANKS AND CARGO HANDLING SYSTEMS Pressure Relief Devices and Vacuum Relief Devices for MPTs 64.61 Rupture disc. If a rupture...

  11. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 2 2013-10-01 2013-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING MARINE PORTABLE TANKS AND CARGO HANDLING SYSTEMS Pressure Relief Devices and Vacuum Relief Devices for MPTs 64.61 Rupture disc. If a rupture...

  12. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 2 2011-10-01 2011-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING MARINE PORTABLE TANKS AND CARGO HANDLING SYSTEMS Pressure Relief Devices and Vacuum Relief Devices for MPTs 64.61 Rupture disc. If a rupture...

  13. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING MARINE PORTABLE TANKS AND CARGO HANDLING SYSTEMS Pressure Relief Devices and Vacuum Relief Devices for MPTs 64.61 Rupture disc. If a rupture...

  14. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 2 2012-10-01 2012-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING MARINE PORTABLE TANKS AND CARGO HANDLING SYSTEMS Pressure Relief Devices and Vacuum Relief Devices for MPTs 64.61 Rupture disc. If a rupture...

  15. Percutaneous laser disc decompression: a 17-year experience.

    PubMed

    Choy, Daniel S J

    2004-10-01

    In this review, we analyze our effort to demonstrate the effectiveness of a new approach to the treatment of herniated disc disease using Nd:YAG laser energy introduced into a herniated disc under fluoroscopic control and local anesthesia. 2400 PLDD procedures (combined number of decompressions in cervical, thoracic, and lumbar discs were performed in the past 18(1/2) years in 1275 patients. The overall success rate according to the MacNab criteria was 89%. The complication rate (only infectious disciitis) was 0.4%; all 10 patients with complications were cured with appropriate antibiotics. The recurrence rate was 5%, and usually due to reinjury. There were no deaths, and no cases of nerve or cord damage. PLDD is a safe and effective outpatient procedure for the treatment of herniated disc disease with the advantages of relative non-invasiveness, usually immediate relief of back and sciatic pain, early return to work (generally 5-6 days), and a low complication and recurrence rate. It can also be repeated if necessary as many as five times. PMID:15671713

  16. Case report: The operation for the lumbar disk herniation just after cesarean delivery in the third trimester of pregnancy

    PubMed Central

    Ochi, Hironori; Ohno, Ryuichi; Kubota, Mitsuaki; Hanyu, Ryo; Sakai, Kensuke; Sugawara, Yu; Mukasa, Fumihiro; Kaneko, Kazuo

    2014-01-01

    INTRODUCTION Low back pain is common during pregnancy. However, the incidence of symptomatic lumbar disc herniation during pregnancy is very rare. We report a case of lumbar disc herniation underwent discectomy just after cesarean delivery in the third trimester of pregnancy. PRESENTATION OF CASE A 33-year-old woman presented at 32 weeks gestation. She had a low back pain and the left-sided leg pain below the knee. At 34 weeks gestation, she had severe weakness of the left extension halluces longus, left ankle dorsiflexion. MRI showed a large disc herniation at L4/5 expanded to the spinal canal more. The cesarean delivery was performed in the supine position. The patient was then turned to a prone position, and a left L4/5 discectomy was performed. But the day after surgery, she had a severe low back pain and the right leg pain below the knee. MRI showed a disc herniation at L4/5 on the right side of the spinal canal. At 6 days after the first surgery, a right L4/5 discectomy was performed. In the immediate postoperative period, the patient experienced complete relief of the right leg pain. DISCUSSION It is necessary to cooperate with a pediatrician, an obstetrician, and an anethesiologists. For obtaining the best outcome on mother and child, it is important to discuss in advance to be able to respond quickly for changeable situation. CONCLUSION It is necessary to conduct the operation under pregnancy in consideration of the great influence on mother and child. PMID:25437670

  17. Trans-mediastinal herniation of bulla: Semilunar sign

    PubMed Central

    Singh, Sheetu; Singh, Nishtha; Singh, Virendra

    2015-01-01

    Trans-mediastinal herniation of lung is seen occasionally but herniation of bulla across the mediastinum is rare. We report two cases with trans-mediastinal herniation of bullae leading to an unusual line appearing near the mediastinum. We propose the name Semilunar signfor this radiological sign because of its resemblance to the half-moon shape. PMID:26664170

  18. Herniated pancreatic body within a paraesophageal hernia

    PubMed Central

    Coughlin, Megan; Fanous, Medhat; Velanovich, Vic

    2011-01-01

    A hiatal hernia can be classified as one of four types according to the position of the gastroesophageal (GE) junction and the extent of herniated stomach. Type I, or sliding hernias, account for up to 95% of all hiatal hernias and occur when the GE junction migrates into the posterior mediastinum through the hiatus. Type II occurs when the fundus herniates through the hiatus alongside a normally positioned GE junction. Type III is a combination of types I and II hernias with a displaced GE junction as well as stomach protruding through the hiatus. Type IV paraesophageal hernias are the rarest of the hiatal hernias. Usually, colon or small bowel is herniated within the mediastinum along with the stomach. We present a case of a paraesophageal hernia with the mid-body of the pancreas as part of the hernia contents. PMID:21394323

  19. Heterotopic ossification associated with myelopathy following cervical disc prosthesis implantation.

    PubMed

    Wenger, Markus; Markwalder, Thomas-Marc

    2016-04-01

    This case report presents a 37-year-old man with clinical signs of myelopathy almost 9years after implantation of a Bryan disc prosthesis (Medtronic Sofamor Danek, Memphis, TN, USA) for C5/C6 soft disc herniation. As demonstrated on MRI and CT scan, spinal cord compression was caused by bony spurs due to heterotopic ossification posterior to the still moving prosthesis. The device, as well as the ectopic bone deposits, had to be removed because of myelopathy and its imminent aggravation. Conversion to anterior spondylodesis was performed. PMID:26633091

  20. DETAIL OF DENVER DISC FILTER IN CO91107, SUCTION END. NOTE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    DETAIL OF DENVER DISC FILTER IN CO-91-107, SUCTION END. NOTE BEARING HOUSING WITH CAST LOGO, SUCTION PIPE GOING OFF TO THE RIGHT, AND FILTER DISC IN BACKGROUND. VACUUM INSIDE DISCS FURTHER DEWATERED CONCENTRATE. AS DISC SLOWLY ROTATED A BAR SCRAPED DRIED CONCENTRATE FROM OUTSIDE OF FILTER CLOTH. - Shenandoah-Dives Mill, 135 County Road 2, Silverton, San Juan County, CO

  1. Lifestyle factors and lumbar disc disease: results of a German multi-center case-control study (EPILIFT)

    PubMed Central

    2010-01-01

    Introduction In the large-scale case-control study EPILIFT, we investigated the dose-response relationship between lifestyle factors (weight, smoking amount, cumulative duration of different sports activities) and lumbar disc disease. Methods In four German study regions (Frankfurt am Main, Freiburg, Halle/Saale, Regensburg), 564 male and female patients with lumbar disc herniation and 351 patients with lumbar disc narrowing (chondrosis) aged 25 to 70 years were prospectively recruited. From the regional population registers, 901 population control subjects were randomly selected. In a structured personal interview, we enquired as to body weight at different ages, body height, cumulative smoking amount and cumulative duration of different sports activities. Confounders were selected according to biological plausibility and to the change-in-estimate criterion. Adjusted, gender-stratified odds ratios with 95% confidence intervals were calculated using unconditional logistic regression analysis. Results The results of this case-control study reveal a positive association between weight and lumbar disc herniation as well as lumbar disc narrowing among men and women. A medium amount of pack-years was associated with lumbar disc herniation and narrowing in men and women. A non-significantly lowered risk of lumbar disc disease was found in men with high levels of cumulative body building and strength training. Conclusions According to our multi-center case-control study, body weight might be related to lumbar disc herniation as well as to lumbar disc narrowing. Further research should clarify the potential protective role of body building or strength training on lumbar disc disease. PMID:20955546

  2. Gene therapy for degenerative disc disease.

    PubMed

    Sobajima, S; Kim, J S; Gilbertson, L G; Kang, J D

    2004-02-01

    Degenerative disc disease (DDD) is a chronic process that can become clinically manifest in multiple disorders such as idiopathic low back pain, disc herniation, radiculopathy, myelopathy, and spinal stenosis. The limited available technology for the treatment of these and other pathologic and disabling conditions arising from DDD is highly invasive (eg, surgical discectomy and fusion), manifesting a certain degree of complications and unsatisfactory clinical outcomes. Although the precise pathophysiology of DDD remains to be clearly delineated, the progressive decline in aggrecan, the primary proteoglycan of the nucleus pulposus, appears to be a final common pathway. It has been hypothesized that imbalance in the synthesis and catabolism of certain critical extracellular matrix components can be mitigated by the transfer of genes to intervertebral disc cells encoding factors that modulate synthesis and catabolism of these components. The successful in vivo transfer of therapeutic genes to target cells within the intervertebral disc in clinically relevant animal models of DDD is one example of the rapid progress that is being made towards the development of gene therapy approaches for the treatment of DDD. This chapter reviews the ability of gene therapy to alter biologic processes in the degenerated intervertebral disc and outlines the work needed to be done before human clinical trials can be contemplated. PMID:14724681

  3. Excision of prolapse of thoracic intervertebral disc. A transthoracic technique.

    PubMed

    Fidler, M W; Goedhart, Z D

    1984-08-01

    A new technique for the transthoracic removal of a prolapsed intervertebral disc in the mid or lower thoracic spine is described. Investigations before operation include thoracic myelography, selective spinal angiography and CT scanning. Image intensification is used at operation to check the level of the prolapse. A tunnel in the coronal plane (vertebrotomy) is made through the posterolateral part of the disc and the adjacent vertebral bodies, to reach the spinal canal at the site of the prolapse. This gives good exposure and enables gentle removal of the disc prolapse and any associated osteophytes, under direct vision without need for retraction or pressure on the dura or spinal cord. Spinal stability is not compromised, and the blood supply of the cord is not disturbed. Five consecutive patients are reported, including one in whom the disc prolapse was calcified and had herniated into the spinal cord. All were treated successfully. PMID:6746685

  4. [Progress on the cause and mechanism of a separation of clinical symptoms and signs and imaging features in lumbar disk herniation].

    PubMed

    Hu, Xing-xin; Liu, Li-min

    2015-10-01

    A few of patients with lumbar disk herniation having a separation of clinical symptoms and signs and imaging features, can be found in clinic, but the traditional theory of direct mechanical compression of nerve roots by herniated nucleus pulposus can't be used to explain this abnormal protrusion of lumbar intervertebral disc. The clinical symptoms and signs of the atypical lumbar disk herniation are affected by multiple factors. The indirect mechanical compression and distraction effect of spinal nerve roots may play an important role in the occurrence of the separation, and the appearance of abnormal clinical symptoms and signs is closely related to the migration of herniated nucleus pulposus tissue, transmission of injury information in the nervous system, and the complex interactions among the nucleus pulposus, dural sac and nerve roots. Moreover,the changes of microcirculation and inflammation secondary to the herniated nucleus pulposus tissue, the hyperosteogeny in the corresponding segment of the lumbar vertebrae and the posture changes all results in a diversity of symptoms and signs in patients with lumbar intervertebral disc herniation. Besides, there exist congenital variation of lumbosacral nerve roots and vertebral bodies in some patients, and the misdiagnosis or missed diagnosis of imaging finding may occur in some cases. However, the appearance of a separation of clinical symptoms and signs and imaging examination in patients may be caused by a variety of reasons in clinic. The exact mechanism involved in the interaction among nucleus pulposus tissue, dural sac and nerve root, secondary changes of pathophysiology and biomechanics around the nucleus pulposus, the determination of lesioned responsible segments, and how to overcome the limitations of imaging all need the further researches. PMID:26727796

  5. Effect of microgravity on the biomechanical properties of lumbar and caudal intervertebral discs in mice.

    PubMed

    Bailey, Jeannie F; Hargens, Alan R; Cheng, Kevin K; Lotz, Jeffrey C

    2014-09-22

    Prolonged exposure to microgravity has shown to have deleterious effects on the human spine, indicated by low back pain during spaceflight and increased incidence of post-spaceflight herniated nucleus pulposus. We examined the effect of microgravity on biomechanical properties of lumbar and caudal discs from mice having been on 15-day shuttle mission STS-131. Sixteen C57BL/C mice (spaceflight group, n=8; ground-based control group, n=8) were sacrificed immediately after spaceflight. Physiological disc height (PDH) was measured in situ, and compressive creep tests were performed to parameterize biomechanical properties into endplate permeability (k), nuclear swelling pressure strain dependence (D), and annular viscoelasticity (G). For caudal discs, the spaceflight group exhibited 32% lower PDH, 70% lower D and crept more compared to the control mice (p=0.03). For lumbar discs, neither PDH nor D was significantly different between murine groups. Initial modulus, osmotic pressure, k and G for lumbar and caudal discs did not appear influenced by microgravity (p>0.05). Decreases in both PDH and D suggest prolonged microgravity effectively diminished biomechanical properties of caudal discs. By contrast, differences were not noted for lumbar discs. This potentially deleterious interaction between prolonged weightlessness and differential ranges of motion along the spine may underlie the increased cervical versus lumbar disc herniation rates observed among astronauts. PMID:25085756

  6. Rapid correction of neurologic deficits by percutaneous laser disc decompression (PLDD).

    PubMed

    Choy, D S

    1996-02-01

    Immediate correction of neurologic deficits due to herniated disc disease following percutaneous laser disc decompression (PLDD) has not previously been reported. In a review of 182 cases of herniated intervertebral disc disease with radicular pain syndromes, the author observed a high percentage of return of absent ankle and knee jerk reflexes, return of straight leg raising to normal, and a change of the characteristic rolling to one side, bending the knees, and propping up with the hands as the usual maneuver to change from a supine to a sitting position ("Choy sign") to an ability to sit up directly by trunk flexion, immediately, and at 1 day after PLDD. The neurophysiologic implications are discussed. PMID:9484094

  7. Optical disc discrimination method

    NASA Astrophysics Data System (ADS)

    Nakahara, Hironori; Takeshita, Nobuo

    2015-09-01

    We propose a method for identifying the type of a disc inserted into an optical drive. The disc is irradiated with light from an LED light source and the diffracted light from the information recording layer of the disc is detected by using the movement of the disc during disc loading. Results of the optical simulation agree well with the experimental results. A total of 61 discs were measured, and it was confirmed that these discs can be distinguished accurately.

  8. Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

    SciTech Connect

    Kelekis, Alexis D. Filippiadis, Dimitris K.; Martin, Jean-Baptiste; Brountzos, Elias

    2010-10-15

    Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

  9. Intercostal lung herniation - The role of imaging

    PubMed Central

    Detorakis, Efstathios E.; Androulidakis, Emmanuel

    2014-01-01

    Extrathoracic lung hernias can be congenital or acquired. Acquired hernias may be classified by etiology into traumatic, spontaneous, and pathologic. We present a case of a 40-year-old male with a history of bronchial asthma and a blunt chest trauma who presented complaining of sharp chest pain of acute onset that began after five consecutive days of vigorous coughing. Upon physical examination a well-demarcated deformity overlying the third intercostal space of the left upper anterior hemithorax was revealed. Thoracic CT scan showed that a portion of the anterior bronchopulmonary segment of the left upper lobe had herniated through a chest wall defect. The role of imaging, especially chest computed tomography with multiplanar image reconstructions and maximum (MIP) and minimum intensity projection (MinIP) reformats can clearly confirm the presence of the herniated lung, the hernial sac, the hernial orifice in the chest wall, and exclude possible complications such as lung tissue strangulation. PMID:24967031

  10. Spinal cord dysfunction from lumbar disk herniation.

    PubMed

    Pau, A; Cossu, M; Turtas, S; Zirattu, G

    1989-12-01

    Two patients with a herniated disk respectively at the level of the L4-L5 and of the L5-S1 intervertebral spaces presented with pyramidal signs, bladder paralysis and radicular impairment. The symptoms subsided immediately following surgical removal of the prolapsed disk. The role of transient ischemia in the lower segments of the spinal cord as possible cause of this uncommon clinical picture is discussed, and the pertinent literature is reviewed. PMID:2618830

  11. Spinal cord herniation with characteristic bone change: a case report

    PubMed Central

    Imai, Tasuku; Nakane, Yukimi; Tachibana, Eiji; Ogura, Koichiro

    2015-01-01

    ABSTRACT Spinal cord herniation (SCH) is a rare disease characterized by herniation of the thoracic spinal cord through an anterior dural defect, presenting with progressive myelopathy. A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented. The strangled spinal cord was released, and the defect was closed microsurgically using an artificial dural patch to prevent re-herniation. Postoperatively, the patient experienced gradual improvement in neurologic function. The SCH mechanism and surgical strategy are discussed. PMID:26412899

  12. Internal herniation with fatal outcome: herniation through an unusual apertura between epiploic appendices and greater omentum.

    PubMed

    Kulacoglu, H; Tumer, H; Aktimur, R; Kusdemir, A

    2006-01-01

    Internal hernia is an unusal cause of intestinal obstruction. Herniation related to epiploic appendix is a very rare entity. We herein report a case of internal herniation due to an adhesion between epiploic appendixes and the greater omentum. A 71-year-old woman complaining of abdominal pain and intermittent nausea was operated on with the pre-operative diagnosis of intestinal obstruction. Three epiploic appendixes of the left side of the transverse colon and the corresponding part of the greater omentum had created a tunnel and a loop of small bowel 25 cm in length was strangulated. No resection was required after releiving the strangulation. However, the patient died due to massive myocardial infarction in the postoperative period. Internal herniation must be included in the differential diagnosis of patients with acute abdomen or intestinal obstruction. A high index of suspicion with prompt surgical intervention may be the key to the reduction of morbidity and mortality. PMID:16612930

  13. Clinical experience in cell-based therapeutics: disc chondrocyte transplantation A treatment for degenerated or damaged intervertebral disc.

    PubMed

    Meisel, Hans Jrg; Siodla, Vilma; Ganey, Timothy; Minkus, Yvonne; Hutton, William C; Alasevic, Olivera J

    2007-02-01

    Disc herniation treated by discectomy results in a significant loss of nucleus material and disc height. Biological restoration through the use of autologous disc chondrocyte transplantation offers a potential to achieve functional integration of disc metabolism and mechanics. Chondrocytes that have been removed from damaged cartilaginous tissues maintain a capacity to proliferate, produce and secrete matrix components and respond to physical stimuli such as dynamic loading. Nucleus regeneration using autologous cultured disc-derived chondrocytes (ADCT) has been demonstrated in a canine model and in clinical pilot studies. In 2002 a prospective, controlled, randomised, multi-center study, EuroDISC, comparing safety and efficacy of autologous disc chondrocyte transplant, chondrotransplant DISC, plus discectomy (ADCT), with discectomy alone was initiated. A dog model was used to investigate the hypothesis that autologous disc chondrocytes can be used to repair damaged intervertebral disc. Disc chondrocytes were harvested and expanded in culture under controlled and defined conditions, returned to the same animals from which they had been sampled (autologous transplantation) via percutaneous delivery. The animals were analyzed at specific times after transplantation by several methods to examine whether disc chondrocytes integrated with the surrounding tissue, produced the appropriate intervertebral disc extracellular matrix, and might provide a formative solution to disc repair. The clinical goals of the EuroDISC study, were to provide long-term pain relief, maintain disc height and prevent adjacent segment disease. Interim analysis was performed after 2 years; Oswestry (low back pain/disability), Quebec Back-Pain Disability Scale, as well as Prolo and VAS score were used for the evaluation. Disc height was assessed by MRI. In the context of degenerative changes in an injury model: () autologous disc chondrocytes were expended in culture and returned to the disc by a minimally invasive procedure after 12 weeks; () disc chondrocytes remained viable after transplantation as shown by bromodeoxyuridine incorporation and maintained a capacity for proliferation after transplantation as depicted by histology; () transplanted disc chondrocytes produced an extracellular matrix that displayed composition similar to normal intervertebral disc tissue. Positive evidence of Proteoglycan content was supported by accepted histochemical staining techniques such as Safranin O-Fast Green; () both Type II and Type I collagens were demonstrated in the regenerated intervertebral disc matrix by immunohistochemistry after chondrocyte transplantation; and () when the disc heights were analyzed for variance according to treatment a statistically significant-correlation between transplanting cells and retention of disc height was achieved. A clinically significant reduction of low back pain in the ADCT-treated group was shown by all three pain score systems. The median total Oswestry score was 2 in the ADCT-treated group compared with 6 in the control group. Decreases in the disability index and VAS score in ADCT-treated patients correlated strongly with the reduction of low back pain. Decreases in disc height over time were only found in the control group, and of potential significance, intervertebral discs in adjacent segments appeared to retain hydration when compared to those adjacent to levels that had undergone discectomy without cell intervention. Autologous chondrocyte transplantation is technically feasible and biologically relevant to repairing disc damage and retarding disc degeneration. PMID:16963315

  14. Extruded lumbar disc associated with epidural hematoma. Case report.

    PubMed

    Giri, Pramod Janardhan; Sharma, Manish Singh; Jaiswal, Awadhesh Kumar; Behari, Sanjay; Jain, Vijendra Kumar

    2006-04-01

    Lumbar disc herniation and spinal epidural hematomas (SEHs) are highly unusual causes of secondary lumbar canal stenosis in the adolescent population. The authors report a unique concomitant occurrence in a 16-year-old boy who presented with left-sided L-5 radiculopathy. Magnetic resonance imaging T1-weighted sequences revealed a left-sided posterolateral prolapsed L4-5 disc with an isointense extruded fragment lying behind the L-5 body. On T2-weighted sequences a hyperintense area was seen in the region of the extruded disc fragment with thecal compression. At surgery the extradural encapsulated hematoma was removed, together with the extruded disc fragment and the L4-5 disc. The characteristics of the biopsy specimen from the epidural collection were consistent with those of a hematoma. At 6 months' follow up, the patient had returned to his normal activities. An SEH may result from tearing of delicate epidural veins following disc extrusion. It can occur at any age, regardless of whether there is a history of significant trauma. Magnetic resonance imaging allows preoperative characterization of the lesion. Results after surgical evacuation are excellent. Distinguishing between a solitary SEH and one caused by a lumbar disc extrusion has significant implications, as the former may resolve completely with conservative management. PMID:16619642

  15. Artificial Disc Replacement

    MedlinePLUS

    ... the annulus, and an inner portion, called the nucleus (Figure 1). In most cases, the disc is ... two general types: total disc replacement and disc nucleus replacement. As the names imply, with a total ...

  16. Redundant disc

    NASA Technical Reports Server (NTRS)

    Barack, W. N.; Domas, P. A.; Beekman, S. W. (inventors)

    1978-01-01

    A rotatable disc is described that consists of parallel plates tightly joined together for rotation about a hub. Each plate is provided with several angularly projecting spaced lands. The lands of each plate are interposed in alternating relationship between the lands of the next adjacent plate. In this manner, circumferential displacement of adjacent sectors in any one plate is prevented in the event that a crack develops. Each plate is redundantly sized so that, in event of structural failure of one plate, the remaining plates support a proportionate share of the load of the failed plate. The plates are prevented from separating laterally through the inclusion of generally radially extending splines which are inserted to interlock cooperating, circumferentially adjacent lands.

  17. D-Zero Cryostat Supplemental Rupture Disc

    SciTech Connect

    Mulholland, G.T.; /Fermilab

    1987-08-03

    The common relief and rupture disc vent line requires a double disc assembly with vented interspace for accurate disc burst pressures. The first disc must take pump and purge vacuum loading, but be set to operate at 110% of the MAWP, 18.3 psig (ASME code). The available solution is 18.3 psig with a burst tolerance of +/- psig. The interspace should be locally vented by a flow limiting vent valve to decouple the vent line backpressure from the vessel rupture disc. The second disc must take the worst case vent line backpressure, the steady state value found in D-Zero engineering note 3740.000-EN-63 with all three cryostats simultaneously venting at the fire condition into the 4-inch x 6-inch and 6-inch x 8-inch sections. This value is less than 2 psid. The maximum rupture value for the second disc must be less than the minimum rupture value for the first disc less 2 psid i.e. < 16.3.

  18. [Spontaneous disappearance of herniation pit on the femoral neck].

    PubMed

    Lerais, J M; Jacob, D; Thibaud, J C; Fourrer, C; Cercueil, J P; Krause, D; Laredo, J D; Baudrillard, J C

    1995-09-01

    The authors present a case of a 39 years old patient who had a herniation pit of the left femoral neck, 5 years ago. This lesion disappeared spontaneously. To our knowledge, no report of healing of a herniation pit has been previously described. PMID:7473400

  19. Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy

    PubMed Central

    Lovi, Alessio; Brayda-Bruno, Marco; Zagra, Antonino; Corriero, Andrea; Giudici, Fabrizio; Minoia, Leone

    2010-01-01

    Existing studies on micro-endoscopic lumbar discectomy report similar outcomes to those of open and microdiscectomy and conflicting results on complications. We designed a randomised controlled trial to investigate the hypothesis of different outcomes and complications obtainable with the three techniques. 240 patients aged 1865years affected by posterior lumbar disc herniation and symptoms lasting over 6weeks of conservative management were randomised to micro-endoscopic (group 1), micro (group 2) or open (group 3) discectomy. Exclusion criteria were less than 6weeks of pain duration, cauda equina compromise, foraminal or extra-foraminal herniations, spinal stenosis, malignancy, previous spinal surgery, spinal deformity, concurrent infection and rheumatic disease. Surgery and follow-up were made at a single Institution. A biomedical researcher independently collected and reviewed the data. ODI, back and leg VAS and SF-36 were the outcome measures used preoperatively, postoperatively and at 6-, 12- and 24-month follow-up. 212/240 (91%) patients completed the 24-month follow-up period. VAS back and leg, ODI and SF36 scores showed clinically and statistically significant improvements within groups without significant difference among groups throughout follow-up. Dural tears, root injuries and recurrent herniations were significantly more common in group 1. Wound infections were similar in group 2 and 3, but did not affect patients in group 1. Overall costs were significantly higher in group 1 and lower in group 3. In conclusion, outcome measures are equivalent 2years following lumbar discectomy with micro-endoscopy, microscopy or open technique, but severe complications are more likely and costs higher with micro-endoscopy. PMID:20127495

  20. MR guidance of laser disc decompression: preliminary in vivo experience.

    PubMed

    Steiner, P; Zweifel, K; Botnar, R; Schoenenberger, A W; Debatin, J F; von Schulthess, G K; Hodler, J

    1998-01-01

    The purpose of this study was to perform percutaneous laser disc decompression (PLDD) under MR guidance in an open configuration 0. 5-T MR system. Following failed conservative treatment for 6 months, eight patients with contained disc herniations were enrolled in the study. Following MR guided introduction of the laser fiber into the targeted disc space, the laser-induced temperature distribution was visualized using a color-coded subtraction technique based on a T1-weighted GRE sequence. In seven patients PLDD could be performed. In all cases laser effects were depicted by MR. In this regard the color-coded technique was found to be superior to conventional magnitude images. Whereas no apparent decrease in the extent of herniation was discovered immediately following PLDD, T2-weighted FSE images showed signal intensity alterations in two of the seven patients. Clinical evaluation, obtained 3-4 months after PLDD, revealed a fair (n = 2) or good (n = 4) response to the treatment. One patient showed no change in symptoms. MR guidance and monitoring of PLDD is feasible within an open 0.5-T system and seems to render PLDD more safe and controllable. PMID:9569329

  1. Non-reclosing pressure relief device for vacuum systems

    DOEpatents

    Swansiger, William A. (Livermore, CA)

    1994-01-01

    A non-reclosing overpressure protection device such as a rupture disc provides a non-reclosing opening upon forcible contact with a knife blade. A bellows, having an inlet capable of being sealably connected to a source of pressure (the vacuum system) and an outlet containing the rupture disc, transmits the pressure in the system to the disc. The bellows maintains the disc away from the knife when the pressure is below an overpressure amount, and carries the disc to a position when the pressure is above an overpressure amount where the disc is ruptured by the knife.

  2. Non-reclosing pressure relief device for vacuum systems

    DOEpatents

    Swansiger, W.A.

    1994-02-08

    A non-reclosing overpressure protection device such as a rupture disc provides a non-reclosing opening upon forcible contact with a knife blade. A bellows, having an inlet capable of being sealably connected to a source of pressure (the vacuum system) and an outlet containing the rupture disc, transmits the pressure in the system to the disc. The bellows maintains the disc away from the knife when the pressure is below an overpressure amount, and carries the disc to a position when the pressure is above an overpressure amount where the disc is ruptured by the knife. 6 figures.

  3. Disc replacement using Pro-Disc C versus fusion: a prospective randomised and controlled radiographic and clinical study

    PubMed Central

    Ahlhelm, F.; Pitzen, T.; Steudel, W. I.; Jung, J.; Shariat, K.; Steimer, O.; Bachelier, F.; Pape, D.

    2006-01-01

    Anterior cervical discectomy and fusion (ACDF) may be considered to be the gold standard for treatment of symptomatic degenerative disc disease within the cervical spine. However, fusion of the segment may result in progressive degeneration of the adjacent segments. Therefore, dynamic stabilization procedures have been introduced. Among these, artificial disc replacement by disc prosthesis seems to be promising. However, to be so, segmental motion must be preserved. This, again, is very difficult to judge and has not yet been proven. The aim of the current study was to first analyse the segmental motion following artificial disc replacement using a disc prosthesis. A second aim was to compare both segmental motion as well as clinical result to the current gold standard (ACDF). This is a prospective controlled study. Twenty-five patients with cervical disc herniation were enrolled and assigned to either study group (receiving a disc prosthesis) or control group (receiving ACDF, using a cage with bone graft and an anterior plate.) Radiostereometric analysis was used to quantify intervertebral motion immediately as well as 3, 6, 12 and 24weeks postoperatively. Further, clinical results were judged using visual analogue scale and neuro-examination. Cervical spine segmental motion decreased over time in the presence of disc prosthesis or ACDF. However, the loss of segmental motion is significantly higher in the ACDF group, when looked at 3, 6, 12 and 24weeks after surgery. We observed significant pain reduction in neck and arm postoperatively, without significant difference between both groups (P>0.05). Cervical spine disc prosthesis preserves cervical spine segmental motion within the first 6months after surgery. The clinical results are the same when compared to the early results following ACDF. PMID:17106665

  4. DETAIL OF FILTER DISCS ON DENVER FILTER IN CO91107. AS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    DETAIL OF FILTER DISCS ON DENVER FILTER IN CO-91-107. AS DISCS SLOWLY ROTATE, VACUUM INSIDE DISCS ATTRACT SLURRY IN THE SUMP AND DEWATERS CONCENTRATE AS DISCS MOVE THROUGH AIR. FURTHER ROTATION PASSES A BAR TO SCRAPE OFF DRIED METAL CONCENTRATE, ASSISTED BY BLASTS OF COMPRESSED AIR. METAL CONCENTRATE READY FOR SHIPMENT TO SMELTER FALLS INTO BIN BELOW. EIMCO FILTERS OPERATE SIMILARLY. - Shenandoah-Dives Mill, 135 County Road 2, Silverton, San Juan County, CO

  5. Intervertebral disc segmentation and volumetric reconstruction from peripheral quantitative computed tomography imaging.

    PubMed

    Wong, Alexander; Mishra, Akshaya; Yates, Justin; Fieguth, Paul; Clausi, David A; Callaghan, Jack P

    2009-11-01

    An automatic system for segmenting and constructing volumetric representations of excised intervertebral discs from peripheral quantitative computed tomography (PQCT) imagery is presented. The system is designed to allow for automatic quantitative analysis of progressive herniation damage to the intervertebral discs under flexion/extension motions combined with a compressive load. Automatic segmentation and volumetric reconstruction of intervertebral disc from PQCT imagery is a very challenging problem due to factors such as streak artifacts and unclear material density separation between contrasted intervertebral disc and surrounding bone in the PQCT imagery, as well as the formation of multiple contrasted regions under axial scans. To address these factors, a novel multiscale level set approach based on the Mumford-Shah energy functional in iterative bilateral scale space is employed to segment the intervertebral disc regions from the PQCT imagery. A Delaunay triangulation is then performed based on the set of points associated with the intervertebral disc regions to construct the volumetric representation of the intervertebral disc. Experimental results show that the proposed system achieves segmentation and volumetric reconstructions of intervertebral discs with mean absolute distance error below 0.8 mm when compared to ground truth measurements. The proposed system is currently in operational use as a visualization tool for studying progressive intervertebral disc damage. PMID:19635691

  6. Vacuum force

    NASA Astrophysics Data System (ADS)

    Han, Yongquan

    2015-03-01

    To study on vacuum force, we must clear what is vacuum, vacuum is a space do not have any air and also ray. There is not exist an absolute the vacuum of space. The vacuum of space is relative, so that the vacuum force is relative. There is a certain that vacuum vacuum space exists. In fact, the vacuum space is relative, if the two spaces compared to the existence of relative vacuum, there must exist a vacuum force, and the direction of the vacuum force point to the vacuum region. Any object rotates and radiates. Rotate bend radiate- centripetal, gravity produced, relative gravity; non gravity is the vacuum force. Gravity is centripetal, is a trend that the objects who attracted wants to Centripetal, or have been do Centripetal movement. Any object moves, so gravity makes the object curve movement, that is to say, the radiation range curve movement must be in the gravitational objects, gravity must be existed in non vacuum region, and make the object who is in the region of do curve movement (for example: The earth moves around the sun), or final attracted in the form gravitational objects, and keep relatively static with attract object. (for example: objects on the earth moves but can't reach the first cosmic speed).

  7. Inguinal herniation with hydrometra/mucometra in a poodle bitch

    PubMed Central

    Sontas, B. Hasan; Toydemir, F.T. Seval; Erdogan, zge; ?ennazli, Glbin; Ekici, Hayri

    2013-01-01

    A 5-year-old, sexually intact poodle bitch was presented with a 2-year history of inguinal mass. A tentative diagnosis of hydrometra/mucometra with inguinal herniation was made and ovariohysterectomy with hernia repair was performed. Both fluid-filled uterine horns, both broad ligaments, and the uterine body were observed to be herniated through the inguinal ring. On histopathology, marked edema and diffuse hemorrhage were diagnosed in the uterus. PMID:24155486

  8. Treatment of the degenerated intervertebral disc; closure, repair and regeneration of the annulus fibrosus.

    PubMed

    Sharifi, Shahriar; Bulstra, Sjoerd K; Grijpma, Dirk W; Kuijer, Roel

    2015-10-01

    Degeneration of the intervertebral disc (IVD) and disc herniation are two causes of low back pain. The aetiology of these disorders is unknown, but tissue weakening, which primarily occurs due to inherited genetic factors, ageing, nutritional compromise and loading history, is the basic factor causing disc degeneration. Symptomatic disc herniation mainly causes radicular pain. Current treatments of intervertebral disc degeneration and low back pain are based on alleviating the symptoms and comprise administration of painkillers or surgical methods such as spinal fusion. None of these methods is completely successful. Current research focuses on regeneration of the IVD and particularly on regeneration of the nucleus pulposus. Less attention has been directed to the repair or regeneration of the annulus fibrosus, although this is the key to successful nucleus pulposus, and therewith IVD, repair. This review focuses on the importance of restoring the function of the annulus fibrosus, as well as on the repair, replacement or regeneration of the annulus fibrosus in combination with restoration of the function of the nucleus pulposus, to treat low back pain. PMID:24616324

  9. The role of radiology in percutaneous laser disc decompression.

    PubMed

    Botsford, J A

    1995-06-01

    Diagnostic imaging has always played a key role in the evaluation of patients with suspected lumbar disc herniation. With the development of percutaneous laser disc decompression (PLDD), radiology is now equally important in its treatment. All physicians involved with the PLDD candidate must be familiar with the imaging techniques unique to this procedure to ensure a successful outcome. The following review is based on the cumulative experience gained in performing over 200 PLDD procedures. It discusses the function of diagnostic radiology in all facets of PLDD including patient selection, intraoperative imaging, postoperative evaluation, and analysis of complications. Fundamental radiologic concepts that apply to PLDD are explained and protocols suggested to optimize results and avoid complications. PMID:10150644

  10. Automotive disc brake squeal

    NASA Astrophysics Data System (ADS)

    Kinkaid, N. M.; O'Reilly, O. M.; Papadopoulos, P.

    2003-10-01

    Disc brake squeal remains an elusive problem in the automotive industry. Since the early 20th century, many investigators have examined the problem with experimental, analytical, and computational techniques, but there is as yet no method to completely suppress disc brake squeal. This paper provides a comprehensive review and bibliography of works on disc brake squeal. In an effort to make this review accessible to a large audience, background sections on vibrations, contact and disc brake systems are also included.

  11. Turbine disc sealing assembly

    DOEpatents

    Diakunchak, Ihor S.

    2013-03-05

    A disc seal assembly for use in a turbine engine. The disc seal assembly includes a plurality of outwardly extending sealing flange members that define a plurality of fluid pockets. The sealing flange members define a labyrinth flow path therebetween to limit leakage between a hot gas path and a disc cavity in the turbine engine.

  12. Video Discs in Education.

    ERIC Educational Resources Information Center

    Barker, Philip

    1986-01-01

    This discussion of the use of images in learning processes focuses on recent developments in optical storage disc technology, particularly compact disc read-only (CD-ROM) and optical video discs. Interactive video systems and user interfaces are described, and applications in education and industry in the United Kingdom are reviewed. (Author/LRW)

  13. Radiological considerations: patient selection for percutaneous laser disc decompression.

    PubMed

    Botsford, J A

    1994-10-01

    Percutaneous laser disc decompression (PLDD) is an effective method of treating the lumbar herniated nucleus pulposis (HNP) that is both contained by the annular/posterior longitudinal ligament (PLL) complex and connected to the parent disc of origin. Not all radiological studies have the same ability to diagnose this specific type of herniation and therefore are not equally useful in the preoperative evaluation of the PLDD candidate. Ninety PLDD treated patients were retrospectively reviewed to determine which of the four most commonly performed lumbar imaging exams, when abnormal, correlated with a successful outcome. Overall MacNab criteria improvement occurred in 73.3% of PLDD-treated patients. An abnormal CT discogram correlated with PLDD success in all patients treated (100%). An abnormal MRI, CT, or myelogram correlated with success in 75% or less of patients treated. The theoretical reasons for the superiority of CT discography are discussed and the diagnostic potential of all major lumbar imaging modalities is reviewed. A diagnostic decision scheme for the evaluation of the prospective PLDD patient is presented. PMID:10150671

  14. Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases

    PubMed Central

    Haufe, Scott M.W.; Mork, Anthony R.; Pyne, Morgan; Baker, Ryan A.

    2010-01-01

    Background: Discogenic pain or herniation causing neural impingement of the thoracic vertebrae is less common than that in the cervical or lumbar regions. Treatment of thoracic discogenic pain usually involves conservative measures. If this fails, conventional fusion or discectomy can be considered, but these procedures carry significant risk. Objectives: To assess the efficacy and safety of percutaneous laser disc decompression (PLDD) for the treatment of thoracic disc disease. Methods: Ten patients with thoracic discogenic pain who were unresponsive to conservative intervention underwent the PLDD procedure. Thoracic pain was assessed using the Visual Analog Scale (VAS) scores preoperatively and at 6-month intervals with a minimum of 18-months follow-up. Patients were diagnosed and chosen for enrollment based on abnormal MRI findings and positive provocative discograms. Patients with gross herniations were not included. Results: Length of follow-up ranged from 18 to 31 months (mean: 24.2 mo). Median pretreatment thoracic VAS score was 8.5 (range: 5-10) and median VAS score at final follow-up was 3.8 (range: 0-9). Postoperative improvement was significant with a 99% confidence interval. Of interest, patients generally fell into two groups, those with significant pain reduction and those with little to no improvement. Although complications such as pneumothorax, discitis, or nerve damage were possible, no adverse events occurred during the procedures. Limitations: The study is limited by its small size and lack of a sham group. Larger controlled studies are warranted. Conclusions: With further clinical evidence, PLDD could be considered a viable option with a low risk of complication for the treatment of thoracic discogenic pain that does not resolve with conservative treatment. PMID:20567616

  15. Human cartilage endplate permeability varies with degeneration and intervertebral disc site.

    PubMed

    DeLucca, John F; Cortes, Daniel H; Jacobs, Nathan T; Vresilovic, Edward J; Duncan, Randall L; Elliott, Dawn M

    2016-02-29

    Despite the critical functions the human cartilage endplate (CEP) plays in the intervertebral disc, little is known about its structural and mechanical properties and their changes with degeneration. Quantifying these changes with degeneration is important for understanding how the CEP contributes to the function and pathology of the disc. Therefore the objectives of this study were to quantify the effect of disc degeneration on human CEP mechanical properties, determine the influence of superior and inferior disc site on mechanics and composition, and simulate the role of collagen fibers in CEP and disc mechanics using a validated finite element model. Confined compression data and biochemical composition data were used in a biphasic-swelling model to calculate compressive extrafibrillar elastic and permeability properties. Tensile properties were obtained by applying published tensile test data to an ellipsoidal fiber distribution. Results showed that with degeneration CEP permeability decreased 50-60% suggesting that transport is inhibited in the degenerate disc. CEP fibers are organized parallel to the vertebrae and nucleus pulposus and may contribute to large shear strains (0.1-0.2) and delamination failure of the CEP commonly seen in herniated disc tissue. Fiber-reinforcement also reduces CEP axial strains thereby enhancing fluid flux by a factor of 1.8. Collectively, these results suggest that the structure and mechanics of the CEP may play critical roles in the solute transport and disc mechanics. PMID:26874969

  16. Herniation of transverse colon into mediastinum after pedicled omental grafting for mediastinitis: report of a case.

    PubMed

    Hashimoto, Makoto; Yamauchi, Akihiko; Shimabuku, Masamori; Higami, Tetsuya

    2015-11-01

    We describe a rare complication and the treating experience of it after pedicled omental grafting for mediastinitis. The patient was diagnosed as an acute mediastinitis soon after the total arch replacement was performed. A two-staged strategy to treat postoperative mediastinitis was scheduled, i.e., the setting up of a vacuum-assisted closure system until the improvement of inflammation followed by wound closure with pedicled omental grafting. The treatment for acute mediastinitis was successful and the patient followed a favorable postoperative course. During the follow-up, chest X-ray film suggested the gradual enlargement of mediastinum and CT showed the herniation of transverse colon into mediastinum. Surgical correction for the hernia was scheduled and performed successfully by the laparoscopic procedure to prevent a possible cardiac and pulmonary dysfunction. PMID:24091537

  17. Outcomes of cervical and lumbar disk herniations in Major League Baseball pitchers.

    PubMed

    Roberts, David W; Roc, Gilbert J; Hsu, Wellington K

    2011-08-01

    The effects of disk herniations on the career and performance outcomes of Major League Baseball (MLB) pitchers are unknown. The purpose of this study is to determine the outcomes after a cervical or lumbar disk herniation for MLB pitchers. Forty MLB pitchers from 1984 to 2009 with a cervical disk herniation or lumbar disk herniation were identified using a previously established protocol. Cervical disk herniation was identified in 11 pitchers, 8 of which were treated operatively. The majority of pitchers with cervical disk herniation (8/11) returned to play at an average of 11.6 months. Lumbar disk herniation was identified in 29 pitchers, 20 of which were treated operatively. All pitchers with lumbar disk herniation (29/29) returned to play at an average of 7.3 months after diagnosis. PMID:21800814

  18. Repair of lung herniation with titanium prosthetic ribs and Prolene mesh.

    PubMed

    Akkas, Yucel; Peri, Neslihan Gülay; Kocer, Bulent; Kaplan, Tevfik

    2016-03-01

    We present a rare case of intercostal lung herniation due to blunt trauma. A 40-year-old man was admitted to our hospital with lung herniation due to falling off a donkey. Computed tomography demonstrated a fracture of the 8th left rib, a comminuted fracture of the 9th rib, and lung herniation into the 8th intercostal space. The herniation was repaired using a titanium prosthetic rib, a rib plate, and Prolene mesh via a thoracotomy. PMID:26612961

  19. Treatment of a Symptomatic Forearm Muscle Herniation With a Mesh Graft

    PubMed Central

    Sanders, Brett S.; Bruce, Jeremy; Robertson, Jason

    2011-01-01

    Symptomatic muscle herniations are an unusual cause of upper extremity pain in the athlete that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion. This article describes a successful repair of a 21-year-old rock climbers ventral forearm herniation with polypropylene mesh. PMID:23016006

  20. Treatment of a symptomatic forearm muscle herniation with a mesh graft.

    PubMed

    Sanders, Brett S; Bruce, Jeremy; Robertson, Jason

    2011-03-01

    Symptomatic muscle herniations are an unusual cause of upper extremity pain in the athlete that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion. This article describes a successful repair of a 21-year-old rock climber's ventral forearm herniation with polypropylene mesh. PMID:23016006

  1. Internal herniation through a defect in the transverse mesocolon

    PubMed Central

    Alaker, Medhat; Mathias, Jegadish

    2014-01-01

    Internal hernias are rare, constituting 5.8% of all intestinal obstruction cases. Congenital transverse mesocolon hernias in adults are specifically rare. We hereby present a case of an adult female presenting with acute intestinal obstruction. Her CT scan showed classic signs of internal herniations: Whirlpool sign, crowding of bowel loops in the upper compartment and the absence of caecum from the Right Iliac Fossa. At operation, she was found to have a congenital defect in the transverse mesocolon, through which have herniated the terminal ileum, caecum and the proximal half of the ascending colon. They have furthermore rotated 360 about the axis of the pedicle forming a volvulus. The bowel was viable. The herniated bowel was derotated, and reduced through the defect, the defect was closed with polydioxanone sutures, and the caecum and ascending colon was fixed to the lateral abdominal wall. PMID:24567183

  2. Spontaneous disappearance of lumbar disk herniation within 3 months.

    PubMed

    Nozawa, Satoshi; Nozawa, Asae; Kojima, Hisashi; Shimizu, Katsuji

    2009-11-01

    Although spontaneous regression of disk herniation is a well-known phenomenon, the time taken for the condition to resolve has not been detailed in previous studies. This article describes a case of vanishing lumbar disk herniation in a 33-year-old man. The patient experienced sudden severe lumbar pain while lifting a 240-kg weight while attempting a Donkey Calf Raise during muscle training. The pain persisted despite the use of a lumbar corset and nonsteroidal anti-inflammatory drugs. Twelve days after onset, sensory disturbance appeared in the right L5 dermatome, and a manual muscle test of the right anterior tibial muscle revealed level 3. The pain gradually spread over the right lower extremity and the indistinct lumbago changed to localized back pain at the L4/5 vertebral level. Magnetic resonance imaging (MRI) of the lumbar spine 12 days after onset revealed a large disk herniation at L4/5. T2-weighted images demonstrated the herniated disk with a sequestrated disk fragment, which compressed the right L5 nerve root. Over the following month, his pain gradually diminished and he was able to resume his muscle-building program. Follow-up MRI 3 months after the lumbar injury showed complete disappearance of the extruded disk material. This is the first reported case of disk herniation that disappeared within only 3 months, as previous reports have reported that a minimum 30-week period was needed. Clinical awareness of the possibility that disk herniation may resolve within a relatively short time may aid both correct informed consent and treatment. PMID:19902881

  3. VACUUM TRAP

    DOEpatents

    Gordon, H.S.

    1959-09-15

    An improved adsorption vacuum trap for use in vacuum systems was designed. The distinguishing feature is the placement of a plurality of torsionally deformed metallic fins within a vacuum jacket extending from the walls to the central axis so that substantially all gas molecules pass through the jacket will impinge upon the fin surfaces. T fins are heated by direct metallic conduction, thereby ol taining a uniform temperature at the adeorbing surfaces so that essentially all of the condensible impurities from the evacuating gas are removed from the vacuum system.

  4. Vacuum Technology

    SciTech Connect

    Biltoft, P J

    2004-10-15

    The environmental condition called vacuum is created any time the pressure of a gas is reduced compared to atmospheric pressure. On earth we typically create a vacuum by connecting a pump capable of moving gas to a relatively leak free vessel. Through operation of the gas pump the number of gas molecules per unit volume is decreased within the vessel. As soon as one creates a vacuum natural forces (in this case entropy) work to restore equilibrium pressure; the practical effect of this is that gas molecules attempt to enter the evacuated space by any means possible. It is useful to think of vacuum in terms of a gas at a pressure below atmospheric pressure. In even the best vacuum vessels ever created there are approximately 3,500,000 molecules of gas per cubic meter of volume remaining inside the vessel. The lowest pressure environment known is in interstellar space where there are approximately four molecules of gas per cubic meter. Researchers are currently developing vacuum technology components (pumps, gauges, valves, etc.) using micro electro mechanical systems (MEMS) technology. Miniature vacuum components and systems will open the possibility for significant savings in energy cost and will open the doors to advances in electronics, manufacturing and semiconductor fabrication. In conclusion, an understanding of the basic principles of vacuum technology as presented in this summary is essential for the successful execution of all projects that involve vacuum technology. Using the principles described above, a practitioner of vacuum technology can design a vacuum system that will achieve the project requirements.

  5. Enhancement of KTP/532 laser disc decompression and arthroscopic microdiscectomy with a vital dye

    NASA Astrophysics Data System (ADS)

    Yeung, Anthony T.

    1993-07-01

    Currently, the clinical indications and results of arthroscopic microdiscectomy and laser disc decompression come close to, but do not exceed, the results of classic discectomy or microdiscectomy for the whole spectrum of surgical disc herniations. However, as minimally invasive techniques continue to evolve, results can be expected to equal or be potentially superior to conventional surgery. This exhibit demonstrates how the use of a vital dye can enhance standard arthroscopic microdiscectomy techniques and, when used in conjunction with KTP/532 laser disc decompression, allows for better arthroscopic visualization, documentation, and extraction of nucleus pulposus, ultimately expanding the current limiting criteria for minimally invasive techniques. When proper patient selection is combined with good clinical indications, the surgical results are rather dramatic, often achieving immediate relief of sciatica in the operating room.

  6. Percutaneous Laser Disc Decompression (PLDD): Experience and Results From Multiple Centers and 19,880 Procedures

    NASA Astrophysics Data System (ADS)

    Paolo Tassi, Gian; Choy, Daniel S. J.; Hellinger, Johannes; Hellinger, Stefan; Lee, Sang-Ho

    2010-05-01

    In mid-February 1986, Peter Ascher and Daniel Choy performed the first Percutaneous Laser Disc Decompression (PLDD) at the Neurosurgical Department, University of Graz, Graz, Austria. It was planned to deliver 1000 joules with a Nd:YAG laser to a herniated L4-5 disc causing sciatica. At 600 joules the procedure was terminated because the pain was gone. Since then, PLDD has spread all over the world, with procedures being performed in the entire spine except for T1-T4 because these discs do not permit percutaneous access with a needle. The success rate has ranged from 70 to 89%, and the complication rate, chiefly discitis, from 0.3 to 1.0%. When successful, return to normal work averages one week. Long term follow-up to 23 years yields a recurrence rate of 4-5%.

  7. Exploring the utility of axial lumbar MRI for automatic diagnosis of intervertebral disc abnormalities

    NASA Astrophysics Data System (ADS)

    Ghosh, Subarna; Chaudhary, Vipin; Dhillon, Gurmeet

    2013-03-01

    In this paper, we explore the importance of axial lumbar MRI slices for automatic detection of abnormalities. In the past, only the sagittal views were taken into account for lumbar CAD systems, ignoring the fact that a radiologist scans through the axial slices as well, to confirm the diagnosis and quantify various abnormalities like herniation and stenosis. Hence, we present an automatic diagnosis system from axial slices using CNN(Convolutional Neural Network) for dynamic feature extraction and classification of normal and abnormal lumbar discs. We show 80:81% accuracy (with a specificity of 85:29% and sensitivity of 75:56%) on 86 cases (391 discs) using only an axial slice for each disc, which implies the usefulness of axial views for automatic lumbar abnormality diagnosis in conjunction with sagittal views.

  8. Vacuum Virtues

    ERIC Educational Resources Information Center

    Rathey, Allen

    2007-01-01

    Upright vacuums, like cars, vary in quality, features and performance. Like automobiles, some uprights are reliable, others may be problematic, and some become a problem as a result of neglect or improper use. So, how do education institutions make an informed choice and, having done so, ensure that an upright vacuum goes the distance? In this…

  9. Vacuum Virtues

    ERIC Educational Resources Information Center

    Rathey, Allen

    2007-01-01

    Upright vacuums, like cars, vary in quality, features and performance. Like automobiles, some uprights are reliable, others may be problematic, and some become a problem as a result of neglect or improper use. So, how do education institutions make an informed choice and, having done so, ensure that an upright vacuum goes the distance? In this

  10. Vacuum mechatronics

    NASA Technical Reports Server (NTRS)

    Hackwood, Susan; Belinski, Steven E.; Beni, Gerardo

    1989-01-01

    The discipline of vacuum mechatronics is defined as the design and development of vacuum-compatible computer-controlled mechanisms for manipulating, sensing and testing in a vacuum environment. The importance of vacuum mechatronics is growing with an increased application of vacuum in space studies and in manufacturing for material processing, medicine, microelectronics, emission studies, lyophylisation, freeze drying and packaging. The quickly developing field of vacuum mechatronics will also be the driving force for the realization of an advanced era of totally enclosed clean manufacturing cells. High technology manufacturing has increasingly demanding requirements for precision manipulation, in situ process monitoring and contamination-free environments. To remove the contamination problems associated with human workers, the tendency in many manufacturing processes is to move towards total automation. This will become a requirement in the near future for e.g., microelectronics manufacturing. Automation in ultra-clean manufacturing environments is evolving into the concept of self-contained and fully enclosed manufacturing. A Self Contained Automated Robotic Factory (SCARF) is being developed as a flexible research facility for totally enclosed manufacturing. The construction and successful operation of a SCARF will provide a novel, flexible, self-contained, clean, vacuum manufacturing environment. SCARF also requires very high reliability and intelligent control. The trends in vacuum mechatronics and some of the key research issues are reviewed.

  11. Intradural Migration of a Sequestrated Lumbar Disc Fragment Masquerading as a Spinal Intradural Tumor

    PubMed Central

    Kim, Hyeong-Suk; Park, Jung-Soo

    2012-01-01

    Intervertebral intradural lumbar disc herniation (ILDH) is a quite rare pathology, and isolated intradural lumbar disc herniation is even more rare. Magnetic resonance imaging (MRI) may not be able to reveal ILDHs, especially if MRI findings show an intact lumbar disc annulus and posterior longitudinal ligament. Here, we present an exceedingly rare case of an isolated IDLH that we initially misidentified as a spinal intradural tumor, in a 54-year-old man hospitalized with a 2-month history of back pain and right sciatica. Neurologic examination revealed a positive straight leg raise test on the right side, but he presented no other sensory, motor, or sphincter disturbances. A gadolinium-enhanced MRI revealed what we believed to be an intradural extramedullary tumor compressing the cauda equina leftward in the thecal sac, at the L2 vertebral level. The patient underwent total L2 laminectomy, and we extirpated the intradural mass under microscopic guidance. Histologic examination of the mass revealed a degenerated nucleus pulposus. PMID:23091677

  12. Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index

    PubMed Central

    2011-01-01

    Background Although histopathological grading systems for disc degeneration are frequently used in research, they are not yet integrated into daily care routine pathology of surgical samples. Therefore, data on histopathological changes in surgically excised disc material and their correlation to clinical parameters such as age, gender or body mass index (BMI) is limited to date. The current study was designed to correlate major physico-clinical parameters from a population of orthopaedic spine center patients (gender, age and BMI) with a quantitative histologic degeneration score (HDS). Methods Excised lumbar disc material from 854 patients (529 men/325 women/mean age 56 (15-96) yrs.) was graded based on a previously validated histologic degeneration score (HDS) in a cohort of surgical disc samples that had been obtained for the treatment of either disc herniation or discogenic back pain. Cases with obvious inflammation, tumor formation or congenital disc pathology were excluded. The degree of histological changes was correlated with sex, age and BMI. Results The HDS (0-15 points) showed significantly higher values in the nucleus pulposus (NP) than in the annulus fibrosus (AF) (Mean: NP 11.45/AF 7.87), with a significantly higher frequency of histomorphological alterations in men in comparison to women. Furthermore, the HDS revealed a positive significant correlation between the BMI and the extent of histological changes. No statistical age relation of the degenerative lesions was seen. Conclusions This study demonstrated that histological disc alterations in surgical specimens can be graded in a reliable manner based on a quantitative histologic degeneration score (HDS). Increased BMI was identified as a positive risk factor for the development of symptomatic, clinically significant disc degeneration. PMID:22087871

  13. Bryan total disc arthroplasty: a replacement disc for cervical disc disease

    PubMed Central

    Wenger, Markus; Markwalder, Thomas-Marc

    2010-01-01

    Total disc arthroplasty is a new option in the treatment of cervical degenerative disc disease. Several types of cervical disc prostheses currently challenge the gold-standard discectomy and fusion procedures. This review describes the Bryan Cervical Disc System and presents the Bryan prosthesis, its indications, surgical technique, complications, and outcomes, as given in the literature. PMID:22915917

  14. Expression of NG2 proteoglycan in the degenerated intervertebral disc in dachshunds.

    PubMed

    Abdel-Hakiem, Mohammed; Yamashita, Ayuko; Atiba, Ayman; Okamura, Yasuhiko; Katayama, Masaaki; Youssef, Haroun; Isomura, Hiroshi; Uzuka, Yuji

    2016-02-01

    The pathogenesis of intervertebral disc (IVD) degeneration is not fully understood. The biomolecular signaling pathways involved in the IVD degeneration require further investigation. The aim of this study was to investigate the expression of NG2 proteoglycan in the degenerated IVD. IVD samples were obtained from 16 Dachshunds that were confirmed to have IVD herniation and subsequently underwent hemilaminectomy. The samples were subjected to histological and immunohistochemical (IHC) examinations. IHC revealed positive results for the expression of NG2 proteoglycan in all examined samples. The results showed the expression of NG2 proteoglycan by the degenerated IVDs. PMID:26300439

  15. Intermittent swelling in the chest; a case of spontaneous intermittent lung herniation

    PubMed Central

    Bangalore Lakshminarayana, Umesh; Cowen, Michael; Kastelik, Jack A; Morjaria, Jaymin B

    2013-01-01

    Herniation of the lung is uncommon and occurs due to protrusion of the lung beyond the confines of the thoracic cavity through an abnormal opening in the chest wall. Any condition associated with raised intrathoracic pressure or that which weakens the thoracic wall may result in lung herniation. We present a case of spontaneous lung herniation which was managed successfully by minimally invasive thoracic surgery. PMID:24177461

  16. Brain Herniations into the Dural Venous Sinuses or Calvarium: MRI of a Recently Recognized Entity

    PubMed Central

    Battal, Bilal; Castillo, Mauricio

    2014-01-01

    Summary Brain herniations into dural venous sinuses (DVS) are rare findings recently described and their etiology and clinical significance are controversial. We describe five patients with brain herniations into the DVS or calvarium identified on MRI, and discuss their imaging findings, possible causes, and relationship to the patient's symptoms. All patients were examined with MRI including high resolution pre- and post-contrast T1- and T2-weighted sequences. With respect to brain herniations we documented their locations, signal intensities in different sequences, and size. We then reviewed clinical records in an attempt to establish if any symptoms were related to the presence of these herniations. Three males and two females were examined (age range, 11-68 years). Three patients had unilateral temporal lobe herniations into transverse sinuses, one had a cerebellar herniation into the skull, and one had bilateral temporal lobe herniations into the transverse sinuses as well as a cerebellar herniation into the sigmoid sinus. In all, the herniated brain and surrounding cerebrospinal fluid (CSF) had normal signal intensity on all MRI sequences. When correlated with clinical symptoms, brain herniations were thought to be incidental and asymptomatic in three patients and two patients had histories of headaches. Brain herniations with surrounding CSF into the DVS/skull should be considered potential sources of filling defects in the DVS. We believe that they are probably incidental findings that may be more common than previously recognized and should be not confused with the more common arachnoid granulations, clots, or tumors. Two patients had headaches, but their relation to the presence of herniated brain was uncertain. PMID:24571834

  17. Irradiated Accretion Disc Models

    NASA Astrophysics Data System (ADS)

    Hammer, N. J.

    2004-08-01

    Most of the known accretion discs in binary systems are composed of hydrogen rich material. A few years ago, a new type of binary system was discovered, in which the disc is obviously free of hydrogen and helium. Nowadays six systems are known, with an accretion disc mainly composed of C, O, Ne and Mg (Juett, Psaltis & Chakrabarty 2001; Schulz et al. 2001). The most prominent representative of these ultra compact binary systems is the LMXB 4U 1626-67. The system is consisting of a 7.66 s X-ray pulsar as primary component and a 0.02 solar mass white dwarf as secondary (Chakrabarty 1998). Having a binary separation of only 300 0000 km (Schulz et al. 2001) one can not neglect the external irradiation of the accretion disc by the neutron star. The external irradiation dominates the disc spectrum over a wide range. In the UV one sees emission lines of highly ionised elements, like OV or CIV. One of the biggest numerical problems, occurring during the calculation of an irradiated accretion disc model, is the extreme temperature stratification and structure. This causes severe problems with the occupation numbers of some atomic levels. These problems should be solved by implementing the depth dependent model atom, during my thesis work. During his PhD thesis, Nagel (2003) has developed the numeric code package AcDc. Therewith one can calculate the vertical structure and the emergent synthetic spectrum of an accretion disc. During the work presented here the depth dependent model atom (DEPTOM) was developed and implemented in AcDc as a code module. DEPTOM identifies the trouble making ionisation stages and deactivates them. Thus the calculation is numerically more stable and, hence, makes AcDc more powerful.

  18. Percutaneous breast implant herniation: a rare complication of miliary TB.

    PubMed

    Dale, Adam P; Dedicoat, Martin J; Saleem, Tausif; Moran, Ed

    2015-01-01

    We describe the case of a 46-year-old female patient treated for disseminated tuberculosis (TB) infection involving the lungs, urinary tract and skin. Following initiation of antituberculous therapy, the patient's right breast implant eroded through the overlying skin and was seen to be herniating through the resulting defect. The breast implant was removed under local anaesthetic and histological analysis of the resected tissue demonstrated granuloma formation consistent with periprosthetic TB. Wound healing following implant removal was poor and future breast augmentation surgery was only considered following completion of 12?months anti-TB treatment. This case constitutes the first report in the literature of percutaneous breast implant herniation resulting from periprosthetic infection with TB. A high index of suspicion is required to ensure early detection and timely management of TB and, in cases where periprosthetic pus aspirate is sterile, mycobacterial infection must be actively excluded. PMID:25568276

  19. Pancreatic herniation: a rare cause of acute pancreatitis?

    PubMed Central

    Kumar, Prashant; Turp, Matthew; Fellows, Sarah; Ellis, Jonathan

    2013-01-01

    Acute pancreatitis is a common and potentially fatal condition, with several well-known causes including gallstones, excessive alcohol consumption and specific medications. We report a case of an 89-year-old man presenting with acute pancreatitis, which we believe to be secondary to a diaphragmatic herniation of the pancreas. This extremely rare anatomical abnormality can be found incidentally in the asymptomatic patient or may present with a variety of acute symptoms. However, there have been only isolated reports of these cases presenting as acute pancreatitis. While the majority of acute pancreatitis cases can be explained by common causes, it is important that clinicians be aware of and should consider investigating for other more unusual possibilities, such as pancreatic herniation, before labelling an episode as idiopathic. PMID:24343805

  20. Herniation of a Pulmonary Emphysematous Bulla to Contralateral Hemithorax

    PubMed Central

    Shameem, Mohammad; Baneen, Ummul; Khan, Nafees Ahmad; Siddiqui, Mohammed Azfar

    2011-01-01

    Herniation of an emphysematous bulla is extremely rare. A 55-year-old male patient presented with complains of shortness of breath and cough for the last 10 years which had exacerbated in the last two days. The patient was a diagnosed case of chronic obstructive pulmonary disease. Chest x-ray showed bilateral hyperinflated lung fields along with loss of lung markings in left upper lobe and a thin white line in right upper lobe suggestive of wall of bulla. High resolution computed tomography of the chest revealed anterior herniation of a pulmonary bulla from left to right side across midline. Patient was put on antibiotics, hydrocortisone and aminophylline by intravenous route and nebulization of steroid and bronchodilator. However, the patient expired after 5 days following admission. PMID:25191377

  1. Idiopathic Spinal Cord Herniation Presented as Brown-Sequard Syndrome : A Case Report and Surgical Outcome

    PubMed Central

    Ju, Min-Wook; Youm, Jin-Young; Kwon, Hyon-Jo

    2015-01-01

    Spinal cord herniation is a rare condition that has become increasingly recognised in the last few years. The authors report a case of idiopathic spinal cord herniation in a 33 year old woman performed with progressive Brown-Sequard syndrome. The diagnosis was made on MR imaging. After repairing the herniation, the patient made a gradual improvement. Potential causes are discussed, including a possible role of dural defect. In conclusion, idiopathic spinal cord herniation is a potentially treatable condition that should be more readily diagnosed that increasing awareness and improved imaging techniques. PMID:26539277

  2. The origin of thick discs

    NASA Astrophysics Data System (ADS)

    Comern, Sbastien

    2015-03-01

    Thick discs are defined to be disc-like components with a scale height larger than that of the classical discs. They are ubiquitous (Yoachim & Dalcanton 2006; Comern et al. 2011a), they are made of mostly old and metal-poor stars and are most easily detected in close to edge-on galaxies. Their origin has been considered mysterious and several formation theories have been proposed: The thick disc being formed secularly by thin disc stars heated by disc overdensities such as giant molecular clouds or spiral arms (Villumsen 1985, ApJ, 290, 75) and by stars moved outwards from their original orbits by radial migration mechanisms (Schnrich & Binney 2009). The thick disc being formed by the heating of the thin disc by satellites (Quinn et al. 1993) and the tidal stripping of them (Abadi et al. 2003). The thick disc being formed fast and already thick at high redshift in an highly unstable disc. Inside that thick disc, a thin disc would form afterwards as suggested by Elemgreen & Elmegreen (2006). The thick disc being formed originally thick at high redshift by the merger of gas-rich protogalactic fragments and a thin disc forming afterwards within it (Brook et al. 2007). The first mechanism is a secular evolution mechanism. The time-scale of the second one is dependent on the merger history of the main galaxy. In the two last mechanisms, the thick disc forms already thick in a short time-scale at high redshift. Recent Milky Way studies, (see, e.g., Bovy et al. 2012), have shown indications that there is no discontinuity between the thin and the thick disc chemical and kinematic properties. Instead, those studies indicate the presence of a monotonic distribution of disc thicknesses. This would suggest a secular origin for the Milky Way thick disc. Studies in external galaxies (Yoachim & Dalcanton 2006; Comern et al. 2011b), have shown that low-mass disc galaxies have thick disc relative masses much larger than those found in large-mass galaxies. Because low-mass galaxies are dynamically younger than their larger counterparts, it seems difficult for their thick discs to have a secular evolution origin, but simulations show that their thick disc masses are compatible with those of a thick disc formed at high redshift. Thus, recent studies seem to indicate that large-mass galaxies have their thick discs formed mainly due to secular evolution and that low-mass galaxies have them formed at high redshift.

  3. Riboflavin crosslinked high-density collagen gel for the repair of annular defects in intervertebral discs: An in vivo study.

    PubMed

    Grunert, Peter; Borde, Brandon H; Towne, Sara B; Moriguchi, Yu; Hudson, Katherine D; Bonassar, Lawrence J; Hrtl, Roger

    2015-10-15

    Open annular defects compromise the ability of the annulus fibrosus to contain nuclear tissue in the disc space, and therefore lead to disc herniation with subsequent degenerative changes to the entire intervertebral disc. This study reports the use of riboflavin crosslinked high-density collagen gel for the repair of annular defects in a needle-punctured rat-tail model. High-density collagen has increased stiffness and greater hydraulic permeability than conventional low-density gels; riboflavin crosslinking further increases these properties. This study found that treating annular defects with crosslinked high-density collagen inhibited the progression of disc degeneration over 18 weeks compared to untreated control discs. Histological sections of FITC-labeled collagen gel revealed an early tight attachment to host annular tissue. The gel was subsequently infiltrated by host fibroblasts which remodeled it into a fibrous cap that bridged the outer disrupted annular fibers and partially repaired the defect. This repair tissue enhanced retention of nucleus pulposus tissue, maintained physiological disc hydration, and preserved hydraulic permeability, according to MRI, histological, and mechanical assessments. Degenerative changes were partially reversed in treated discs, as indicated by an increase in nucleus pulposus size and hydration between weeks 5 and 18. The collagen gel appeared to work as an instant sealant and by enhancing the intrinsic healing capabilities of the host tissue. PMID:26116448

  4. Potential regenerative treatment strategies for intervertebral disc degeneration in dogs

    PubMed Central

    2014-01-01

    Pain due to spontaneous intervertebral disc (IVD) disease is common in dogs. In chondrodystrophic (CD) dogs, IVD disease typically develops in the cervical or thoracolumbar spine at about 3–7 years of age, whereas in non-chondrodystrophic (NCD) dogs, it usually develops in the caudal cervical or lumbosacral spine at about 6–8 years of age. IVD degeneration is characterized by changes in the biochemical composition and mechanical integrity of the IVD. In the degenerated IVD, the content of glycosaminoglycan (GAG, a proteoglycan side chain) decreases and that of denatured collagen increases. Dehydration leads to tearing of the annulus fibrosus (AF) and/or disc herniation, which is clinically characterized by pain and/or neurological signs. Current treatments (physiotherapy, anti-inflammatory/analgesic medication, surgery) for IVD disease may resolve neurological deficits and reduce pain (although in many cases insufficient), but do not lead to repair of the degenerated disc. For this reason, there is interest in new regenerative therapies that can repair the degenerated disc matrix, resulting in restoration of the biomechanical function of the IVD. CD dogs are considered a suitable animal model for human IVD degeneration because of their spontaneous IVD degeneration, and therefore studies investigating cell-, growth factor-, and/or gene therapy-based regenerative therapies with this model provide information relevant to both human and canine patients. The aim of this article is to review potential regenerative treatment strategies for canine IVD degeneration, with specific emphasis on cell-based strategies. PMID:24387033

  5. The DISC Quotient

    NASA Astrophysics Data System (ADS)

    Elliott, John R.; Baxter, Stephen

    2012-09-01

    D.I.S.C: Decipherment Impact of a Signal's Content. The authors present a numerical method to characterise the significance of the receipt of a complex and potentially decipherable signal from extraterrestrial intelligence (ETI). The purpose of the scale is to facilitate the public communication of work on any such claimed signal, as such work proceeds, and to assist in its discussion and interpretation. Building on a "position" paper rationale, this paper looks at the DISC quotient proposed and develops the algorithmic steps and comprising measures that form this post detection strategy for information dissemination, based on prior work on message detection, decipherment. As argued, we require a robust and incremental strategy, to disseminate timely, accurate and meaningful information, to the scientific community and the general public, in the event we receive an "alien" signal that displays decipherable information. This post-detection strategy is to serve as a stepwise algorithm for a logical approach to information extraction and a vehicle for sequential information dissemination, to manage societal impact. The "DISC Quotient", which is based on signal analysis processing stages, includes factors based on the signal's data quantity, structure, affinity to known human languages, and likely decipherment times. Comparisons with human and other phenomena are included as a guide to assessing likely societal impact. It is submitted that the development, refinement and implementation of DISC as an integral strategy, during the complex processes involved in post detection and decipherment, is essential if we wish to minimize disruption and optimize dissemination.

  6. Learning Language on Disc.

    ERIC Educational Resources Information Center

    Desmarais, Norman

    1995-01-01

    Presents a comparison of two types of compact disc (CD-ROM) foreign language tutorials: (1) those made by publishers who favor an immersion approach; and (2) those made by publishers who use grammar-based approaches. Both types of CD-ROMs address various age groups, skill levels, and learning styles. (JMV)

  7. The Teddy Bears' Disc.

    ERIC Educational Resources Information Center

    Laurillard, Diana

    1985-01-01

    Reports an evaluation of the Teddy Bear disc, an interactive videodisc developed at the Open University for a second-level course in metallurgy and materials technology. Findings from observation of students utilizing the videodisc are reviewed; successful design features and design problems are considered; and development costs are outlined. (MBR)

  8. The Chemistry of Optical Discs.

    ERIC Educational Resources Information Center

    Birkett, David

    2002-01-01

    Explains the chemistry used in compact discs (CD), digital versatile discs (DVD), and magneto-optical (MO) discs focusing on the steps of initial creation of the mold, the molding of the polycarbonate, the deposition of the reflective layers, the lacquering of the CDs, and the bonding of DVDs. (Contains 15 references.) (YDS)

  9. Revival of the Jumping Disc

    ERIC Educational Resources Information Center

    Ucke, C.; Schlichting, H-J.

    2009-01-01

    Snap discs made of bimetal have many technical applications as thermostats. Jumping discs are a toy version of such snap discs. Besides giving technical information, we describe physical investigations. We show especially how, through simple measurements and calculations, you can determine the initial speed ([approximately equal to]3.5 m

  10. Recurrent wound dehiscence and small bowel herniation following Caesarean section in a woman with hidradenitis suppurativa

    PubMed Central

    Fernando, Magage; Schultz, Meleesa J.

    2014-01-01

    Caesarean wound dehiscence that is severe enough to result in bowel herniation is exceptionally rare. This case describes a woman who experienced wound dehiscence following each of her two Caesarean sections, with bowel herniation present in the second case. The contribution of her comorbid hidradenitis suppurativa will be discussed. PMID:24876503

  11. Efficacy of percutaneous laser disc decompression on lumbar spinal stenosis.

    PubMed

    Ren, Longxi; Han, Zhengfeng; Zhang, Jianhua; Zhang, Tongtong; Yin, Jian; Liang, Xibin; Guo, Han; Zeng, Yanjun

    2014-05-01

    The objective of this study is to observe the effect of percutaneous laser disc decompression (PLDD) on lumbar spinal stenosis (LSS). Thirty-two LSS patients were treated using pulsed Nd: YAG laser, of which 21 cases (11 males and 10 females with an average age of 64 years old) were followed up for 2 years. All of the 21 patients had intermittent claudication with negative straight leg raising test results. Fifteen patients suffered from anterior central disc herniation which often compressed the cauda equina but seldom compressed the posterior part; six patients suffered from posterior ligamentum flavum hypertrophy which often compressed the cauda equina but seldom compressed the anterior part. The efficacy was evaluated 1, 3, 6, 12 and 24 months after surgery on 21 patients using the performance evaluation criteria of the lumbago treatment by the Japanese Orthopaedic Association (JOA 29 scores). The fineness (i.e. excellent and good treatment outcome) rate 1, 3, 6, 12 and 24 months after the operation were 46.7%, 66.7%, 66.7%, 66.7% and 66.7%, respectively, in patients with severe anterior compression and 16.7%, 33.3%, 33.3%, 33.3% and 33.3%, respectively, in patients with severe posterior compression. PLDD had certain positive efficacy on the treatment of lumbar spinal stenosis, which was more significant on LSS dominated by the anterior compression than that by the posterior compression. PMID:23996073

  12. Ozone Nucleolysis for Management of Pain and Disability in Prolapsed Lumber Intervertebral Disc

    PubMed Central

    Das, G.; Ray, S.; Ishwarari, S.; Roy, M.; Ghosh, P.

    2009-01-01

    Summary The prevalence rate of low back pain in a number of studies ranged from 22% to 65% in one year, and lifetime prevalence ranged from 11% to 84%. Over the years many percutaneous minimally invasive therapeutic modalities have evolved. Intradiscal oxygen-ozone therapy has also showed promising results. We undertook a prospective cohort study to evaluate the therapeutic outcome of oxygen-ozone therapy on patients with lumber disc herniation in the Indian population. After obtaining ethical committee and investigational review board permission, 53 consecutive patients complying with selection criteria were treated with a single session of oxygen-ozone therapy. All presented with clinical signs of lumber nerve root compression supported by CT and MRI findings. All patients received 3-7 ml of ozone-oxygen mixture at an ozone concentration of29-32 mc/ml of oxygen. Therapeutic outcome was assessed after three weeks, three months, six months, one year and two years on a visual analog scale and Oswestry low back pain disability questionnaire. Pain intensity was significantly reduced following treatment (VAS baseline 7.580.86, after three weeks 2.75 1.42 and after two years 2.642.14). Similarly the Oswestry disability index showed a remarkable improvement in the functional status of the patients (p<0.05). No major complication was observed in this case series. Oxygen-ozone treatment is highly effective in relieving low back pain due to lumber disc herniation. PMID:20465917

  13. Warp Propagation in Astrophysical Discs

    NASA Astrophysics Data System (ADS)

    Nixon, Chris; King, Andrew

    Astrophysical discs are often warped, that is, their orbital planes change with radius. This occurs whenever there is a non-axisymmetric force acting on the disc, for example the Lense-Thirring precession induced by a misaligned spinning black hole, or the gravitational pull of a misaligned companion. Such misalignments appear to be generic in astrophysics. The wide range of systems that can harbour warped discsprotostars, X-ray binaries, tidal disruption events, quasars and othersallows for a rich variety in the disc's response. Here we review the basic physics of warped discs and its implications.

  14. Biomechanics of Disc Degeneration

    PubMed Central

    Palepu, V.; Kodigudla, M.; Goel, V. K.

    2012-01-01

    Disc degeneration and associated disorders are among the most debated topics in the orthopedic literature over the past few decades. These may be attributed to interrelated mechanical, biochemical, and environmental factors. The treatment options vary from conservative approaches to surgery, depending on the severity of degeneration and response to conservative therapies. Spinal fusion is considered to be the “gold standard” in surgical methods till date. However, the association of adjacent level degeneration has led to the evolution of motion preservation technologies like spinal arthroplasty and posterior dynamic stabilization systems. These new technologies are aimed to address pain and preserve motion while maintaining a proper load sharing among various spinal elements. This paper provides an elaborative biomechanical review of the technologies aimed to address the disc degeneration and reiterates the point that biomechanical efficacy followed by long-term clinical success will allow these nonfusion technologies as alternatives to fusion, at least in certain patient population. PMID:22745914

  15. Mechanotransduction in intervertebral discs

    PubMed Central

    Tsai, Tsung-Ting; Cheng, Chao-Min; Chen, Chien-Fu; Lai, Po-Liang

    2014-01-01

    Mechanotransduction plays a critical role in intracellular functioningit allows cells to translate external physical forces into internal biochemical activities, thereby affecting processes ranging from proliferation and apoptosis to gene expression and protein synthesis in a complex web of interactions and reactions. Accordingly, aberrant mechanotransduction can either lead to, or be a result of, a variety of diseases or degenerative states. In this review, we provide an overview of mechanotransduction in the context of intervertebral discs, with a focus on the latest methods of investigating mechanotransduction and the most recent findings regarding the means and effects of mechanotransduction in healthy and degenerative discs. We also provide some discussion of potential directions for future research and treatments. PMID:25267492

  16. Magnetic resonance imaging on disc degeneration changes after implantation of an interspinous spacer and fusion of the adjacent segment

    PubMed Central

    Liu, Xiaokang; Liu, Yingjie; Lian, Xiaofeng; Xu, Jianguang

    2015-01-01

    The aim of the study was to investigate the changes of the lumbar intervertebral disc degeneration by magnetic resonance imaging (MRI) after the implantation of interspinous device and the fusion of the adjacent segment. A total of 62 consecutive patients suffering L5/S1 lumbar disc herniation (LDH) with concomitant disc space narrowing or low-grade instability up to 5 mm translational slip in L5/S1 level were treated with lumbar interbody fusion (LIF) via posterior approach. Thirty-four of these patients (Coflex group) received an additional implantation of the interspinous spacer device (Coflex) in the level L4/L5, while the rest of 28 patients (fusion group) underwent the fusion surgery alone. Clinical and radiographic examinations were performed at pre- and postoperative visits to compare the clinical outcomes and the changes of the L4/L5 vertebral disc degeneration on MRI in both Coflex and fusion group. Although both Coflex and fusion group showed improvements of the clinical outcomes assessed by the Oswestry Disability Index (ODI) after surgery, patients in Coflex group had more significant amelioration (P < 0.05) compared to fusion group. During follow up, the postoperative disc degeneration changes in Coflex group assessed by the relative signal intensity (RSI) differed from those in fusion group (P < 0.05). The supplemental implantation of Coflex after the fusion surgery could delay the disc degeneration of the adjacent segment. PMID:26131210

  17. Lumbar disc replacement: update.

    PubMed

    Heider, F C; Mayer, H M; Siepe, C J

    2015-06-01

    Over the last decades, fusion of lumbar spinal motion segments has represented the mainstay of treatment of lumbar degenerative conditions which failed to respond adequately to conservative therapy. Increasing demands and expectations from patients as well as the necessity to avoid fusion related negative side effects such as adjacent level disc degeneration, considerable complication and reoperation rates, cranial facet joint violations, pseudarthrosis and others led to the development of motion preserving technologies such as total lumbar disc replacement (TDR). The first and rudimentary attempts to preserve motion of lumbar motion segments can be dated back to the early 1950s. Over the past two to three decades, a variety of new implants with different motion characteristics have been developed and introduced into the market. Despite of the extensive knowledge which has been gained in this field of research, insurers in the United States have refused to reimburse surgeons due to fear of late complications and reoperations as well as unknown secondary costs, which led to a global decline in the numbers of TDR procedures. The current literature review intends to provide a concise summary of the adequate indications for TDR as well as outcome determining factors and delineate the role of TDR in the currently available armamentarium for the treatment of low back pain (LBP) resulting from degenerative disc disease (DDD) without instabilities or deformities. PMID:25649068

  18. Symptomatic Thoracic Spinal Cord Herniation: Case Series and Technical Report

    PubMed Central

    Hawasli, Ammar H.; Ray, Wilson Z.; Wright, Neill M.

    2014-01-01

    Background and Importance Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on treatment algorithm and surgical technique, and there is little data on clinical outcomes. Clinical Presentation In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially due to multiple sclerosis. Finally compared to compressive myelopathy in the thoracic spine, surgical treatment of ISH led to rapid improvement despite long duration of symptoms. Conclusion Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair. PMID:24871148

  19. Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult

    PubMed Central

    Rosat, Adri; Alonso, Ayaya; Padilla, Javier; Sanz, Pablo; Varona, M. Arnzazu; Mndiz, Javier; Moneva, Enrique; Barrera, Manuel

    2015-01-01

    Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient's condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms. PMID:26064764

  20. Apsidal precession, disc breaking and viscosity in warped discs

    NASA Astrophysics Data System (ADS)

    Nealon, Rebecca; Nixon, Chris; Price, Daniel J.; King, Andrew

    2016-01-01

    We demonstrate the importance of general relativistic apsidal precession in warped black hole accretion discs by comparing three-dimensional smoothed particle hydrodynamic simulations in which this effect is first neglected, and then included. If apsidal precession is neglected, we confirm the results of an earlier magnetohydrodynamic simulation which made this assumption, showing that at least in this case the α viscosity model produces very similar results to those of simulations where angular momentum transport is due to the magnetorotational instability. Including apsidal precession significantly changes the predicted disc evolution. For moderately inclined discs thick enough that tilt is transported by bending waves, we find a disc tilt which is non-zero at the inner disc edge and oscillates with radius, consistent with published analytic results. For larger inclinations, we find disc breaking.

  1. Polarimetric microlensing of circumstellar discs

    NASA Astrophysics Data System (ADS)

    Sajadian, Sedighe; Rahvar, Sohrab

    2015-12-01

    We study the benefits of polarimetry observations of microlensing events to detect and characterize circumstellar discs around the microlensed stars located at the Galactic bulge. These discs which are unresolvable from their host stars make a net polarization effect due to their projected elliptical shapes. Gravitational microlensing can magnify these signals and make them be resolved. The main aim of this work is to determine what extra information about these discs can be extracted from polarimetry observations of microlensing events in addition to those given by photometry ones. Hot discs which are closer to their host stars are more likely to be detected by microlensing, owing to more contributions in the total flux. By considering this kind of discs, we show that although the polarimetric efficiency for detecting discs is similar to the photometric observation, but polarimetry observations can help to constraint the disc geometrical parameters e.g. the disc inner radius and the lens trajectory with respect to the disc semimajor axis. On the other hand, the time-scale of polarimetric curves of these microlensing events generally increases while their photometric time-scale does not change. By performing a Monte Carlo simulation, we show that almost four optically thin discs around the Galactic bulge sources are detected (or even characterized) through photometry (or polarimetry) observations of high-magnification microlensing events during 10-yr monitoring of 150 million objects.

  2. Have protoplanetary discs formed planets?

    NASA Astrophysics Data System (ADS)

    Greaves, J. S.; Rice, W. K. M.

    2010-09-01

    It has recently been noted that many discs around T Tauri stars appear to comprise only a few Jupiter masses of gas and dust. Using millimetre surveys of discs within six local star formation regions, we confirm this result, and find that only a few per cent of young stars have enough circumstellar material to build gas giant planets, in standard core accretion models. Since the frequency of observed exoplanets is greater than this, there is a `missing-mass' problem. As alternatives to simply adjusting the conversion of dust flux to disc mass, we investigate three other classes of solution. Migration of planets could hypothetically sweep up the disc mass reservoir more efficiently, but trends in multiplanet systems do not support such a model, and theoretical models suggest that the gas accretion time-scale is too short for migration to sweep the disc. Enhanced inner-disc mass reservoirs are possible, agreeing with predictions of disc evolution through self-gravity, but not adding to millimetre dust flux as the inner disc is optically thick. Finally, the incidence of massive discs is shown to be higher at the protostellar stages, Classes 0 and I, where discs substantial enough to form planets via core accretion are abundant enough to match the frequency of exoplanets. Gravitational instability may also operate in the Class 0 epoch, where half the objects have potentially unstable discs of >~30 per cent of the stellar mass. However, recent calculations indicate that forming gas giants inside 50 au by instability is unlikely, even in such massive discs. Overall, the results presented suggest that the canonically `protoplanetary' discs of Class II T Tauri stars have globally low masses in dust observable at millimetre wavelengths, and conversion to larger bodies (anywhere from small rocks up to planetary cores) must already have occurred.

  3. One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy

    PubMed Central

    Cincu, Rafael; Lorente, Francisco de Asis; Gomez, Joaquin; Eiras, Jose; Agrawal, Amit

    2015-01-01

    Objectives: Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc. Methods: In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed. Results: There were 27 male and 23 female with followup mean follow up of 115 months (range 105130 months) with a mean age was 52 years (range 2674 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L34 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions. Conclusions: Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective. PMID:25767571

  4. The Effects of Platelet-Rich Plasma on Halting the Progression in Porcine Intervertebral Disc Degeneration.

    PubMed

    Cho, Hongsik; Holt, David C; Smith, Richard; Kim, Song-Ja; Gardocki, Raymond J; Hasty, Karen A

    2016-02-01

    Disc degeneration and the subsequent herniation and/or rupture of the intervertebral disc (IVD) are due to a failure of the extracellular matrix of the annulus to contain the contents of the nucleus. This results from inadequate maintenance of the matrix components as well as the proteolytic activity of matrix metalloproteinases (MMPs) that degrade matrix molecules. Arresting progression of disc degeneration in the annulus holds greater clinical potential at this point than prevention of its onset in the nucleus. Therefore, in this study, we have therapeutic aims that would decrease levels of the cytokines and growth factors that indirectly lead to disc degeneration via stimulating MMP and increase levels of several beneficial growth factors, such as transforming growth factor-?, with the addition of platelet-rich plasma (PRP) that would stimulate cell growth and matrix synthesis. For this study, we attempted to address these imbalances of metabolism by using tumor necrosis factor-? treated annulus fibrosus cells isolated from porcine IVD tissue and incubating the cells in a growth factor rich environment with PRP. These results indicate that the PRP in vitro increased the production of the major matrix components (type II collagen and aggrecan) and decreased the inhibitory collagenase MMP-1. This application will address a therapeutic approach for intervening early in the degenerative process. PMID:26147759

  5. CT-guided percutaneous laser disc decompression with Ceralas D, a diode laser with 980-nm wavelength and 200-microm fiber optics.

    PubMed

    Gevargez, A; Groenemeyer, D W; Czerwinski, F

    2000-01-01

    The aim of this study was to evaluate the compact, portable Ceralas-D diode laser (CeramOptec; 980 + 30 nm wavelength, 200-microm optical fiber) concerning clinical usefulness, handling, and clinical results in the CT-guided treatment of herniated lumbar discs. The positioning of the canula in intradiscal space, the placement of the laser fiber into the disc through the lying canula, and the vaporization itself were carried out under CT-guidance. Due to the thin fiber optic, it was possible to use a thin 23-gauge canula. The laser procedure was performed in 0.1- to 1-s shots with 1-s pulse pause and 4-W power output. A total of 1650-2300 J was applied on each percutaneous laser disc decompression (PLDD). Results in 26 patients were established with a visual-analogue scale (VAS). On the follow-up examinations, 46% of the patients were absolutely pain free ( > 85 % VAS) and fully active in everyday life after 4 postoperative weeks. Thirty-one percent of patients were relieved of the leg pain but had occasional back pain without sensorimotor impairment. Fifteen percent sensed a slight alleviation ( > 50% VAS) of the radiate pain. Eight percent did not experience radicular or pseudo-radicular pain alleviation (< 25% VAS). Cerales-D proves to be an efficient tool for CT-guided PLDD on non-sequestered herniated lumbar discs. PMID:10939481

  6. Pathophysiology of Degenerative Disc Disease

    PubMed Central

    2009-01-01

    The intervertebral disc is characterized by a tension-resisting annulus fibrosus and a compression-resisting nucleus pulposus composed largely of proteoglycan. The most important function of the annulus and nucleus is to provide mechanical stability to the disc. Degenerative disc disease in the lumbar spine is a serious health problem. Although the three joint complex model of the degenerative process is widely accepted, the etiological basis of this degeneration is poorly understood. With the recent progress in molecular biology and modern biological techniques, there has been dramatic improvement in the understanding of aging and degenerative changes of the disc. Knowledge of the pathophysiology of the disc degeneration can help in the appropriate choice of treatment and to develop tissue engineering for biological restoration of degenerated discs. PMID:20404946

  7. Enclosed rotary disc air pulser

    DOEpatents

    Olson, A. L. (Idaho Falls, ID); Batcheller, Tom A. (Idaho Falls, ID); Rindfleisch, J. A. (Arco, ID); Morgan, John M. (Arco, ID)

    1989-01-01

    An enclosed rotary disc air pulser for use with a solvent extraction pulse olumn includes a housing having inlet, exhaust and pulse leg ports, a shaft mounted in the housing and adapted for axial rotation therein, first and second disc members secured to the shaft within the housing in spaced relation to each other to define a chamber therebetween, the chamber being in communication with the pulse leg port, the first disc member located adjacent the inlet port, the second disc member being located adjacent the exhaust port, each disc member having a milled out portion, the disc members positioned on the shaft so that as the shaft rotates, the milled out portions permit alternative cyclical communication between the inlet port and the chamber and the exhaust port and the chamber.

  8. Preparation of intact bovine tail intervertebral discs for organ culture.

    PubMed

    Chan, Samantha C W; Gantenbein-Ritter, Benjamin

    2012-01-01

    The intervertebral disc (IVD) is the joint of the spine connecting vertebra to vertebra. It functions to transmit loading of the spine and give flexibility to the spine. It composes of three compartments: the innermost nucleus pulposus (NP) encompassing by the annulus fibrosus (AF), and two cartilaginous endplates connecting the NP and AF to the vertebral body on both sides. Discogenic pain possibly caused by degenerative intervertebral disc disease (DDD) and disc herniations has been identified as a major problem in our modern society. To study possible mechanisms of IVD degeneration, in vitro organ culture systems with live disc cells are highly appealing. The in vitro culture of intact bovine coccygeal IVDs has advanced to a relevant model system, which allows the study of mechano-biological aspects in a well-controlled physiological and mechanical environment. Bovine tail IVDs can be obtained relatively easy in higher numbers and are very similar to the human lumbar IVDs with respect to cell density, cell population and dimensions. However, previous bovine caudal IVD harvesting techniques retaining cartilaginous endplates and bony endplates failed after 1-2 days of culture since the nutrition pathways were obviously blocked by clotted blood. IVDs are the biggest avascular organs, thus, the nutrients to the cells in the NP are solely dependent on diffusion via the capillary buds from the adjacent vertebral body. Presence of bone debris and clotted blood on the endplate surfaces can hinder nutrient diffusion into the center of the disc and compromise cell viability. Our group established a relatively quick protocol to "crack"-out the IVDs from the tail with a low risk for contamination. We are able to permeabilize the freshly-cut bony endplate surfaces by using a surgical jet lavage system, which removes the blood clots and cutting debris and very efficiently reopens the nutrition diffusion pathway to the center of the IVD. The presence of growth plates on both sides of the vertebral bone has to be avoided and to be removed prior to culture. In this video, we outline the crucial steps during preparation and demonstrate the key to a successful organ culture maintaining high cell viability for 14 days under free swelling culture. The culture time could be extended when appropriate mechanical environment can be maintained by using mechanical loading bioreactor. The technique demonstrated here can be extended to other animal species such as porcine, ovine and leporine caudal and lumbar IVD isolation. PMID:22330901

  9. Preparation of Intact Bovine Tail Intervertebral Discs for Organ Culture

    PubMed Central

    Chan, Samantha C.W.; Gantenbein-Ritter, Benjamin

    2012-01-01

    The intervertebral disc (IVD) is the joint of the spine connecting vertebra to vertebra. It functions to transmit loading of the spine and give flexibility to the spine. It composes of three compartments: the innermost nucleus pulposus (NP) encompassing by the annulus fibrosus (AF), and two cartilaginous endplates connecting the NP and AF to the vertebral body on both sides. Discogenic pain possibly caused by degenerative intervertebral disc disease (DDD) and disc herniations has been identified as a major problem in our modern society. To study possible mechanisms of IVD degeneration, in vitro organ culture systems with live disc cells are highly appealing. The in vitro culture of intact bovine coccygeal IVDs has advanced to a relevant model system, which allows the study of mechano-biological aspects in a well-controlled physiological and mechanical environment. Bovine tail IVDs can be obtained relatively easy in higher numbers and are very similar to the human lumbar IVDs with respect to cell density, cell population and dimensions. However, previous bovine caudal IVD harvesting techniques retaining cartilaginous endplates and bony endplates failed after 1-2 days of culture since the nutrition pathways were obviously blocked by clotted blood. IVDs are the biggest avascular organs, thus, the nutrients to the cells in the NP are solely dependent on diffusion via the capillary buds from the adjacent vertebral body. Presence of bone debris and clotted blood on the endplate surfaces can hinder nutrient diffusion into the center of the disc and compromise cell viability. Our group established a relatively quick protocol to "crack"-out the IVDs from the tail with a low risk for contamination. We are able to permeabilize the freshly-cut bony endplate surfaces by using a surgical jet lavage system, which removes the blood clots and cutting debris and very efficiently reopens the nutrition diffusion pathway to the center of the IVD. The presence of growth plates on both sides of the vertebral bone has to be avoided and to be removed prior to culture. In this video, we outline the crucial steps during preparation and demonstrate the key to a successful organ culture maintaining high cell viability for 14 days under free swelling culture. The culture time could be extended when appropriate mechanical environment can be maintained by using mechanical loading bioreactor. The technique demonstrated here can be extended to other animal species such as porcine, ovine and leporine caudal and lumbar IVD isolation. PMID:22330901

  10. Numbered nasal discs for waterfowl

    USGS Publications Warehouse

    Bartonek, J.C.; Dane, C.W.

    1964-01-01

    Numbered nasal discs were successfully used in studies requiring large numbers of individually marked waterfowl. The procedure for constructing these discs is outlined. Blue-winged teal (Anas discors) with 5/8-inch discs, and canvasback (Aythya valisineria) and redhead (A. americana) with 3/4-inch discs can be individually identified up to 50 and 80 yards, respectively, with a gunstock-mounted, 20-power spotting scope. The particular value of these markers is their durability, the number of combinations possible, and the apparent absence of behavioral or mortality influence among such species as the blue-winged teal.

  11. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation

    PubMed Central

    Weinstein, James N.; Lurie, Jon D.; Tosteson, Tor D.; Skinner, Jonathan S.; Hanscom, Brett; Tosteson, Anna N. A.; Herkowitz, Harry; Fischgrund, Jeffrey; Cammisa, Frank P.; Albert, Todd; Deyo, Richard A.

    2008-01-01

    Context For patients with lumbar disk herniation, the Spine Patient Outcomes Research Trial (SPORT) randomized trial intent-to-treat analysis showed small but not statistically significant differences in favor of diskectomy compared with usual care. However, the large numbers of patients who crossed over between assigned groups precluded any conclusions about the comparative effectiveness of operative therapy vs usual care. Objective To compare the treatment effects of diskectomy and usual care. Design, Setting, and Patients Prospective observational cohort of surgical candidates with imaging-confirmed lumbar intervertebral disk herniation who were treated at 13 spine clinics in 11 US states and who met the SPORT eligibility criteria but declined randomization between March 2000 and March 2003. Interventions Standard open diskectomy vs usual nonoperative care. Main Outcome Measures Changes from baseline in the Medical Outcomes Study Short-Form Health Survey (SF-36) bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons/MODEMS version). Results Of the 743 patients enrolled in the observational cohort, 528 patients received surgery and 191 received usual nonoperative care. At 3 months, patients who chose surgery had greater improvement in the primary outcome measures of bodily pain (mean change: surgery, 40.9 vs nonoperative care, 26.0; treatment effect, 14.8; 95% confidence interval, 10.8-18.9), physical function (mean change: surgery, 40.7 vs nonoperative care, 25.3; treatment effect, 15.4; 95% CI, 11.6-19.2), and Oswestry Disability Index (mean change: surgery, ?36.1 vs nonoperative care, ?20.9; treatment effect, ?15.2; 95% CI, ?18.5. to ?11.8). These differences narrowed somewhat at 2 years: bodily pain (mean change: surgery, 42.6 vs nonoperative care, 32.4; treatment effect, 10.2; 95% CI, 5.9-14.5), physical function (mean change: surgery, 43.9 vs nonoperavtive care 31.9; treatment effect, 12.0; 95% CI; 7.9-16.1), and Oswestry Disability Index (mean change: surgery ?37.6 vs nonoperative care ?24.2; treatment effect, ?13.4; 95% CI, ?17.0 to ?9.7). Conclusions Patients with persistent sciatica from lumbar disk herniation improved in both operated and usual care groups. Those who chose operative intervention reported greater improvements than patients who elected nonoperative care. However, nonrandomized comparisons of self-reported outcomes are subject to potential confounding and must be interpreted cautiously. Trial Registration clinicaltrials.gov Identifier: NCT00000410 PMID:17119141

  12. Preparation of ormetoprim sulfadimethoxine medicated discs for disc diffusion assay

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Romet (a blend of ormetoprim and sulfadimethoxine) is a typeA medicated article for the manufacture of medicated feed in the catfish industry. Recently, the commercial manufacture of ormetoprimsulfadimethoxine susceptibility discs was discontinued. Ormetoprimsulfadimethoxine discs were prepared at...

  13. CT of lumbar spine disk herniation: correlation with surgical findings

    SciTech Connect

    Firooznia, H.; Benjamin, V.; Kricheff, I.I.; Rafii, M.; Golimbu, C.

    1984-03-01

    Computed tomography (CT) of the lumbar spine was performed with selectively positioned 5-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. One hundred consecutive patients with 116 surgical disk explorations were reviewed. There was agreement between the CT and surgical findings in 89 patients (104 explorations) in determination of presence or absence of a herniated nucleus pulposus (HNP). Discrepancy occurred in 12 instances (11 patients): two because of incorrect interpretations, five in previously operated patients, three in spondylolisthesis, and two in spinal stenosis. There were 97 true-positives, eight false-negatives, seven true-negatives, and four false-positives. If nine previously operated patients are excluded from the study, then CT was accurate in detection of presence or absence of an HNP in 93% of the disk explorations.

  14. Seckel syndrome with asymptomatic tonsillar herniation and congenital mirror movements.

    PubMed

    Thapa, Rajoo; Mukherjee, Kabita

    2010-02-01

    Seckel syndrome is a rare genetic disorder of recessive inheritance characterized by prenatal-onset growth retardation, abnormally small head, varying degrees of mental retardation and an unusual ''beak-like'' protrusion of the nose. Additionally, it is associated with multiple organ system anomalies, including that of the central nervous system. An 8-year-old male child with typical features of Seckel syndrome and asymptomatic cerebellar tonsillar herniation diagnosed by magnetic resonance imaging associated with congenital mirror movements of the upper extremities is described. The child, additionally, had agenesis of the corpus callosum. Previously reported central nervous system anomalies associated with congenital mirror movements include corpus callosal agenesis and cranio-vertebral anomalies, both of which were present in this child. To the best of our knowledge, this is the first report of congenital mirror movements occurring in association with Seckel syndrome. PMID:19372093

  15. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation

    PubMed Central

    Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna N. A.; Hanscom, Brett; Skinner, Jonathan S.; Abdu, William A.; Hilibrand, Alan S.; Boden, Scott D.; Deyo, Richard A.

    2008-01-01

    Context Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial. Objective To assess the efficacy of surgery for lumbar intervertebral disk herniation. Design, Setting, and Patients The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Patients were 501 surgical candidates (mean age, 42 years; 42% women) with imaging-confirmed lumbar intervertebral disk herniation and persistent signs and symptoms of radiculopathy for at least 6 weeks. Interventions Standard open diskectomy vs nonoperative treatment individualized to the patient. Main Outcome Measures Primary outcomes were changes from baseline for the Medical Outcomes Study 36-item Short-Form Health Survey bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons MODEMS version) at 6 weeks, 3 months, 6 months, and 1 and 2 years from enrollment. Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status. Results Adherence to assigned treatment was limited: 50% of patients assigned to surgery received surgery within 3 months of enrollment, while 30% of those assigned to nonoperative treatment received surgery in the same period. Intent-to-treat analyses demonstrated substantial improvements for all primary and secondary outcomes in both treatment groups. Between-group differences in improvements were consistently in favor of surgery for all periods but were small and not statistically significant for the primary outcomes. Conclusions Patients in both the surgery and the nonoperative treatment groups improved substantially over a 2-year period. Because of the large numbers of patients who crossed over in both directions, conclusions about the superiority or equivalence of the treatments are not warranted based on the intent-to-treat analysis. Trial Registration clinicaltrials.gov Identifier: NCT00000410 PMID:17119140

  16. THE VACUUM/STEAM/VACUUM PROCESS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Vacuum/Steam/Vacuum surface intervention pilot plant process was developed. The process was developed for chicken, hot dogs, fruits and vegetables, and catfish. Optimum process conditions were determined as nominally, 138 C saturated steam, vacuum and steam times of 0.1 s except that the final...

  17. Extraperitoneal inguinoscrotal herniation of the ureter: a rare case of recurrence after hernia repair.

    PubMed

    Golgor, E; Stroszczynski, C; Froehner, M

    2009-01-01

    Inguinoscrotal herniation of the ureter is a rare finding with the potential for serious surgical complications. Two anatomic forms are defined. In the more common paraperitoneal variant, the herniating peritoneal sac drags the ureter and sometimes other abdominal structures with it. The uncommon variant--extraperitoneal inguinal herniais without a peritoneal sac and consists of the ureter and fat tissue. We report a case of extraperitoneal inguinoscrotal hernia possibly due to a prior inguinal hernia repair. PMID:19641370

  18. Spontaneous intercostal lung herniation complicated by rib fractures: a therapeutic dilemma

    PubMed Central

    Wani, Adil S.; Kalamkar, Prachi; Alhassan, Sulaiman; Farrell, Michael J.

    2015-01-01

    Lung herniation has been defined as a protrusion of lung tissue through its bounding structure. We present a case of spontaneous intercostal lung herniation following bouts of cough, which was complicated by multiple rib fractures, in which we had to adopt a non-surgical approach due to the clinical circumstance. Its understanding in the field of internal medicine is important as appropriate therapeutic judgment, and long-term follow-up is essential for full recovery. PMID:26719812

  19. Cervical total disc arthroplasty.

    PubMed

    Basho, Rahul; Hood, Kenneth A

    2012-06-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer. PMID:24353955

  20. Diagnosis, treatment, and complications of adult lumbar disk herniation: evidence-based data for the healthcare professional.

    PubMed

    Klineberg, Eric; Ching, Alexander; Mundis, Greg; Burton, Douglas; Bess, Shay

    2015-01-01

    Lumbar disk herniation is a commonly seen disorder that requires care by spinal surgeons and healthcare professionals. Although there has been substantial research on the diagnosis, treatment, complications, and outcomes of lumbar disk herniation, patient management varies. A review and evaluation of the literature (with special regard for high-quality randomized studies) and familiarity with best practices guidelines for the evaluation, management, and treatment of adult lumbar disk herniation will enhance the optimal delivery of health care to affected patients. PMID:25745924

  1. The Vacuum Bubble Nucleation

    SciTech Connect

    Lee, Bum-Hoon; Lee, Wonwoo

    2009-07-10

    We study the nucleation of a vacuum bubble via the vacuum-to-vacuum tunneling transition in curved spacetime. We consider Coleman-de Luccia's semiclassical approximation at zero temperature in pure Einstein theory of gravity and the theory with nonminimal coupling. We discuss the dynamics of a nucleated vacuum bubble.

  2. Vacuum mechatronics. Proceedings.

    NASA Astrophysics Data System (ADS)

    Belinski, S. E.; Shirazi, M.; Hackwood, S.; Beni, G.

    The discipline of vacuum mechatronics is the design and development of vacuum-compatible, computer-controlled mechanisms for manipulating, sensing and testing in a vacuum environment. Vacuum mechantronics is relevant to research engineers in integrated circuit manufacturing, surface physics, food processing, biotechnology, materials handling, space sciences and manufacturing.

  3. Medical Information on Optical Disc*

    PubMed Central

    Schipma, Peter B.; Cichocki, Edward M.; Ziemer, Susan M.

    1987-01-01

    Optical discs may permit a revolutionary change in the distribution and use of medical information. A single compact disc, similar in size to that used for digital audio recording, can contain over 500 million characters of information that is accessible by a Personal Computer. These discs can be manufactured at a cost lower than that of print on paper, at reasonable volumes. Software can provide the health care professional with nearly instantaneous access to the information. Thus, for the first time, the opportunity exists to have large local medical information collections. This paper describes an application of this technology in the field of Oncology.

  4. Germanium detector vacuum encapsulation

    NASA Astrophysics Data System (ADS)

    Madden, N. W.; Malone, D. F.; Pehl, R. H.; Cork, C. P.; Luke, P. N.; Landis, D. A.; Pollard, M. J.

    1991-08-01

    This paper describes an encapsulation technology that should significantly improve the viability of germanium gamma-ray detectors for a number of important applications. A specialized vacuum chamber has been constructed in which the detector and the encapsulating module are processed in high vacuum. Very high vacuum conductance is achieved within the valveless encapsulating module. The detector module is then sealed without breaking the chamber vacuum. The details of the vacuum chamber, valveless module, processing, and sealing method are presented.

  5. Germanium detector vacuum encapsulation

    NASA Technical Reports Server (NTRS)

    Madden, N. W.; Malone, D. F.; Pehl, R. H.; Cork, C. P.; Luke, P. N.; Landis, D. A.; Pollard, M. J.

    1991-01-01

    This paper describes an encapsulation technology that should significantly improve the viability of germanium gamma-ray detectors for a number of important applications. A specialized vacuum chamber has been constructed in which the detector and the encapsulating module are processed in high vacuum. Very high vacuum conductance is achieved within the valveless encapsulating module. The detector module is then sealed without breaking the chamber vacuum. The details of the vacuum chamber, valveless module, processing, and sealing method are presented.

  6. Natural vacuum electronics

    NASA Technical Reports Server (NTRS)

    Leggett, Nickolaus

    1990-01-01

    The ambient natural vacuum of space is proposed as a basis for electron valves. Each valve is an electron controlling structure similiar to a vacuum tube that is operated without a vacuum sustaining envelope. The natural vacuum electron valves discussed offer a viable substitute for solid state devices. The natural vacuum valve is highly resistant to ionizing radiation, system generated electromagnetic pulse, current transients, and direct exposure to space conditions.

  7. Associations between Alpha Angle and Herniation Pit on MRI Revisited in 185 Asymptomatic Hip Joints

    PubMed Central

    Lee, Eunchae

    2015-01-01

    Objective To evaluate the association between alpha angle and herniation pit on MRI in asymptomatic hip joints and their associations with demographic variables. Materials and Methods Hip MRI of 185 asymptomatic hip joints of 105 adults (age 18 to 80 years) from September 2011 through December 2012 were retrospectively studied. Alpha angles were measured on oblique axial MR images by 2 observers. Herniation pit was determined by 1 observer. Size measures, prevalence, and statistical analyses were conducted regarding its association with age, gender, laterality (right or left hip). Intra- and inter-observer agreements were determined by intra-class correlation coefficient. Results The prevalence of herniation pit in asymptomatic hips was 21.6%. The range of alpha angle was 27.6-65.0 degrees. Seventeen and 16 out of 185 (9.1% and 8.6%) hip joints showed alpha angle of ≥ 55 degrees in first and second measurement sessions, respectively. There was no association between alpha angle ≥ 55 and presence of herniation pit. There was no association between alpha angle ≥ 55 and the size of herniation pit. Inter-observer agreement of alpha angle was 0.485 between first measurements of first vs. second observer, respectively. Intra-observer agreement of alpha angle was 0.654, respectively. Forty (21.6%) of 185 hip joints (35 of 105 patients, 33.3%) had herniation pit, with no difference according to age, gender, or laterality of hip joint. Conclusion There is no association between alpha angle ≥ 55 degrees and presence of herniation pit or demographic variables. PMID:26576122

  8. Acute intraoperative brain herniation during elective neurosurgery: pathophysiology and management considerations.

    PubMed Central

    Whittle, I R; Viswanathan, R

    1996-01-01

    OBJECTIVES: To describe operative procedures, pathophysiological events, management strategies, and clinical outcomes after acute intraoperative brain herniation during elective neurosurgery. METHODS: Review of clinical diagnoses, operative events, postoperative CT findings, intracranial pressure, and arterial blood pressure changes and outcomes in a series of patients in whom elective neurosurgery had to be abandoned because of severe brain herniation. RESULTS: Acute intraoperative brain herniation occurred in seven patients. In each patient subarachnoid or intraventricular haemorrhage preceded the brain herniation. The haemorrhage occurred after intraoperative aneurysm rupture either before arachnoidal dissection (three) or during clip placement (one); after resection of 70% of a recurrent hemispheric astroblastoma; after resection of a pineal tumour; and after a stereotactic biopsy of an AIDS lesion. In all patients the procedure was abandoned because of loss of access to the intracranial operating site, medical measures to control intracranial pressure undertaken (intravenous thiopentone), an intraventricular catheter or Camino intracranial pressure monitor inserted, and CT performed immediately after scalp closure. The patients were transferred to an intensive care unit for elective ventilation and multimodality physiological monitoring. Using this strategy all patients recovered from the acute ictus and no patient had intracranial pressure > 35 mm Hg. Although one patient with an aneurysm rebled and died three days later the other six patients did well considering the dramatic and apparently catastrophic nature of the open brain herniation. CONCLUSIONS: There are fundamental differences in the pathophysiological mechanisms, neuroradiological findings, and outcomes between open brain herniation occurring in post-traumatic and elective neurosurgical patients. The surprisingly good outcomes in this series may have occurred because the intraoperative brain herniation was secondary to extra-axial subarachnoid or intraventricular haemorrhage rather than intraparenchymal haemorrhage or acute brain oedema. Expeditious abandonment of the procedure and closure of the cranium may also have contributed to the often very satisfactory clinical outcome. Images PMID:8971104

  9. Percutaneous laser lumbar disc decompression - mechanism of action, indications and contraindications.

    PubMed

    Maksymowicz, Wojciech; Barczewska, Monika; Sobieraj, Andrzej

    2004-06-30

    This article describes the development of minimally invasive methods in the treatment of lumbar discopathy, with particular attention to percutaneous laser disc decompression (PLDD). The authors discus the therapeutic operating mechanism of PLDD, emphasizing the importance of the thermal characteristics of laser light, which is responsible for the vaporization and ablation of a small amount of tissue from the nucleus pulposus. This causes a significant reduction in pressure in the closed structure of the disc, and consequently reduced compression exerted by the disk on the dural sac and the nerve roots. Improvement in the flow of cerebro-spinal fluid has also been observed on the level at which the operation is performed. On the basis of our own experience and the reports of other authors, we have specified indications and contra-indications for PLDD. Our conclusion is that PLDD is an effective treatment method for low back pain and ischialgia caused by protrusion or herniation of the nucleus pulposus, with elimination or significant reduction in symptoms in over 75% of those treated; reduction or resolution of neurological deficits that arise in the course of lumbar discopathy has also been observed. This method enables one-stage treatment of multi-level degenerative changes in the intervertebral disc. The only absolute contraindications for PLDD are the presence of sequestration, disturbances in blood coagulation, and bacterial infection. PMID:17675991

  10. Ruptured anterior spinal artery aneurysm from a herniated cervical disc. A case report and review of the literature

    PubMed Central

    Nakhla, Jonathan; Nasser, Rani; Yassari, Reza; Pasquale, David; Altschul, David

    2016-01-01

    Background: Subarachnoid hemorrhage (SAH) caused by a ruptured cervical anterior spinal artery aneurysm is extremely rare and in the setting of cervical spondylosis. This case presentation reviews the diagnosis, management, and treatment of such aneurysms. Case Presentation: An 88-year-old female presented with the worst headache of her life without focal deficits. She was found to have diffuse SAH in the basal cisterns extending inferiorly down the spinal canal. Review of the neurodiagnostic images revealed an anterior spinal artery aneurysm in the setting of cervical spondylosis. Conclusions: Clinicians should be suspicious of cervical spondylosis as a rare etiology for an SAH when cerebral angiograms prove negative for intracranial aneurysms. PMID:26862449

  11. Cover layer technology and a new hard coat for cartridge-free Blu-ray disc

    NASA Astrophysics Data System (ADS)

    Kang, Tae-Sik; Han, Mi Young; Lee, Seong-Keun; Jang, Sung Hoon; Hong, Young Jun; Seo, Hun; Lee, Chang-Ho

    2004-09-01

    Spin coating method for cover layer of Blu-ray Disc (BD) has been studied and a new hard coat resin including antifouling property has been developed. A vacuum chuck was newly designed to minimize the ski-jump effect. 3 mm hard coat layer was stacked onto the 97 mm cover layer by spin coating method.

  12. A case of nerve root heat injury induced by percutaneous laser disc decompression performed at an outside institution: technical case report.

    TOXLINE Toxicology Bibliographic Information

    Kobayashi S; Uchida K; Takeno K; Yayama T; Nakajima H; Nomura E; Hayakawa K; Meir A; Yonezawa T; Baba H

    2007-02-01

    OBJECTIVE: In recent years, percutaneous laser disc decompression (PLDD) has become a routine surgical procedure because it can be performed under local anesthesia and is minimally invasive. However, there is a risk of nerve root and endplate injury owing to heat generated by laser irradiation during PLDD. We recently performed salvage surgery on a patient with heat injury to the L5 nerve root that developed after PLDD.CLINICAL PRESENTATION: One month before presenting to our hospital, the patient underwent two sessions of PLDD for lumbar vertebral disk herniation at another institution. The patient developed worsening sciatica, as well as bowel and urinary problems after the PLDD.INTERVENTION: We performed salvage surgery after PLDD. The intraoperative findings in the present case included carbon spots in the dura mater of the nerve root and a disc herniation strongly adherent to the nerve roots. These findings indicate that the area adjacent to the nerve roots was damaged by excessive heat during laser irradiation.CONCLUSION: When salvage surgery is performed after a PLDD procedure, disc and nerve root injuries owing to laser heat energy must be considered.

  13. Enlivening Physics, a Local Video Disc Project.

    ERIC Educational Resources Information Center

    McInerney, M.

    1989-01-01

    Describes how to make and use an inexpensive video disc of physics demonstrations. Discusses the background, production of the disc, subject of the disc including angular momentum, "monkey and the hunter" experiment, Doppler shift, pressure of a constant volume of gas thermometer, and wave effects, and using the disc in classroom. (YP)

  14. Disc Golf: Teaching a Lifetime Activity

    ERIC Educational Resources Information Center

    Eastham, Susan L.

    2015-01-01

    Disc golf is a lifetime activity that can be enjoyed by students of varying skill levels and abilities. Disc golf follows the principles of ball golf but is generally easier for students to play and enjoy success. The object of disc golf is similar to ball golf and involves throwing a disc from the teeing area to the target in as few throws as

  15. Tissue engineering: A live disc

    NASA Astrophysics Data System (ADS)

    Hukins, David W. L.

    2005-12-01

    A material-cell hybrid device that mimics the anatomic shape of the intervertebral disc has been made and successfully implanted into mice to show that tissue engineering may, in the future, benefit sufferers from back pain.

  16. Disc Golf, a Growing Sport

    PubMed Central

    Nelson, Joseph T.; Jones, Richard E.; Runstrom, Michael; Hardy, Jolene

    2015-01-01

    Background Disc golf is a sport played much like traditional golf, but rather than using a ball and club, players throw flying discs with various throwing motions. It has been played by an estimated 8 to 12 million people in the United States. Like all sports, injuries sustained while playing disc golf are not uncommon. Although formalized in the 1970s, it has grown at a rapid pace; however, disc golfrelated injuries have yet to be described in the medical literature. Purpose To describe the most common injuries incurred by disc golf players while comparing the different types of throwing styles. Study Design Descriptive epidemiology study. Methods The data in this study were collected from 883 disc golf players who responded to an online survey collected over a 1-month period. Respondents answered 49 questions related to demographics, experience, style of play, and injury details. Using a chi-square analysis, common injuries sustained in players using backhand and forehand throwing styles were compared. Results More than 81% of respondents stated that they had sustained an injury playing disc golf, including injuries to the elbow (n = 325), shoulder (n = 305), back (n = 218), and knee (n = 199). The injuries were most commonly described as a muscle strain (n = 241), sprain (n = 162), and tendinitis (n = 145). The type of throw primarily used by players varied, with 86.2% using backhand, 12.7% using forehand, and 1.1% using an overhead throw. Players using a forehand throw were more likely to sustain an elbow injury (P = .014). Many players (n = 115) stated they had undergone surgery due to a disc golfrelated injury, with the most common surgeries including meniscal, shoulder, spine, and foot/ankle surgeries. Conclusion The majority of surveyed disc golfers sustained at least 1 injury while playing disc golf, with many requiring surgery. The types of injuries sustained by players varied by the types of throw primarily used. As the sport of disc golf continues to expand, health professionals should be aware of injuries sustained, with future studies focusing on injury prevention and education strategies. PMID:26665099

  17. Disc piezoelectric ceramic transformers.

    PubMed

    Erhart, Jiri; P?lpn, Petr; Dole?ek, Roman; Psota, Pavel; Ldl, Vt

    2013-08-01

    In this contribution, we present our study on disc-shaped and homogeneously poled piezoelectric ceramic transformers working in planar-extensional vibration modes. Transformers are designed with electrodes divided into wedge, axisymmetrical ring-dot, moonie, smile, or yin-yang segments. Transformation ratio, efficiency, and input and output impedances were measured for low-power signals. Transformer efficiency and transformation ratio were measured as a function of frequency and impedance load in the secondary circuit. Optimum impedance for the maximum efficiency has been found. Maximum efficiency and no-load transformation ratio can reach almost 100% and 52 for the fundamental resonance of ring-dot transformers and 98% and 67 for the second resonance of 2-segment wedge transformers. Maximum efficiency was reached at optimum impedance, which is in the range from 500 ? to 10 k?, depending on the electrode pattern and size. Fundamental vibration mode and its overtones were further studied using frequency-modulated digital holographic interferometry and by the finite element method. Complementary information has been obtained by the infrared camera visualization of surface temperature profiles at higher driving power. PMID:25004532

  18. Experimental Studies of Spray Deposition on a Flat Surface in a Vacuum Environment

    NASA Technical Reports Server (NTRS)

    Golliher, Eric L.; Yao, S. C.

    2015-01-01

    Cooling of spacecraft components in the space environment is an on-going research effort. The electronics used in modern spacecraft are always changing and the heat flux is increasing. New, one-of-a-kind missions require new approaches to thermal control. In this research, under vacuum conditions, a pulsed water spray impinged on a small disc, while a high speed data acquisition system recorded the temperature histories of this copper disc. The water droplets froze quickly and accumulated on the disc as the spray continued. After the spray stopped, the frozen water that remained on the disc then sublimated into the vacuum environment and cooled the disc. This paper examines two important aspects of this process: 1) the difference in spray start up and shutdown in a vacuum environment versus in a standard atmospheric pressure environment, and 2) the water utilization efficiency in a vacuum environment due to the effects of drop trajectories and drop bouncing on the surface. Both phenomena play a role during spray cooling in a vacuum. This knowledge should help spacecraft designers plan for spray cooling as an option to cool spacecraft electronics, human metabolic generated heat, and heat from other sources.

  19. Inguinoscrotal herniation of the ureter: Description of five cases

    PubMed Central

    E.S., Allam; D.Y., Johnson; S.G., Grewal; F.E., Johnson

    2015-01-01

    INTRODUCTION Descent of the ureter into the inguinal canal or scrotum is rare but undoubtedly underreported. Most known cases were recognized at the time of surgery for hernia repair. We encountered five cases recently. PRESENTATION OF CASE We reviewed the records and CT images of five patients with inguinal hernias containing a segment of the ureter. All of our cases, like most reported cases, featured obese adult males. Our cases had different outcomes, ranging from inadvertent injury of the displaced ureter to correction of the anomaly at the time of hernia repair. DISCUSSION In all of our cases, the affected ureter was displaced anteriorly from the psoas muscle by greater than 1cm at the level of the L4 vertebra on abdominal CT. This association has not been previously described. CONCLUSION Pre-operative diagnosis by CT can prevent injury to the ureter. We hypothesize that anterior displacement of the ureter at the level of L4 as seen on CT may be predictive of inguinoscrotal herniation of the ureter. PMID:26280912

  20. Lung herniation: an uncommon presentation of Poland's syndrome in a neonate at birth.

    PubMed

    Chandran, Suresh; Revanna, Krishna Gopagondanahalli; Ari, Dinesh; Rana, Aftab Ahmed

    2013-01-01

    A term male infant was admitted to the neonatal intensive care unit with an asymmetric chest wall and a herniating mass through the left fourth intercostal space. While crying, the left fourth intercostal space revealed a mass which herniated on expiration and receded on inspiration. On auscultation, the heart sounds were audible on the right side of the chest. Systemic examination was otherwise unremarkable. A roentgenogram of the chest revealed dextrocardia and hyperlucent left lung fields. Echocardiogram showed dextrocardia with a structurally normal heart. A clinical diagnosis of Poland's syndrome was made based on the hypoplasia of the left pectoral muscles, ribs and nipple, dextrocardia and lung herniation. He was thriving well when reviewed at 2 years of age. PMID:23921692

  1. Radiation hard vacuum switch

    DOEpatents

    Boettcher, Gordon E. (Albuquerque, NM)

    1990-01-01

    A vacuum switch with an isolated trigger probe which is not directly connected to the switching electrodes. The vacuum switch within the plasmatron is triggered by plasma expansion initiated by the trigger probe which travels through an opening to reach the vacuum switch elements. The plasma arc created is directed by the opening to the space between the anode and cathode of the vacuum switch to cause conduction.

  2. The Classical Vacuum.

    ERIC Educational Resources Information Center

    Boyer, Timothy H.

    1985-01-01

    The classical vacuum of physics is not empty, but contains a distinctive pattern of electromagnetic fields. Discovery of the vacuum, thermal spectrum, classical electron theory, zero-point spectrum, and effects of acceleration are discussed. Connection between thermal radiation and the classical vacuum reveals unexpected unity in the laws of

  3. Chondrule transport in protoplanetary discs

    NASA Astrophysics Data System (ADS)

    Goldberg, Aaron Z.; Owen, James E.; Jacquet, Emmanuel

    2015-10-01

    Chondrule formation remains one of the most elusive early Solar system events. Here, we take the novel approach of employing numerical simulations to investigate chondrule origin beyond purely cosmochemical methods. We model the transport of generically produced chondrules and dust in a 1D viscous protoplanetary disc model in order to constrain the chondrule formation events. For a single formation event we are able to match analytical predictions of the memory they retain of each other (complementarity), finding that a large mass accretion rate (≳10-7 M⊙ yr-1) allows for delays on the order of the disc's viscous time-scale between chondrule formation and chondrite accretion. Further, we find older discs to be severely diminished of chondrules, with accretion rates ≲10-9 M⊙ yr-1 for nominal parameters. We then characterize the distribution of chondrule origins in both space and time, as functions of disc parameters and chondrule formation rates, in runs with continuous chondrule formation and both static and evolving discs. Our data suggest that these can account for the observed diversity between distinct chondrite classes, if some diversity in accretion time is allowed for.

  4. Paradoxical Herniation After Unilateral Decompressive Craniectomy Predicts Better Patient Survival

    PubMed Central

    Chen, Weiqiang; Guo, Jingfang; Wu, Jin; Peng, Guoyi; Huang, Mindong; Cai, Chuwei; Yang, Yingming; Wang, Shousen

    2016-01-01

    Abstract Paradoxical herniation (PH) is a life-threatening emergency after decompressive craniectomy. In the current study, we examined patient survival in patients who developed PH after decompressive craniectomy versus those who did not. Risk factors for, and management of, PH were also analyzed. This retrospective analysis included 429 consecutive patients receiving decompressive craniectomy during a period from January 2007 to December 2012. Mortality rate and Glasgow Outcome Scale (GOS) were compared between those who developed PH (n = 13) versus those who did not (n = 416). A stepwise multivariate logistic regression analysis was carried out to examine the risk factors for PH. The overall mortality in the entire sample was 22.8%, with a median follow-up of 6 months. Oddly enough, all 13 patients who developed PH survived beyond 6 months. Glasgow Coma Scale did not differ between the 2 groups upon admission, but GOS was significantly higher in subjects who developed PH. Both the disease type and coma degree were comparable between the 13 PH patients and the remaining 416 patients. In all PH episodes, patients responded to emergency treatments that included intravenous hydration, cerebral spinal fluid drainage discontinuation, and Trendelenburg position. A regression analysis indicated the following independent risk factors for PH: external ventriculostomy, lumbar puncture, and continuous external lumbar drainage. The rate of PH is approximately 3% after decompressive craniectomy. The most intriguing findings of the current study were the 0% mortality in those who developed PH versus 23.6% mortality in those who did not develop PH and significant difference of GOS score at 6-month follow-up between the 2 groups, suggesting that PH after decompressive craniectomy should be managed aggressively. The risk factors for PH include external ventriculostomy, ventriculoperitoneal shunt, lumbar puncture, and continuous external lumbar drainage. PMID:26945365

  5. Intestinal Rotation and Physiological Umbilical Herniation During the Embryonic Period.

    PubMed

    Ueda, Yui; Yamada, Shigehito; Uwabe, Chigako; Kose, Katsumi; Takakuwa, Tetsuya

    2016-02-01

    Drastic changes occur during the formation of the intestinal loop (IL), including elongation, physiological umbilical herniation (PUH), and midgut rotation. Fifty-four sets of magnetic resonance images of embryos between Carnegie stage (CS) 14 and CS 23 were used to reconstruct embryonic digestive tract in three dimensions in the Amira program. Elongation, PUH, and rotation were quantified in relation to the proximal part of the superior mesenteric artery (SMA), designated as the origin. Up to CS 16, IL rotation was initially observed as a slight deviation of the duodenum and colorectum from the median plane. The PUH was noticeable after CS 17. At CS 18, the IL showed a hairpin-like structure, with the SMA running parallel to the straight part and the cecum located to the left. After CS 19, the IL began to form a complex structure as a result of the rapid growth of the small intestinal portion. By CS 20, the IL starting point had moved from the right cranial region to an area caudal to the origin, though elongation of the duodenum was not conspicuous-this was a change of almost 180 in position. The end of the IL remained in roughly the same place, to the left of and caudal to the origin. Notably, the IL rotated around the origin only during earlier stages and gradually moved away, running transversely after CS 19. The movements of the IL may be explained as the result of differential growth, suggesting that IL rotation is passive. Anat Rec, 299:197-206, 2016. 2015 Wiley Periodicals, Inc. PMID:26599074

  6. Continuous venovenous hemofiltration rapidly lowers toxic metabolites in a patient with MSUD and imminent cerebral herniation.

    PubMed

    Thimm, E; Hadzik, B; Hhn, T

    2010-07-01

    Maple syrup urine disease (MSUD) is an inborn error of amino acid metabolism. During catabolic stress encephalopathy and brain swelling that can culminate in brain herniation may occur. Beyond the neonatal period, these metabolic decompensations normally can be treated with a conservative dietary emergency regimen. Nevertheless in exceptionally severe cases also older patients may require extracorporeal interventions. We present the case of a 12-year-old patient with cerebral edema and imminent cerebral herniation. Continuous venovenous hemofiltration (CVVH) caused a prompt decrease of the toxic metabolite levels as well as an improvement of the patient's condition. PMID:20309789

  7. Delayed Presentation of Traumatic Diaphragmatic Rupture with Herniation of the Left Kidney and Bowel Loops

    PubMed Central

    Dwari, Amiya Kumar; Mandal, Abhijit; Sarkar, Sudhansu

    2013-01-01

    Rupture of the diaphragm mostly occurs following major trauma. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44-year-old male who presented two weeks after a minor blunt trauma. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. This case demonstrates the importance of considering the diagnosis in all cases of blunt trauma of the trunk. It also illustrates the rare possibility of herniation of kidney through the diaphragmatic tear. PMID:23956912

  8. Blunt Force Thoracic Trauma: A Case Study of Pericardial Rupture and Associated Cardiac Herniation

    PubMed Central

    Glotzer, O. S.; Bhakta, A.; Fabian, T.

    2014-01-01

    Pericardial rupture, with associated cardiac herniation, is generally fatal. Diagnosis is difficult and frequently missed due to the subtlety of identifying characteristics. We report a case of a left sided pericardial rupture and cardiac herniation resulting from a high speed motorcycle collision. This report describes the course of treatment from the emergent admission to the diagnosis of the pericardial tear to retrospective CT analysis and rupture identification. In addition the difficulties of initial diagnosis, key symptoms, and identification of CT images are presented and discussed. PMID:25184070

  9. Black hole accretion disc impacts

    NASA Astrophysics Data System (ADS)

    Pihajoki, P.

    2016-04-01

    We present an analytic model for computing the luminosity and spectral evolution of flares caused by a supermassive black hole impacting the accretion disc of another supermassive black hole. Our model includes photon diffusion, emission from optically thin regions and relativistic corrections to the observed spectrum and time-scales. We test the observability of the impact scenario with a simulated population of quasars hosting supermassive black hole binaries. The results indicate that for a moderate binary mass ratio of 0.3, and impact distances of 100 primary Schwarzschild radii, the accretion disc impacts can be expected to equal or exceed the host quasar in brightness at observed wavelength λ = 510 nm up to z = 0.6. We conclude that accretion disc impacts may function as an independent probe for supermassive black hole binaries. We release the code used for computing the model light curves to the community.

  10. Precision of spinal radiographs as a screening test for intervertebral disc calcification in Dachshunds.

    PubMed

    Rosenblatt, Alana J; Hill, Peter B; Davies, Sarah E; Webster, Natalie S; Lappalainen, Anu K; Bottema, Cynthia D K; Caraguel, Charles G B

    2015-11-01

    Among dog breeds, the Dachshund has the highest lifetime incidence of intervertebral disc disease (IVDD). Intervertebral disc (IVD) calcification is an indicator of severe degeneration that predisposes to disc herniation. IVDD is heritable in Dachshunds, and in some countries, breeding candidates are screened to reduce IVDD occurrence by selecting dogs according to their score of radiographically detectable intervertebral disc calcification (RDIDC) and excluding dogs with ≥5 RDIDCs from breeding. This study evaluated the precision of scoring spinal radiographs for IVD calcification and subsequent classification of Dachshund dogs for breeding based on their RDIDC score. Digital radiographs of the spine were obtained in 19 clinically healthy, young adult Dachshunds, and scored for RDIDC independently by five scorers with varying levels of experience, three times each. Within scorer (repeatability) and between scorer (reproducibility) variability was estimated both at the individual IVD level and at the whole dog level for breeding classification purposes. At the IVD level, some degree of scorer effect was supported by the pairwise repeatability (92.3%; 95% CI: 88.8-94.7%) being marginally higher than the reproducibility (89.2%; 95% CI: 85.7-91.8%). Scorer-specific patterns confirmed the presence of scorer subjectivity. Repeatability significantly increased with scorer experience but the reproducibility did not. RDIDC scoring repeatability and reproducibility substantially decreased at the cervicothoracic spine region, likely due to anatomical superimpositions. At the dog level, a breeding classification could be repeated by the same scorer for 83.6% (95% CI: 73.8-90.2%) of the dogs, and was reproduced between two scorers for 80.2% (95% CI: 66.6-89.1%) of the dogs. The repeatability of breeding classification also seemed to increase with scorer experience but not the reproducibility. Overall, RDIDC scoring revealed some degree of inconsistency explained by scorer subjectivity and inexperience, and anatomical superimpositions. Scorer training and experience is strongly recommended to improve test precision and ensure appropriate classification of Dachshunds for breeding. PMID:26493589

  11. Debris disc formation induced by planetary growth

    NASA Astrophysics Data System (ADS)

    Kobayashi, H.; Lhne, T.

    2014-08-01

    Several hundred stars older than 10 million years have been observed to have infrared excesses. These observations are explained by dust grains formed by the collisional fragmentation of hidden planetesimals. Such dusty planetesimal discs are known as debris discs. In a dynamically cold planetesimal disc, collisional coagulation of planetesimals produces planetary embryos which then stir the surrounding leftover planetesimals. Thus, the collisional fragmentation of planetesimals that results from planet formation forms a debris disc. We aim to determine the properties of the underlying planetesimals in debris discs by numerically modelling the coagulation and fragmentation of planetesimal populations. The brightness and temporal evolution of debris discs depend on the radial distribution of planetesimal discs, the location of their inner and outer edges, their total mass, and the size of planetesimals in the disc. We find that a radially narrow planetesimal disc is most likely to result in a debris disc that can explain the trend of observed infrared excesses of debris discsvvv around G-type stars, for which planet formation occurs only before 100 million years. Early debris disc formation is induced by planet formation, while the later evolution is explained by the collisional decay of leftover planetesimals around planets that have already formed. Planetesimal discs with underlying planetesimals of radii 100 km at ?30 au most readily explain the Spitzer Space Telescope 24 and 70 ?m fluxes from debris discs around G-type stars.

  12. Indian Vacuum Society: The Indian Vacuum Society

    NASA Astrophysics Data System (ADS)

    Saha, T. K.

    2008-03-01

    The Indian Vacuum Society (IVS) was established in 1970. It has over 800 members including many from Industry and R & D Institutions spread throughout India. The society has an active chapter at Kolkata. The society was formed with the main aim to promote, encourage and develop the growth of Vacuum Science, Techniques and Applications in India. In order to achieve this aim it has conducted a number of short term courses at graduate and technician levels on vacuum science and technology on topics ranging from low vacuum to ultrahigh vacuum So far it has conducted 39 such courses at different parts of the country and imparted training to more than 1200 persons in the field. Some of these courses were in-plant training courses conducted on the premises of the establishment and designed to take care of the special needs of the establishment. IVS also regularly conducts national and international seminars and symposia on vacuum science and technology with special emphasis on some theme related to applications of vacuum. A large number of delegates from all over India take part in the deliberations of such seminars and symposia and present their work. IVS also arranges technical visits to different industries and research institutes. The society also helped in the UNESCO sponsored post-graduate level courses in vacuum science, technology and applications conducted by Mumbai University. The society has also designed a certificate and diploma course for graduate level students studying vacuum science and technology and has submitted a syllabus to the academic council of the University of Mumbai for their approval, we hope that some colleges affiliated to the university will start this course from the coming academic year. IVS extended its support in standardizing many of the vacuum instruments and played a vital role in helping to set up a Regional Testing Centre along with BARC. As part of the development of vacuum education, the society arranges the participation of expert members on the subject to deliver lectures and take part in devising courses in the universities. IVS publishes a quarterly called the `Bulletin of Indian Vacuum Society' since its inception, in which articles on vacuum and related topics are published. NIRVAT, news, announcements, and reports are the other features of the Bulletin. The articles in the Bulletin are internationally abstracted. The Bulletin is distributed free to all the members of the society. The society also publishes proceedings of national/international symposia and seminars, manuals, lecture notes etc. It has published a `Vacuum Directory' containing very useful information on vacuum technology. IVS has also set up its own website http://www.ivsnet.org in January 2002. The website contains information about IVS, list of members, list of EC members, events and news, abstracts of articles published in the `Bulletin of Indian Vacuum Society', utilities, announcements, reports, membership and other forms which can be completed online and also gives links to other vacuum societies. Our Society has been a member of the executive council of the International Union of Vacuum Science, Techniques and Applications (IUVSTA) and its various committees since 1970. In 1983 IVS conducted an International Symposium on Vacuum Technology and Nuclear Applications in BARC, Mumbai, under the sponsorship of IUVSTA. In 1987 IVS arranged the Triennial International Conference on Thin Films in New Delhi, where more than 200 foreign delegates participated. IVS also hosted the IUVSTA Executive Council Meeting along with the conference. The society organized yet again an International Conference on Vacuum Science and Technology and SRS Vacuum Systems at CAT, Indore in1995. IVS arranges the prestigious Professor Balakrishnan Memorial Lecture in memory of its founder vice-president. Leading scientists from India and abroad in the field are invited to deliver the talks. So far 23 lectures have been held in this series. IVS has instituted the `IVS- Professor D Y Phadke Memorial Prize' in memory of our founder president, the late Professor D Y Phadke at the University of Mumbai. The prize is given every year to the student ranked top in the MSc (PHY.) examination conducted by the university. The IVS Kolkata Chapter has established the Dr A S Divatia Memorial Trust with the objective of organizing the Dr A S Divatia Memorial Lecture and a seminar once a year and to set up a vacuum testing and calibration facility. IVS has instituted an award in memory of the late Shri C Ambasankaran, its past president and pioneer of vacuum technology in India. This award is given to one of the best papers presented in the national symposium conducted by IVS. One more best paper award `Smt. Shakuntalabai Vyawahare Memorial Prize' is established from a donation given by Shri Mohan R Vyawahare, a life member and a present EC member of the society, in memory of his mother. During the symposia, IVS felicitates two of its members, one from Industry and one from an R & D Institution for their lifetime contribution to vacuum science and technology. Dr A K Gupta, Ex BARC, Ex Generla Manager, IBP, Head, Energy Group, Shapoorji Pallonji & Co Ltd (Industry), and Dr S R Gowariker, Ex BARC, Ex Director, CSIO, Chandigarh, Director, Tolani Education Foundation (R & D) are being honoured this year. T K Saha Geneneral Secretary, IVS

  13. Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Relief in Patients with Lumbar Disc Degeneration Compared to Anterior Lumbar Interbody Fusion

    PubMed Central

    Rischke, Burkhard; Smith, Eric

    2015-01-01

    Background Lumbar disc degeneration (LDD) is one of the most frequently diagnosed spinal diseases. The symptoms these disorders cause are anticipated to increase as the population in Western countries ages. Purpose Compare back and leg pain alleviation in patients with LDD and a viscoelastic disc prosthesis documented in the SWISSspine registry versus patients with anterior lumbar interbody fusion documented in the Spine Tango registry. Study Design Prospectively collected clinical and outcome data in two independent spine registries. Outcome Measures were back and leg pain relief on 0 to 10 numerical rating scales. Materials and Methods The analysis included a single surgeon series of 48 patients with viscoelastic total disc replacement (VTDR) from the SWISSspine registry which were compared to 131 patients with anterior lumbar interbody fusion (ALIF) from the Spine Tango registry. Two linear multivariate regression models were built to assess the associations of patient characteristics with back and leg pain relief. The following covariates were included in the models: patient age and sex, disc herniation as additional diagnosis, number of treated segments, level of treated segment, treatment type (VTDR, ALIF), preoperative back and leg pain levels and follow-up interval. Results Both models showed VTDR to be associated with significantly higher back (2.76 points; 95% confidence interval (CI) 1.78 - 3.73; p < 0.001) and leg pain (2.12 points; 95% CI 1.12 to 3.13; p < 0.001) relief than ALIF. Other influential factors for higher back pain relief were female sex compared with male sex (1.03 additional points; 95% CI 0.27 to 1.78; p = 0.008), monosegmental surgery compared with bisegmental surgery (1.02 additional points; 95% CI 0.21 to 1.83; p = 0.014), and higher back pain at baseline (0.87 points additional pain relief per level of preoperative back pain; 95% CI 0.70 to 1.03; p < 0.001). Other influential factors for leg pain relief were monosegmental surgery (0.93 additional points; 95% CI 0.10 to 1.77; p = 0.029) and higher leg pain at baseline (0.83 points additional pain relief per level of preoperative leg pain; 95% CI 0.70 to 0.96). In both models the L3/4 segment showed 2.36 points (95% CI -4.27 to -0.45; p = 0.016) and 3.69 points (95% CI -5.66 to -1.71; p < 0.001) less pain relief than L5/S1. Discussion Significantly higher back and leg pain relief were observed after viscoelastic total disc replacement in comparison with anterior lumbar interbody fusion. The new less rigid materials used in the second generation total disc replacements (TDRs) may make artificial disc replacement an increasingly attractive option for patients with degenerative lumbar disc disease. Further controlled and long-term follow-up studies are required for more detailed comparisons of the outcomes of these types of disc implants. The Freedom Lumbar Disc is limited by U.S. federal law to investigational use only. PMID:26196033

  14. Artificial Cervical Disc Replacement Improves Mobility

    MedlinePLUS

    Artificial Cervical Disc Replacement Improves Mobility February 18, 2009 From PinnacleHealth, Harrisburg, PA Welcome to this “OR ... this new technology with the use of an artificial disc has some significant benefits over the previous ...

  15. Numerical Simulations of Disc-Planet Interactions

    NASA Astrophysics Data System (ADS)

    Nelson, Richard P.; Paardekooper, Sijme-Jan

    2011-02-01

    The gravitational interaction between a protoplanetary disc and planetary sized bodies that form within it leads to the exchange of angular momentum, resulting in migration of the planets and possible gap formation in the disc for more massive planets. In this article, we review the basic theory of disc-planet interactions, and discuss the results of recent numerical simulations of planets embedded in protoplanetary discs. We consider the migration of low mass planets and recent developments in our understanding of so-called type I migration when a fuller treatment of the disc thermodynamics is included. We discuss the runaway migration of intermediate mass planets (so-called type III migration), and the migration of giant planets (type II migration) and the associated gap formation in this disc. The availability of high performance computing facilities has enabled global simulations of magnetised, turbulent discs to be computed, and we discuss recent results for both low and high mass planets embedded in such discs.

  16. Proceedings: Fossil steam turbine disc cracking workshop

    SciTech Connect

    Not Available

    1991-04-01

    The objectives of the workshop were to review and consolidate the state of the art of cracking in fossil steam turbine discs; to identify further work needed to assist utilities in evaluating fossil turbine discs subject to SCC. Participants included 18 representatives from utilities, 12 representatives from equipment manufacturing organizations, and 5 consultants. Canadian, European, Japanese, and domestic organizations were represented. Topics included: A Review of GE Fossil Shrunk-On Wheel Stress Corrosion Cracking; Effects on Material and Environmental Factors on SCC of NiCrMoV Rotor Steels; SCC Experience of Shrunk On Discs; Studies on SCC For Steam Turbine Rotor and Disc; Advanced Disc-Type LP Turbine Rotors; Recent Experience of Stress Corrosion Cracking in the LP Discs of Fossil-Fired Reheat Turbines; Stress Corrosion of NiCrMoV LP Disc and Shaft Steels Under Cyclic Loading; NYIT'S Focused Approach for Ultrasonically Scanning Steam Turbine Discs; Probabilistic Assessment of Crack Initiation and Growth in Shrunk-On Discs; Low-Pressure Rotor Disc Cracking and Remaining Life Analysis; Assessment of Probability of Survival of Built Up LP Turbine Rotors With Discs Containing Semi-Circular Keyways; Electric Power Research Institute Turbine Disc Inspection Program; Fossil Turbine Disc Inspections--A Utility Dilemma; In-Service Accumulation of Chemicals in the Keyways and Their Effect on Stress Corrosion Cracking of Turbine Discs; Pitting and Compositional Effects on Stress Corrosion Cracking of Turbine Disc Steels; and TVA's Recent Experience With Inspection and Testing of Shrink-On Discs. Individual papers are processed separately for the data bases.

  17. Electromagnetic Levitation of a Disc

    ERIC Educational Resources Information Center

    Valle, R.; Neves, F.; de Andrade, R., Jr.; Stephan, R. M.

    2012-01-01

    This paper presents a teaching experiment that explores the levitation of a disc of ferromagnetic material in the presence of the magnetic field produced by a single electromagnet. In comparison to the classical experiment of the levitation of a sphere, the main advantage of the proposed laboratory bench is that the uniform magnetic field…

  18. Optical Disc Applications in Libraries.

    ERIC Educational Resources Information Center

    Andre, Pamela Q. J.

    1989-01-01

    Discusses a variety of library applications of optical disc storage technology, including CD-ROM, digital videodisc, and WORM. Research and development projects at the Library of Congress, National Library of Medicine, and National Agricultural Library are described, products offered by library networks are reviewed, and activities in academic and

  19. Electromagnetic Levitation of a Disc

    ERIC Educational Resources Information Center

    Valle, R.; Neves, F.; de Andrade, R., Jr.; Stephan, R. M.

    2012-01-01

    This paper presents a teaching experiment that explores the levitation of a disc of ferromagnetic material in the presence of the magnetic field produced by a single electromagnet. In comparison to the classical experiment of the levitation of a sphere, the main advantage of the proposed laboratory bench is that the uniform magnetic field

  20. Tension arachnoid cyst causing uncal herniation in a 60 year old: a rare presentation.

    PubMed

    Tahir, Muhammad Zubair; Quadri, S A; Farooqui, Mudassir; Bari, Muhammad Ehsan; Di, Xiao

    2012-03-01

    Arachnoid cysts are congenital benign cysts accounting for approximately 1% of all intracranial mass lesions. Uncal herniation due to arachnoid cyst is a rare mode of presentation. It is hypothesized that only tension arachnoid cyst could cause the life-threatening condition that results from a progressive deterioration and worsening of a simple and usually congenital arachnoid cyst, associated with the formation of a "ball valve" at the point of an opening on the cyst wall. To-date only one case of an arachnoid cyst causing Uncal herniation has been reported to the best of our knowledge. We present a rare case of uncal herniation in a 60-year-old lady caused by a giant left temporal arachnoid cyst. She presented to us in emergency room after experiencing headaches since last one week followed by vomiting, seizures, and altered state of consciousness. She was operated immediately and marsupialization of the arachnoid cyst was performed. She showed good recovery. Although arachnoid cyst is a benign slowly growing pathology, it can lead to Uncal herniation as a "tension" arachnoid cyst, possible due to "ball-valve" mechanism. Elective treatment should be considered to prevent progressive significant enlargement of cyst. PMID:22483281

  1. A technique for repair of traumatic parasternal lung herniation: case report.

    PubMed

    Cernilia, J; Lin, J; Ott, R; Scannell, G; Waxman, K

    1995-06-01

    A case of traumatic lung herniation through an area of costalsternal separation in a 36-year-old male is presented. Persistent pain and the threat of strangulated lung tissue prompted repair that was accomplished with an expanded polytetrafluoroethylene Gortex tissue patch. PMID:7602639

  2. Inguinal Herniation of a Transplant Ureter: Lessons Learned From a Case of "Water Over the Bridge".

    PubMed

    Hakeem, Abdul R; Gopalakrishnan, Palanivel; Dooldeniya, Mohantha D; Irving, Henry C; Ahmad, Niaz

    2016-02-01

    Inguinal herniation of the transplant ureter is rare, and there is a paucity of reports in the literature. Herniation is usually secondary to implanting a long redundant ureter and may be precipitated by its course over the spermatic cord. Most often, there is loss of the allograft owing to delayed presentation and chronic ureteric obstruction. Here, we report a case of inguinal herniation of a transplant ureter with obstruction and graft dysfunction. A 72-year-old man presented 9 years after deceased-donor kidney transplant, with progressive graft dysfunction and a symptomatic right inguinal hernia. A nephrostogram and subsequent surgery confirmed herniation of a loop of transplant ureter into the inguinal canal with a proximal dilated ureter and hydronephrosis. A long and redundant ureter had been anastomosed "over" the spermatic cord to the bladder during the original operation. The ureter was shortened by excising the distal segment, and the proximal dilated ureter was anastomosed to the bladder passing it "underneath" the spermatic cord. We used a Vicryl (polyglactin 910) mesh to repair the hernia. The graft function improved to baseline levels after the nephrostomy and remained stable after the surgery. This case emphasizes the need to keep the ureter short, and the importance of passing it underneath the spermatic cord before anastomosing to the bladder. Transplant and general surgeons should be aware of such presentations of graft dysfunction with inguinal hernia to avoid delayed diagnosis and graft loss. PMID:26114341

  3. Urinary bladder herniation through a caudoventral abdominal wall defect in a mature cat

    PubMed Central

    Neville-Towle, Jack; Sakals, Sherisse

    2015-01-01

    A 16-year-old spayed female domestic shorthair cat with no history of trauma was presented to the Western College of Veterinary Medicine for assessment of urinary incontinence. Diagnostic investigation revealed herniation of the urinary bladder through a caudoventral abdominal wall defect. Clinical signs resolved after surgical reduction of the bladder. PMID:26347198

  4. Optical Discs: New Storage Media for Education.

    ERIC Educational Resources Information Center

    Helgerson, Linda W.

    1987-01-01

    Discusses three new advances in the use of optical disc technology in education. Describes the storage formats and capabilities of the videodisc, the compact disc, and the optical write-once disc. Contrasts the three technologies in terms of their production requirements, the hardware involved, and some projected applications in education. (TW)

  5. Relatively uniform and accelerated degradation of pure iron coated with micro-patterned Au disc arrays.

    PubMed

    Cheng, J; Huang, T; Zheng, Y F

    2015-03-01

    Pure iron has been proven to be a potential biodegradable metal, but its degradation rate was too slow. To accelerate its biodegradation, micro-patterned Au disc films were deposited on the surface of pure iron by vacuum sputtering. The influence of Au disc films on the degradation of pure iron matrix in vitro was investigated in the present study. Electrochemical measurement results indicated that the corrosion current density of pure iron coated with micro-patterned Au disc films in Hank's solution was 4 times larger than that of the uncoated one, while the difference between the influences of micro-patterned Au discs with different diameters on the corrosion rate of pure iron was insignificant. Immersion test indicated that the corrosion depth for pure iron coated with Au disc films was about three times as that of bare pure iron. Both electrochemical test and immersion test revealed that the corrosion of pure iron matrix coated with Au disc array became more uniform. PMID:25579971

  6. Vacuum pump aids ejectors

    SciTech Connect

    Nelson, R.E.

    1982-12-01

    The steam ejector/vacuum pump hybrid system has been operating satisfactorily since the summer of 1981. This system has essentially been as troublefree as the all-ejector system and, of course, has provided a substantial cost savings. Construction is currently under way to convert the vacuum system of another crude still which is equipped with steam ejectors and barometric condensers to the hybrid system of steam ejectors, surface condensers, and vacuum pumps. This current project is even more financially attractive because it allows a dirty water cooling tower which serves the barometric condensers to be shut down. Providing a vacuum for crude distillation vacuum towers with this hybrid system is by no means the only application of this technique. Any vacuum system consisting of all steam ejectors would be a candidate for this hybrid system and the resulting savings in energy.

  7. Loss and re-adaptation of lumbar intervertebral disc water signal intensity after prolonged bedrest.

    PubMed

    Kordi, M; Belav, D L; Armbrecht, G; Sheikh, A; Felsenberg, D; Trudel, G

    2015-09-01

    The adaptation and re-adaptation process of the intervertebral disc (IVD) to prolonged bedrest is important for understanding IVD physiology and IVD herniations in astronauts. Little information is available on changes in IVD composition. In this study, 24 male subjects underwent 60-day bedrest and In/Out Phase magnetic resonance imaging sequences were performed to evaluate IVD shape and water signal intensity. Scanning was performed before bedrest (baseline), twice during bedrest, and three, six and twenty-four months after bedrest. Area, signal intensity, average height, and anteroposterior diameter of the lumbar L3/4 and L4/5 IVDs were measured. At the end of bedrest, disc height and area were significantly increased with no change in water signal intensity. After bedrest, we observed reduced IVD signal intensity three months (p=0.004 versus baseline), six months (p=0.003 versus baseline), but not twenty-four months (p=0.25 versus baseline) post-bedrest. At these same time points post-bedrest, IVD height and area remained increased. The reduced lumbar IVD water signal intensity in the first months after bedrest implies a reduction of glycosaminoglycans and/or free water in the IVD. Subsequently, at two years after bedrest, IVD hydration status returned towards pre-bedrest levels, suggesting a gradual, but slow, re-adaptation process of the IVD after prolonged bedrest. PMID:26350949

  8. Localized strain measurements of the intervertebral disc annulus during biaxial tensile testing.

    PubMed

    Karakolis, Thomas; Callaghan, Jack P

    2015-01-01

    Both inter-lamellar and intra-lamellar failures of the annulus have been described as potential modes of disc herniation. Attempts to characterize initial lamellar failure of the annulus have involved tensile testing of small tissue samples. The purpose of this study was to evaluate a method of measuring local surface strains through image analysis of a tensile test conducted on an isolated sample of annular tissue in order to enhance future studies of intervertebral disc failure. An annulus tissue sample was biaxial strained to 10%. High-resolution images captured the tissue surface throughout testing. Three test conditions were evaluated: submerged, non-submerged and marker. Surface strains were calculated for the two non-marker conditions based on motion of virtual tracking points. Tracking algorithm parameters (grid resolution and template size) were varied to determine the effect on estimated strains. Accuracy of point tracking was assessed through a comparison of the non-marker conditions to a condition involving markers placed on tissue surface. Grid resolution had a larger effect on local strain than template size. Average local strain error ranged from 3% to 9.25% and 0.1% to 2.0%, for the non-submerged and submerged conditions, respectively. Local strain estimation has a relatively high potential for error. Submerging the tissue provided superior strain estimates. PMID:25145810

  9. Early results of percutaneous laser disc decompression (PLDD) as a treatment of discopathic lumbar pain.

    PubMed

    Sobieraj, Andrzej; Maksymowicz, Wojciech; Barczewska, Monika; Konopielko, Marcin; Mazur, Dariusz

    2004-06-30

    Background. The purpose of this paper is to present the technique of percutaneous laser disc decompression (PLDD), give some indications for its use, and provide a preliminary evaluation of the clinical effectiveness of this procedure in the treatment of low back pain, based on the authors' own experience. Material and methods. We performed a prospective analysis of treatment outcome in 212 patients who received PLDD in our clinic between March 2003 and January 2004, and who reported for the planned follow-up examination. Results. In 79.2% of these cases we achieved resolution or significant reduction of pain, and this effect persisted throughout the observation period of 6 weeks post surgery. In 3.8% of our patients, transient improvement was followed by intensification of low back pain, associated with the appearance of the most common complication after PLDD: inflammation of the disk and adjacent fragments of the elastic lamina of the vertebral bodies. Conclusions. In most cases PLDD is not a genuine alternative to open surgery on lumbar discopathy. It is most often administered to patients who have chronic pain from a slight extrusion of the disc, typically not qualified for surgery as the treatment method of choice. All other patients, even with larger herniations, can be administered PLDD as a last attempt at minimally invasive treatment prior to surgery, provided there are no obvious features of disruption of the posterior longitudinal ligament. PMID:17675983

  10. NSLS II Vacuum System

    SciTech Connect

    Ferreira, M.; Doom, L.; Hseuh, H.; Longo, C.; Settepani, P.; Wilson, K.; Hu, J.

    2009-09-13

    National Synchrotron Light Source II, being constructed at Brookhaven, is a 3-GeV, 500 mA, 3rd generation synchrotron radiation facility with ultra low emittance electron beams. The storage ring vacuum system has a circumference of 792 m and consists of over 250 vacuum chambers with a simulated average operating pressure of less than 1 x 10{sup -9} mbar. A summary of the update design of the vacuum system including girder supports of the chambers, gauges, vacuum pumps, bellows, beam position monitors and simulation of the average pressure will be shown. A brief description of the techniques and procedures for cleaning and mounting the chambers are given.

  11. Vacuum probe surface sampler

    NASA Technical Reports Server (NTRS)

    Zahlava, B. A. (inventor)

    1973-01-01

    A vacuum probe surface sampler is described for rapidly sampling relatively large surface areas which possess relatively light loading densities of micro-organism, drug particles or the like. A vacuum head with a hollow handle connected to a suitable vacuum source is frictionally attached to a cone assembly terminating in a flared tip adapted to be passed over the surface to be sampled. A fine mesh screen carried by the vacuum head provides support for a membrane filter which collects the microorganisms or other particles. The head assembly is easily removed from the cone assembly without contacting the cone assembly with human hands.

  12. Space vacuum processing

    NASA Technical Reports Server (NTRS)

    Ignatiev, A.; Shih, H. D.; Daniels, M.; Sega, R.; Bonner, T.

    1991-01-01

    The unique ultra-vacuum environment of low-earth orbit space is to be utilized for vacuum processing of advanced semiconductor and superconductor materials through epitaxial thin-film growth. The quality of semiconductor single crystal (epitaxial) thin-films can be significantly enhanced in the space ultra-vacuum through the reduction of impurities. This will be accomplished by the development of the free-flying Wake Shield Facility presently being built by the Space Vacuum Epitaxy Center in conjunction with industry and NASA under a low-cost, short time commercial approach to space hardware development.

  13. Evolution of linear warps in accretion discs and applications to protoplanetary discs in binaries

    NASA Astrophysics Data System (ADS)

    Foucart, Francois; Lai, Dong

    2014-12-01

    Warped accretion discs are expected in many protostellar binary systems. In this paper, we study the long-term evolution of disc warp and precession for discs with dimensionless thickness H/r larger than their viscosity parameter ?, such that bending waves can propagate and dominate the warp evolution. For small warps, these discs undergo approximately rigid-body precession. We derive analytical expressions for the warp/twist profiles of the disc and the alignment time-scale for a variety of models. Applying our results to circumbinary discs, we find that these discs align with the orbital plane of the binary on a time-scale comparable to the global precession time of the disc, and typically much smaller than its viscous time-scale. We discuss the implications of our finding for the observations of misaligned circumbinary discs (such as KH 15D) and circumbinary planetary systems (such as Kepler-413); these observed misalignments provide useful constraints on the uncertain aspects of the disc warp theory. On the other hand, we find that circumstellar discs can maintain large misalignments with respect to the plane of the binary companion over their entire lifetime. We estimate that inclination angles larger than 20 can be maintained for typical disc parameters. Overall, our results suggest that while highly misaligned circumstellar discs in binaries are expected to be common, such misalignments should be rare for circumbinary discs. These expectations are consistent with current observations of protoplanetary discs and exoplanets in binaries, and can be tested with future observations.

  14. Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation

    PubMed Central

    Abdel Razek, Naglaa M.

    2015-01-01

    Study Design This is a prospective, randomized, controlled study designed and conducted over 10 years from 2002 to 2012. Purpose The study aimed to monitor the effect of suction drains (SD) on the incidence of epidural fibrosis (EF) and to test, if the use of SD alone, SD with local steroids application, SD combined with fat grafts and local steroids application, or SD combined with fat grafts and without local steroids application, would improve outcome. Overview of Literature EF contributes to significant unsatisfactory failed-back syndrome. Efforts have been tried to reduce postoperative EF, but none were ideal. Methods Between September 2002 and 2012, 290 patients with symptomatic unilateral or bilateral, single-level lumbar disc herniation were included in the study. Two groups were included, with 165 patients in group I (intervention group) and 125 patients in group II (control group). Group I was subdivided into four subgroups: group Ia (SD alone), group Ib (SD+fat graft), group Ic (SD+local steroids), and group Id (SD+fat graft+local steroids). Results The use of SD alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome and significantly reduced EF as measured by magnetic resonance imaging (MRI). Conclusions This study has clearly demonstrated the fact that the use of suction drainage alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome with respect to pain relief and functional outcome and significantly reduced EF as measured by an MRI. A simple grading system of EF on MRI was described. PMID:26097652

  15. Shear Mechanics of the TMJ Disc

    PubMed Central

    Juran, C.M.; Dolwick, M.F.; McFetridge, P.S.

    2013-01-01

    The temporomandibular joint (TMJ) is a complex hinge and gliding joint that induces significant shear loads onto the fibrocartilage TMJ disc during jaw motion. The purpose of this study was to assess regional variation in the discs shear loading characteristics under physiologically relevant loads and to associate those mechanical findings with common clinical observations of disc fatigue and damage. Porcine TMJ discs were compressed between an axially translating bottom platen and a 2.5-cm-diameter indenter within a hydrated testing chamber. Discs were cyclically sheared at 0.5, 1, or 5 Hz to 1, 3, or 5% shear strain. Within the anterior and intermediate regions of the disc when sheared in the anteroposterior direction, both shear and compressive moduli experienced a significant decrease from instantaneous to steady state, while the posterior regions compressive modulus decreased approximately 5%, and no significant loss of shear modulus was noted. All regions retained their shear modulus within 0.5% of instantaneous values when shear was applied in the mediolateral direction. The results of the discs regional shear mechanics suggest an observable and predictable link with the common clinical observation that the posterior region of the disc is most often the zone in which fatigue occurs, which may lead to disc damage and perforation. PMID:23166043

  16. Modelling spikes in quasar accretion disc temperature

    NASA Astrophysics Data System (ADS)

    Hall, P. B.; Noordeh, E. S.; Chajet, L. S.; Weiss, E.; Nixon, C. J.

    2014-08-01

    Microlensing observations indicate that quasar accretion discs have half-light radii larger than standard theories predict. The observations of Blackburne and colleagues suggest that these half-light radii may have a weak wavelength dependence. We consider disc temperature profiles that might match these observations. Nixon and colleagues have suggested that misaligned discs around spinning black holes can have annuli torn off them at radii where the Lense-Thirring torque overcomes the disc's viscosity. These annuli precess, spread radially, and intersect with the remaining disc, heating the disc at potentially large radii. However, unless the intersections occur at an angle of <1°, highly supersonic collisions will shock heat intersecting gas to T ˜ 107 K. Discs with such shock-heated regions have significantly larger half-light radii, but are overluminous in X-rays. If instead heating occurs through intermittent weak shocks, the X-ray luminosities are consistent with observations but the half-light radii are not significantly larger. We also study two phenomenological disc temperature profiles. Discs with a temperature spike at relatively large radii and lowered temperatures at radii inside the spike yield improved and acceptable fits to microlensing sizes in most cases. Such temperature profiles could in principle occur in sub-Keplerian discs partially supported by magnetic pressure. However, such discs overpredict the fluxes from quasars studied with microlensing except in the limit of negligible continuum emission from radii inside the temperature spike.

  17. Working in a Vacuum

    ERIC Educational Resources Information Center

    Rathey, Allen

    2005-01-01

    In this article, the author discusses several myths about vacuum cleaners and offers tips on evaluating and purchasing this essential maintenance tool. These myths are: (1) Amps mean performance; (2) Everyone needs high-efficiency particulate air (HEPA): (3) Picking up a "bowling ball" shows cleaning power; (4) All vacuum bags are the same; (5)

  18. Laminated composite disc flywheel development

    NASA Astrophysics Data System (ADS)

    Nimmer, R. P.; Torossian, K.; Hickey, J.

    1980-02-01

    A flywheel concept for an electric powered vehicle uses a laminated disc and a filament wound outer ring assembled with an interference fit between these two components. The laminated, central disc is made of S2-glass-epoxy and the outer ring is filament-wound graphite-epoxy. Projections for this particular flywheel design indicate that it will be both practical and relatively inexpensive to produce, and that it will have a high energy density capacity. Two hybrid composite flywheels of 37 cm O.D. were successfully assembled. The spin test data are summarized, the nondestructive test dat are discussed and the fabrication techniques developed for the hybrid flywheel assembly are described.

  19. Microfabricated triggered vacuum switch

    DOEpatents

    Roesler, Alexander W. (Tijeras, NM); Schare, Joshua M. (Albuquerque, NM); Bunch, Kyle (Albuquerque, NM)

    2010-05-11

    A microfabricated vacuum switch is disclosed which includes a substrate upon which an anode, cathode and trigger electrode are located. A cover is sealed over the substrate under vacuum to complete the vacuum switch. In some embodiments of the present invention, a metal cover can be used in place of the trigger electrode on the substrate. Materials used for the vacuum switch are compatible with high vacuum, relatively high temperature processing. These materials include molybdenum, niobium, copper, tungsten, aluminum and alloys thereof for the anode and cathode. Carbon in the form of graphitic carbon, a diamond-like material, or carbon nanotubes can be used in the trigger electrode. Channels can be optionally formed in the substrate to mitigate against surface breakdown.

  20. Vacuum tunneling in gravity

    NASA Astrophysics Data System (ADS)

    Cho, Y. M.; Pak, D. G.

    2011-08-01

    Topologically non-trivial vacuum structures in gravity models with Cartan variables (vielbein and contortion) are considered. We study the possibility of vacuum spacetime tunneling in Einstein gravity assuming that the vielbein may play a fundamental role in quantum gravitational phenomena. It has been shown that in the case of RP3 space topology, the tunneling between non-trivial topological vacuums can be realized by means of Eguchi-Hanson gravitational instanton. In the Riemann-Cartan geometric approach to quantum gravity, the vacuum tunneling can be provided by means of contortion quantum fluctuations. We define a double self-duality condition for the contortion and give explicit self-dual configurations which can contribute to vacuum tunneling amplitude.

  1. Successful repair of a bladder herniation after old traumatic pubic symphysis diastasis using bone graft and hernia mesh.

    PubMed

    Seckiner, Ilker; Keser, Selcuk; Bayar, Ahmet; Yesilli, Cetin; Mungan, Aydin

    2007-10-01

    Bladder herniation associated with pubic symphysis diastasis is a very rare condition. We report a case with bladder herniation after traumatic pubic symphysis disruption. The patient was treated with open reduction of the bladder and definitive internal fixation of the pubis. We used a bone allograft for closure of the diastasis and a prolene mesh graft for supporting the abdominal wall. We obtained a successful outcome during a 12-month follow-up period. PMID:17245600

  2. Transdural Nerve Rootlet Entrapment in the Intervertebral Disc Space through Minimal Dural Tear : Report of 4 Cases

    PubMed Central

    Choi, Jeong Hoon; Jang, Jee-Soo; Lee, Dong Yeob

    2013-01-01

    Four patients underwent lumbar surgery. In all four patients, the dura was minimally torn during the operation. However, none exhibited signs of postoperative cerebrospinal fluid leakage. In each case, a few days after the operation, the patient suddenly experienced severe recurring pain in the leg. Repeat magnetic resonance imaging showed transdural nerve rootlets entrapped in the intervertebral disc space. On exploration, ventral dural tears and transdural nerve rootlet entrapment were confirmed. Midline durotomy, herniated rootlet repositioning, and ventral dural tear repair were performed, and patients' symptoms improved after rootlet repositioning. Even with minimal dural tearing, nerve rootlets may become entrapped, resulting in severe recurring symptoms. Therefore, the dural tear must be identified and repaired during the first operation. PMID:23441074

  3. The Aerodynamics of a Flying Sports Disc

    NASA Astrophysics Data System (ADS)

    Potts, Jonathan R.; Crowther, William J.

    2001-11-01

    The flying sports disc is a spin-stabilised axi-symmetric wing of quite remarkable design. A typical disc has an approximate elliptical cross-section and hollowed out under-side cavity, such as the Frisbee(TM) disc. An experimental study of flying disc aerodynamics, including both spinning and non-spinning tests, has been carried out in the wind tunnel. Load measurements, pressure data and flow visualisation techniques have enabled an explanation of the flow physics and provided data for free-flight simulations. A computer simulation that predicts free-flight trajectories from a given set of initial conditions was used to investigate the dynamics of a flying disc. This includes a six-degree of freedom mathematical model of disc flight mechanics, with aerodynamic coefficients derived from experimental data. A flying sports disc generates lift through forward velocity just like a conventional wing. The lift contributed by spin is insignificant and does not provide nearly enough down force to support hover. Without spin, the disc tumbles ground-ward under the influence of an unstable aerodynamic pitching moment. From a backhand throw however, spin is naturally given to the disc. The unchanged pitching moment now results in roll, due to gyroscopic precession, stabilising the disc in free-flight.

  4. Magnetorotational instability in protoplanetary discs

    NASA Astrophysics Data System (ADS)

    Salmeron, Raquel; Wardle, Mark

    2005-07-01

    We investigate the linear growth and vertical structure of the magnetorotational instability (MRI) in weakly ionized, stratified accretion discs. The magnetic field is initially vertical and dust grains are assumed to have settled towards the mid-plane, so charges are carried by electrons and ions only. Solutions are obtained at representative radial locations from the central protostar for different choices of the initial magnetic field strength, sources of ionization, disc structure and configuration of the conductivity tensor. The MRI is active over a wide range of magnetic field strengths and fluid conditions in low-conductivity discs. Moreover, no evidence was found of a low-limit field strength below which unstable modes do not exist. For the minimum-mass solar nebula model, incorporating cosmic ray ionization, perturbations grow at 1 au for B<~ 8 G. For a significant subset of these strengths (200mG <~B<~ 5G), the maximum growth rate is of the order of the ideal magnetohydrodynamic (MHD) rate (0.75?). Hall conductivity modifies the structure and growth rate of global unstable modes at 1 au for all magnetic field strengths that support MRI. As a result, at this radius, modes obtained with a full conductivity tensor grow faster and are active over a more extended cross-section of the disc than perturbations in the ambipolar diffusion limit. For relatively strong fields (e.g. B>~ 200 mG), ambipolar diffusion alters the envelope shapes of the unstable modes, which peak at an intermediate height, instead of being mostly flat as modes in the Hall limit are in this region of parameter space. Similarly, when cosmic rays are assumed to be excluded from the disc by the winds emitted by the magnetically active protostar, unstable modes grow at this radius for B<~ 2 G. For strong fields, perturbations exhibit a kink at the height where X-ray ionization becomes active. Finally, for R= 5 au (10 au), unstable modes exist for B<~ 800 mG (B<~ 250 mG) and the maximum growth rate is close to the ideal-MHD rate for 20 <~B<~ 500 mG (2 <~B<~ 50 mG). Similarly, perturbations incorporating Hall conductivity have a higher wavenumber and grow faster than solutions in the ambipolar diffusion limit for B<~ 100 mG (B<~ 10 mG). Unstable modes grow even at the mid-plane for B>~ 100 mG (B~ 1 mG), but for weaker fields, a small dead region exists. This study shows that, despite the low magnetic coupling, the magnetic field is dynamically important for a large range of fluid conditions and field strengths in protostellar discs. An example of such magnetic activity is the generation of MRI unstable modes, which are supported at 1 au for field strengths up to a few gauss. Hall diffusion largely determines the structure and growth rate of these perturbations for all studied radii. At radii of order 1 au, in particular, it is crucial to incorporate the full conductivity tensor in the analysis of this instability and more generally in studies of the dynamics of astrophysical discs.

  5. Proto-planetary disc evolution and dispersal

    NASA Astrophysics Data System (ADS)

    Rosotti, Giovanni Pietro

    2015-05-01

    Planets form from gas and dust discs in orbit around young stars. The timescale for planet formation is constrained by the lifetime of these discs. The properties of the formed planetary systems depend thus on the evolution and final dispersal of the discs, which is the main topic of this thesis. Observations reveal the existence of a class of discs called "transitional", which lack dust in their inner regions. They are thought to be the last stage before the complete disc dispersal, and hence they may provide the key to understanding the mechanisms behind disc evolution. X-ray photoevaporation and planet formation have been studied as possible physical mechanisms responsible for the final dispersal of discs. However up to now, these two phenomena have been studied separately, neglecting any possible feedback or interaction. In this thesis we have investigated what is the interplay between these two processes. We show that the presence of a giant planet in a photo-evaporating disc can significantly shorten its lifetime, by cutting the inner regions from the mass reservoir in the exterior of the disc. This mechanism produces transition discs that for a given mass accretion rate have larger holes than in models considering only X-ray photo-evaporation, constituting a possible route to the formation of accreting transition discs with large holes. These discs are found in observations and still constitute a puzzle for the theory. Inclusion of the phenomenon called "thermal sweeping", a violent instability that can destroy a whole disc in as little as 10 4 years, shows that the outer disc left can be very short-lived (depending on the X-ray luminosity of the star), possibly explaining why very few non accreting transition discs are observed. However the mechanism does not seem to be efficient enough to reconcile with observations. In this thesis we also show that X-ray photo-evaporation naturally explains the observed correlation between stellar masses and accretion rates and is therefore the ideal candidate for driving disc evolution. Another process that can influence discs is a close encounter with another star. In this thesis we develop a model to study the effect of stellar dynamics in the natal stellar cluster on the discs, following for the first time at the same time the stellar dynamics together with the evolution of the discs. We find that, although close encounters with stars are unlikely to change significantly the mass of a disc, they can change substantially its size, hence imposing an upper limit on the observed disc radii. Finally, we investigated in this thesis whether discs can be reformed after their dispersal. If a star happens to be in a region that is currently forming stars, it can accrete material from the interstellar medium. This mechanism may result in the production of "second generation" discs such that in a given star forming region a few percent of stars may still possess a disc, in tentative agreement with observations of so called "old accretors", which are difficult to explain within the current paradigm of disc evolution and dispersal.

  6. Housing protects laser in vacuum

    NASA Technical Reports Server (NTRS)

    Canali, V. G.

    1978-01-01

    Airtight housing encloses laser for easy alinement and operation in high-vacuum chamber. Beam is transmitted through window into vacuum chamber. Flexible line runs through vacuum chamber to outside, maintaining laser enclosure at atmospheric pressure.

  7. Hydrodynamics of the Vacuum

    NASA Astrophysics Data System (ADS)

    Stevenson, P. M.

    Hydrodynamics is the appropriate "effective theory" for describing any fluid medium at sufficiently long length scales. This paper treats the vacuum as such a medium and derives the corresponding hydrodynamic equations. Unlike a normal medium the vacuum has no linear sound-wave regime; disturbances always "propagate" nonlinearly. For an "empty vacuum" the hydrodynamic equations are familiar ones (shallow water-wave equations) and they describe an experimentally observed phenomenon the spreading of a clump of zero-temperature atoms into empty space. The "Higgs vacuum" case is much stranger; pressure and energy density, and hence time and space, exchange roles. The speed of sound is formally infinite, rather than zero as in the empty vacuum. Higher-derivative corrections to the vacuum hydrodynamic equations are also considered. In the empty-vacuum case the corrections are of quantum origin and the post-hydrodynamic description corresponds to the Gross-Pitaevskii equation. We conjecture the form of the post-hydrodynamic corrections in the Higgs case. In the (1+1)-dimensional case the equations possess remarkable "soliton" solutions and appear to constitute a new exactly integrable system.

  8. Factors regulating viable cell density in the intervertebral disc: blood supply in relation to disc height

    PubMed Central

    Boubriak, Olga A; Watson, Natasha; Sivan, Sarit S; Stubbens, Naomi; Urban, Jill P G

    2013-01-01

    The intervertebral disc is an avascular tissue, maintained by a small population of cells that obtain nutrients mainly by diffusion from capillaries at the disc–vertebral body interface. Loss of this nutrient supply is thought to lead to disc degeneration, but how nutrient supply influences viable cell density is unclear. We investigated two factors that influence nutrient delivery to disc cells and hence cell viability: disc height and blood supply. We used bovine caudal discs as our model as these show a gradation in disc height. We found that although disc height varied twofold from the largest to the smallest disc studied, it had no significant effect on cell density, unlike the situation found in articular cartilage. The density of blood vessels supplying the discs was markedly greater for the largest disc than the smallest disc, as was the density of pores allowing capillary penetration through the bony endplate. Results indicate that changes in blood vessels in the vertebral bodies supplying the disc, as well as changes in endplate architecture appear to influence density of cells in intervertebral discs. PMID:23311982

  9. Thermophoretic vacuum wand

    DOEpatents

    Klebanoff, Leonard Elliott (San Ramon, CA); Rader, Daniel John (Lafayette, CA)

    2000-01-01

    A thermophoretic vacuum wand that is particularly suited for transporting articles in a cleanroom environment so that potential particle contaminants in the air do not become adhered to the surface of the article is described. The wand includes a housing having a platen with a front surface with suction port(s) through the platen; a vacuum source for applying a negative pressure to the suction port(s); and heating device for the object. Heating the article when it is held by the vacuum wand affords thermophoretic protection that effectively prevents particles in the air from depositing onto the article.

  10. Thermophoretic vacuum wand

    DOEpatents

    Klebanoff, Leonard Elliott (San Ramon, CA); Rader, Daniel John (Lafayette, CA)

    2001-01-01

    A thermophoretic vacuum wand that is particularly suited for transporting articles in a cleanroom environment so that potential particle contaminants in the air do not become adhered to the surface of the article is described. The wand includes a housing having a platen with a front surface with suction port(s) through the platen; a vacuum source for applying a negative pressure to the suction port(s); and heating device for the object. Heating the article when it is held by the vacuum wand affords thermophoretic protection that effectively prevents particles in the air from depositing onto the article.

  11. Fournier's gangrene secondary to an acutely inflamed appendix herniating into the deep inguinal ring.

    PubMed

    Sarmah, Piyush B; Khan, Mashuk; Zilvetti, Miguel

    2015-01-01

    Fournier's gangrene (FG) requires prompt recognition and management. We report the case of a 68-year-old man who presented with extensive pain and purple discolouration from the right iliac fossa to perineum. Computed tomography demonstrated gas within the right hemiscrotum extending into the inguinal canal and right buttock, with a right pelvic fluid and air collection. At debridement necrotic fluid was arising from the superficial inguinal ring so laparotomy was performed, revealing a grossly inflamed appendix herniating into the inguinal canal; a right hemicolectomy was performed. Unfortunately, the patient went into cardiac arrest and passed away on the operating table. Histological analysis demonstrated acute-on-chronic inflammation involving the appendix. The condition where appendicitis is implicated in FG is usually due to retroperitoneal rupture and tracking into the perineal spaces. This is the first case reported of an inflamed appendix herniating into the inguinal canal and thus causing FG. PMID:25829533

  12. Detection of Myofascial Herniation on Dynamic Sonography and Magnetic Resonance Imaging

    PubMed Central

    Khaladkar, Sanjay M.; Kondapavuluri, Sushen Kumar; Kamal, Anubhav; Kalra, Raghav; Kamal, Vigyat

    2016-01-01

    Muscle hernia is an uncommon cause of leg swelling. It can be detected in the early stages only if there is a high index of suspicion. It is common in lower extremity compared to the upper extremity. Tibialis anterior muscle in the leg is commonly involved. Dynamic sonography and magnetic resonance imaging (MRI) are the mainstay in their diagnosis, which demonstrate a facial defect with herniation of muscle fibers. We report a case of 23-year-old male patient who presented with a painless swelling in the anterolateral aspect of the left upper leg. Dynamic sonography done with high-resolution probe demonstrated a defect in fascia overlying tibialis anterior with herniation of outer muscle fibers which increased during dorsiflexion and reduced in the supine position at rest. MRI of the left leg confirmed the findings. PMID:26885428

  13. Bilateral tibialis anterior muscle herniation simulating a soft tissue tumour in a young amateur football player.

    PubMed

    Ceyhan, Ali Murat; Chen, Wenchieh; Yener, Mahmut; Yildirim, Mehmet; Yesildag, Ahmet; Akkaya, Vahide Baysal

    2010-05-01

    Muscle herniation is a focal protrusion of muscle tissue through a defect in the deep fascial layer. Anterior tibial muscle is the most commonly affected muscle of the lower extremities because its fascia is the most vulnerable to trauma. Clinically it is characterized by asymptomatic or painful, skin-coloured, soft, subcutaneous nodules of various size depending on the position. The diagnosis is usually made clinically based on its typical manifestations, but ultrasonographic examination is useful for detecting the fascial defect and excluding other conditions caused by soft tissue tumours such as lipomas, angiolipomas, fibromas, schwannomas or varicosities. Although this entity is not rare, it has been less well documented in the dermatological literature. We report a case of bilateral tibialis anterior muscle herniation mimicking a soft tissue tumour in a young amateur football player. PMID:20546224

  14. Fournier's gangrene secondary to an acutely inflamed appendix herniating into the deep inguinal ring

    PubMed Central

    Sarmah, Piyush B.; Khan, Mashuk; Zilvetti, Miguel

    2015-01-01

    Fournier's gangrene (FG) requires prompt recognition and management. We report the case of a 68-year-old man who presented with extensive pain and purple discolouration from the right iliac fossa to perineum. Computed tomography demonstrated gas within the right hemiscrotum extending into the inguinal canal and right buttock, with a right pelvic fluid and air collection. At debridement necrotic fluid was arising from the superficial inguinal ring so laparotomy was performed, revealing a grossly inflamed appendix herniating into the inguinal canal; a right hemicolectomy was performed. Unfortunately, the patient went into cardiac arrest and passed away on the operating table. Histological analysis demonstrated acute-on-chronic inflammation involving the appendix. The condition where appendicitis is implicated in FG is usually due to retroperitoneal rupture and tracking into the perineal spaces. This is the first case reported of an inflamed appendix herniating into the inguinal canal and thus causing FG. PMID:25829533

  15. Collapse of vacuum bubbles in a vacuum

    SciTech Connect

    Ng, Kin-Wang; Wang, Shang-Yung

    2011-02-15

    We revisit the dynamics of a false vacuum bubble in a background de Sitter spacetime. We find that there exists a large parameter space that allows the bubble to collapse into a black hole or to form a wormhole. This may have interesting implications for the creation of a baby universe in the laboratory, the string landscape where the bubble nucleation takes place among a plenitude of metastable vacua, and the inflationary physics.

  16. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

    PubMed Central

    2009-01-01

    Background Blunt Traumatic Pericardial Rupture (BTPR) with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%. Methods We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury Conclusion BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with: Cardiovascular instability with no obvious cause Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest. PMID:20003497

  17. Persistent Atrial Fibrillation Related to a Congenital Pericardial Defect and Left Atrial Appendage Herniation.

    PubMed

    Lee, Heemoon; Jeong, Dong Seop; Kim, In Sook; Park, Byung Jo

    2015-12-01

    Congenital pericardial defects (CPDs) are infrequent anomalies that are usually asymptomatic and are discovered incidentally during unrelated interventions. Here we report the case of a CPD with herniation of an enlarged left atrial appendage identified during total thoracoscopic ablation (TTA) for persistent atrial fibrillation (AF). The persistent AF was successfully treated with a hybrid procedure, in which TTA was followed by an electrophysiological study. PMID:26665114

  18. Poland syndrome involving the left hemithorax with dextrocardia and herniation of the spleen

    PubMed Central

    Panda, Shasanka Shekhar; Bajpai, Minu; Singh, Amit; Jana, Manisha

    2014-01-01

    Poland syndrome is characterised by unilateral absence of the large pectoral muscle, ipsilateral symbrachydactyly and occasionally other malformations of the anterior chest wall and breast. The condition is more frequent among men and usually occurs on the right hemithorax in the unilateral form. This case is unique because we believe it is a rare case of Poland syndrome involving the left hemithorax along with dextrocardia and herniation of the spleen from the left subcostal region. PMID:24567179

  19. Delayed buccal fat pad herniation: An unusual complication of buccal flap in cleft surgery

    PubMed Central

    Tuli, Puneet; Parashar, Atul; Nanda, Vipul; Sharma, Ramesh K.

    2009-01-01

    Buccal musculomucosal flap is commonly used in cleft palate surgery for providing additional lining when nasal mucosa is inadequate. We report an unusual complication of progressively increasing fat herniation from the sutured donor site which started appearing on the third postoperative day. This necessitated excision of the protruding fat pad on the seventh postoperative day. The possible mechanism and precautions for prevention of this complication are discussed. PMID:19881029

  20. Persistent Atrial Fibrillation Related to a Congenital Pericardial Defect and Left Atrial Appendage Herniation

    PubMed Central

    Lee, Heemoon; Jeong, Dong Seop; Kim, In Sook; Park, Byung Jo

    2015-01-01

    Congenital pericardial defects (CPDs) are infrequent anomalies that are usually asymptomatic and are discovered incidentally during unrelated interventions. Here we report the case of a CPD with herniation of an enlarged left atrial appendage identified during total thoracoscopic ablation (TTA) for persistent atrial fibrillation (AF). The persistent AF was successfully treated with a hybrid procedure, in which TTA was followed by an electrophysiological study. PMID:26665114

  1. Close-packing of growing discs

    SciTech Connect

    Bursill, L.A.; Xudong, F. . School of Physics)

    1988-12-01

    Spiral lattices are derived by allowing growing discs to aggregate under a close-packing rule. Both Fibonacci and Lucas numbers of visible spirals arise naturally, dependent only on the choice of growth centre. Both the rate of convergence towards an ideal spiral, and chirality, are determined by the initial placement of the first few discs (initial conditions). Thus the appearance of spiral packings is no more or less mysterious than the appearance of hexagonal packed arrays of equal discs.

  2. Vacuum Camera Cooler

    NASA Technical Reports Server (NTRS)

    Laugen, Geoffrey A.

    2011-01-01

    Acquiring cheap, moving video was impossible in a vacuum environment, due to camera overheating. This overheating is brought on by the lack of cooling media in vacuum. A water-jacketed camera cooler enclosure machined and assembled from copper plate and tube has been developed. The camera cooler (see figure) is cup-shaped and cooled by circulating water or nitrogen gas through copper tubing. The camera, a store-bought "spy type," is not designed to work in a vacuum. With some modifications the unit can be thermally connected when mounted in the cup portion of the camera cooler. The thermal conductivity is provided by copper tape between parts of the camera and the cooled enclosure. During initial testing of the demonstration unit, the camera cooler kept the CPU (central processing unit) of this video camera at operating temperature. This development allowed video recording of an in-progress test, within a vacuum environment.

  3. Welding space vacuum technology

    NASA Technical Reports Server (NTRS)

    Johnson, R. Barry

    1991-01-01

    The objective was to assist the EH 42 Division in putting together a vacuum system that could attain the desired pressure and be large enough to accommodate the gas-metal arc (GMA) welding fixture apparatus. A major accomplishment was the design and fabrication of the controller/annunciator for the 4' by 8' system. It contains many safety features such as thermocouple set point relays that will only allow inlet and exit gas and vacuum valves to be operated at pre-selected system pressures, and a fail safe mode for power interruptions and operator mistakes. It is felt that significant progress was made in this research effort to weld in a vacuum environment. With continued efforts to increase the pump speeds for vacuum chambers and further studies on weld fixtures and gas inlet pressures, the NASA program will be successful.

  4. [Meningeal herniation associated to chronic otitis media in an otology center in the City of Mexico].

    PubMed

    Esparza Castro, M; Martnez Gutirrez, N; Juregui Renaud, K

    2006-01-01

    To assess the frequency and clinical characteristics of meningocele and meningoencephalocele into the middle ear, at an otological referral center of Mexico city. After analyzing 586 recordings of middle ear surgery, we identified that 3 (0.5%) had defects of the tegmen timpani, 2 had brain abscesses (0.34%) and 1 had (0.17%) a facial palsy. Two of the patients with defects of the tegmen timpani had herniation of the intracraneal tissue. Case 1. A 38 year old woman with a history of bilateral chronic otitis media, with 2 surgeries in the left ear. She was seeking medical care because of right hearing loss. However, computed tomography and magnetic resonance showed a defect of the tegmen timpani with temporal lobe herniation in the left ear. Case 2 was a 46 year old woman with no history of ear disease, just high blood pressure. She was seeking medical care because of right hearing loss, vertigo and headache. The clinical evaluation suggested tissue in the middle ear and the computed tomography showed a defect of the tegmen timpani, meningocele was confirmed by surgery. In the 2 patients the clinical characteristics did not suggest herniation of intracraneal tissue as the first diagnosis. This show us the importance of an intended evaluation and image studies to make an early diagnosis. PMID:16503034

  5. Dorsal Epidural Intervertebral Disk Herniation With Atypical Radiographic Findings: Case Report and Literature Review

    PubMed Central

    Teufack, Sonia G; Singh, Harminder; Harrop, James; Ratliff, John

    2010-01-01

    Background/Objective: Intervertebral disk herniation is relatively common. Migration usually occurs in the ventral epidural space; rarely, disks migrate to the dorsal epidural space due to the natural anatomical barriers of the thecal sac. Design: Case report. Findings: A 49-year-old man presented with 1week of severe back pain with bilateral radiculopathy to the lateral aspect of his lower extremities and weakness of the ankle dorsiflexors and toe extensors. Lumbar spine magnetic resonance imaging with gadolinium revealed a peripheral enhancing dorsal epidural lesion with severe compression of the thecal sac. Initial differential diagnosis included spontaneous hematoma, synovial cyst, and epidural abscess. Posterior lumbar decompression was performed; intraoperatively, the lesion was identified as a large herniated disk fragment. Conclusions: Dorsal migration of a herniated intervertebral disk is rare and may be difficult to definitively diagnose preoperatively. Dorsal disk migration may present in a variety of clinical scenarios and, as in this case, may mimic other epidural lesions on magnetic resonance imaging. PMID:20737802

  6. Against the Odds: Massive Lumbar Intradural Disk Herniation in the Elderly

    PubMed Central

    Orakcioglu, Berk; Dao Trong, Huy Philip; Jungk, Christine; Unterberg, Andreas

    2015-01-01

    Study Design?Case report. Objective?Presentation of an unusual case of an elderly patient with massive intradural disk herniation at the L2L3 level. Methods?Clinical and imaging data are presented after obtaining informed consent from the patient. Results?A 90-year-old man suffering from sudden-onset neurogenic bladder dysfunction and lower back pain but no further neurologic deficits initially presented with magnetic resonance imaging and laboratory values suggestive of an intraspinal infection. However, intraoperative inspection proved the unexpected finding of a large intradural lumbar disk herniation at the L2L3 level. Conclusions?Lumbar soft disk herniation to the intradural space is a rare event and has never been described in a patient over the age of 75. This case of a 90-year-old man with acute-onset bladder dysfunction underlines the necessity to consider this as a differential diagnosis in the case of a newly diagnosed intradural mass. PMID:26430608

  7. Total Disc Replacement in Lumbar Degenerative Disc Diseases.

    PubMed

    Park, Chun Kun

    2015-11-01

    More than 10 years have passed since lumbar total disc replacement (LTDR) was introduced for the first time to the world market for the surgical management of lumbar degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where LTDR stands on now, and is heading forward to. The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, LTDR has been expected to replace fusion surgery. A great deal of LTDR reports has come out. Among them, more than 5-year follow-up prospective randomized controlled studies including USA IDE trials were expected to elucidate whether for LTDR to have therapeutic benefit compared to fusion. The results of these studies revealed that LTDR was not inferior to fusion. Most of clinical studies dealing with LTDR revealed that there was no strong evidence for preventive effect of LTDR against symptomatic degenerative changes of adjacent segment disease. LTDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications. LTDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above. PMID:26713139

  8. Total Disc Replacement in Lumbar Degenerative Disc Diseases

    PubMed Central

    2015-01-01

    More than 10 years have passed since lumbar total disc replacement (LTDR) was introduced for the first time to the world market for the surgical management of lumbar degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where LTDR stands on now, and is heading forward to. The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, LTDR has been expected to replace fusion surgery. A great deal of LTDR reports has come out. Among them, more than 5-year follow-up prospective randomized controlled studies including USA IDE trials were expected to elucidate whether for LTDR to have therapeutic benefit compared to fusion. The results of these studies revealed that LTDR was not inferior to fusion. Most of clinical studies dealing with LTDR revealed that there was no strong evidence for preventive effect of LTDR against symptomatic degenerative changes of adjacent segment disease. LTDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications. LTDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above. PMID:26713139

  9. Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease

    PubMed Central

    2015-01-01

    Study Design Lumber disc arthroplasty is a technological advancement that has occurred in the last decade to treat lumbar degenerative disk diseases. Purpose The aim of this retrospective study was to establish the impact and outcomes of managing patients with lumbar degenerative disk disease who have been treated with lumbar total disc arthroplasty (TDA). Overview of Literature Several studies have shown promising results following this surgery. Methods We reviewed the files of 104 patients at the Department of Neurosurgery in Colmar (France) who had been operated on by lumbar spine arthroplasty (Prodisc) between April 2002 and October 2008. Results Among the 104 patients, 67 were female and 37 were male with an average age of 33.1 years. We followed the cases for a mean of 20 months. The most frequent level of discopathy was L4-L5 with 62 patients (59.6%) followed by L5-S1 level with 52 patients (50%). Eighty-three patients suffered from low back pain, 21 of which were associated with radiculopathy. The status of 82 patients improved after surgery according to the Oswestry Disability Index score, and 92 patients returned to work. Conclusions The results indicate that TDA is a good alternative treatment for lumbar spine disk disease, particularly for patients with disabling and chronic low back pain. This technique contributes to improve living conditions with correct patient selection for surgery. PMID:25705336

  10. An infinite family of generalized Kalnajs discs

    NASA Astrophysics Data System (ADS)

    Gonzlez, Guillermo A.; Reina, Jerson I.

    2006-10-01

    An infinite family of axially symmetric thin discs of finite radius is presented. The family of discs is obtained by means of a method developed by Hunter and contains, as its first member, the Kalnajs disc. The surface densities of the discs present a maximum at the centre of the disc and then decrease smoothly to zero at the edge, in such a way that the mass distribution of the higher members of the family is more concentrated at the centre. The first member of the family has a circular velocity proportional to the radius, thus representing a uniformly rotating disc. On the other hand, the circular velocities of the other members of the family increase from a value of zero at the centre of the discs to a maximum and then decrease smoothly to a finite value at the edge of the discs, in such a way that, for the higher members of the family, the maximum value of the circular velocity is attained nearest the centre of the discs.

  11. On the evolution of the protolunar disc.

    PubMed

    Ward, William R

    2014-09-13

    The structure and viscous evolution of a post-impact, protolunar disc is examined. The equations for a silicate disc in two-phase (vapour-liquid) equilibrium are employed to derive an analytical solution to vertical structure. Both a vertically mixed phase disc and a stratified disc, where a magma layer exists in the mid-plane surrounded by a vapour reservoir, are considered. The former largely reproduces the low gas mass fraction, x≪1, profiles of the disc described in earlier literature that proposed that the disc would hover on the brink of gravitational instability. In the latter, the vapour layer has x∼1 and is generally gravitationally stable, while the magma layer is vigorously unstable. The viscous evolution of the stratified model is then explored. Initially, the disc quickly settles to a quasi-steady state with a vapour reservoir containing the majority of the disc mass. The magma layer viscously spreads on a time scale of approximately 3-4 years, during which vapour continuously condenses into droplets that settle to the mid-plane, maintaining the magma surface density in spite of disc spreading. Material flowing inwards is accreted by the Earth; material flowing outwards past the Roche boundary can become incorporated into accreting moonlets. This evolution persists until the vapour reservoir is depleted in approximately 50-100 years, depending on its initial mass. PMID:25114314

  12. Accretion Discs Show Their True Colours

    NASA Astrophysics Data System (ADS)

    2008-07-01

    Quasars are the brilliant cores of remote galaxies, at the hearts of which lie supermassive black holes that can generate enough power to outshine the Sun a trillion times. These mighty power sources are fuelled by interstellar gas, thought to be sucked into the hole from a surrounding 'accretion disc'. A paper in this week's issue of the journal Nature, partly based on observations collected with ESO's Very Large Telescope, verifies a long-standing prediction about the intensely luminous radiation emitted by these accretion discs. Uncovering the disc ESO PR Photo 21/08 Uncovering the inner disc "Astronomers were puzzled by the fact that the best models of these discs couldn't quite be reconciled with some of the observations, in particular, with the fact that these discs did not appear as blue as they should be," explains lead-author Makoto Kishimoto. Such a discrepancy could be the signal that there was something very wrong with the models. With his colleagues, he investigated this discrepancy by studying the polarised light from six quasars. This enabled them to demonstrate that the disc spectrum is as blue as predicted. "The crucial observational difficulty here has been that the disc is surrounded by a much larger torus containing hot dust, whose light partly outshines that of the disc," says Kishimoto. "Because the light coming from the disc is scattered in the disc vicinity and thus polarised, by observing only polarised light from the quasars, one can uncover the buried light from the disc." In a similar way that a fisherman would wear polarised sunglasses to help get rid of the glare from the water surface and allow him to see more clearly under the water, the filter on the telescope allowed the astronomers to see beyond surrounding clouds of dust and gas to the blue colour of the disc in infrared light. The observations were done with the FORS and ISAAC instruments on one of the 8.2-m Unit Telescopes of ESO's Very Large Telescope, located in the Atacama Desert, in Chile, as well as several other telescopes, including STFC's UKIRT. The standard picture of the accretion disc is therefore vindicated. The authors believe that further measurements could eventually provide valuable insight into how and where the disc ends, and how material is being supplied to the disc.

  13. TFTR diagnostic vacuum controller

    SciTech Connect

    Olsen, D.; Persons, R.

    1981-01-01

    The TFTR diagnostic vacuum controller (DVC) provides in conjunction with the Central Instrumentation Control and Data Acquisition System (CICADA), control and monitoring for the pumps, valves and gauges associated with each individual diagnostic vacuum system. There will be approximately 50 systems on TFTR. Two standard versions of the controller (A and B) wil be provided in order to meet the requirements of two diagnostic manifold arrangements. All pump and valve sequencing, as well as protection features, will be implemented by the controller.

  14. Crown Gall Tumor Disc Bioassay

    PubMed Central

    Galsky, Alan G.; Wilsey, James P.; Powell, Richard G.

    1980-01-01

    Seventeen samples consisting of purified compounds and various ethanol extracts from plant sources were tested for activity on the initiation of crown gall tumors on potato discs. The results demonstrated definite correlation between the ability of these samples to inhibit the formation of crown gall tumors and their activity on the P388 leukemia system in mice. Samples showing only cytotoxic effects in KB cell cultures did not affect tumor initiation in our system. The active materials had no effects on bacterial viability or on the ability of the bacteria to attach to a tumorbinding site. PMID:16661157

  15. Vacuum self-magnetization?

    SciTech Connect

    Perez Rojas, H.; Rodriguez Querts, E.

    2006-06-19

    We study vacuum properties in a strong magnetic field as the zero temperature and zero density limit of quantum statistics. For charged vector bosons (W bosons) the vacuum energy density diverges for B > B{sub c} = m{sub w}{sup 2}/e, leading to vacuum instability. A logarithmic divergence of vacuum magnetization is found for B = Bc, which suggests that if the magnetic field is large enough, it is self-consistently maintained, and this mechanism actually prevents B from reaching the critical value Bc. For virtual neutral vector bosons bearing an anomalous magnetic moment, the instability of the ground state for B > B{sub c}{sup '} = m{sub n}{sup 2}/q also leads to the vacuum energy density divergence for fields B > B{sub c}{sup '} and to the magnetization divergence for B B{sub c}{sup '}. The possibility of virtual electron-positron pairs bosonization in strong magnetic field and the applicability of the neutral bosons model to describe the virtual positronium behavior in a magnetic field are discussed. We conjecture that this could lead to vacuum self-magnetization in QED.

  16. Use of adipose stem cells and polylactide discs for tissue engineering of the temporomandibular joint disc

    PubMed Central

    Mäenpää, Katja; Ellä, Ville; Mauno, Jari; Kellomäki, Minna; Suuronen, Riitta; Ylikomi, Timo; Miettinen, Susanna

    2010-01-01

    There is currently no suitable replacement for damaged temporomandibular joint (TMJ) discs after discectomy. In the present study, we fabricated bilayer biodegradable polylactide (PLA) discs comprising a non-woven mat of poly(L/D)lactide (P(L/D)LA) 96/4 and a P(L/DL)LA 70/30 membrane plate. The PLA disc was examined in combination with adipose stem cells (ASCs) for tissue engineering of the fibrocartilaginous TMJ disc in vitro. ASCs were cultured in parallel in control and chondrogenic medium for a maximum of six weeks. Relative expression of the genes, aggrecan, type I collagen and type II collagen present in the TMJ disc extracellular matrix increased in the ASC-seeded PLA discs in the chondrogenic medium. The hypertrophic marker, type X collagen, was moderately induced. Alcian blue staining showed accumulation of sulphated glycosaminoglycans. ASC differentiation in the PLA discs was close to that observed in pellet cultures. Comparison of the mRNA levels revealed that the degree of ASC differentiation was lower than that in TMJ disc-derived cells and tissue. The pellet format supported the phenotype of the TMJ disc-derived cells under chondrogenic conditions and also enhanced their hyalinization potential, which is considered part of the TMJ disc degeneration process. Accordingly, the combination of ASCs and PLA discs has potential for the development of a tissue-engineered TMJ disc replacement. PMID:19474082

  17. A method for quantitative measurement of lumbar intervertebral disc structures: an intra- and inter-rater agreement and reliability study

    PubMed Central

    2013-01-01

    Background There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MRI, 2) to evaluate intra- and inter-rater agreement and reliability for the measurements included, and 3) to identify factors compromising agreement. Methods Measurements were performed on MRIs from 16 people with and 16 without lumbar disc herniation, purposefully chosen to represent all possible disc contours among participants in a general population study cohort. Using the new method, MRIs were measured twice by one rater and once by a second rater. Agreement on the sagittal start- and end-slice was evaluated using weighted Kappa. Length and volume measurements were conducted on available slices between intervertebral foramens, and cross-sectional areas (CSA) were calculated from length measurements and slice thickness. Results were reported as Bland and Altmans limits of agreement (LOA) and intraclass correlation coefficients (ICC). Results Weighted Kappa (Kw (95% CI)) for start- and end-slice were: intra-: 0.82(0.60;0.97) & 0.71(0.43;0.93); inter-rater: 0.56(0.29;0.78) & 0.60(0.35;0.81). For length measurements, LOA ranged from [?1.0;1.0] mm to [?2.0;2.3] mm for intra-; and from [?1.1; 1.4] mm to [?2.6;2.0] mm for inter-rater. For volume measurements, LOA ranged from [?293;199] mm3 to [?582;382] mm3 for intra-, and from [?17;801] mm3 to [?450;713] mm3 for inter-rater. For CSAs, LOA ranged between [?21.3; 18.8] mm2 and [?31.2; 43.7] mm2 for intra-, and between [?10.8; 16.4] mm2 and [?64.6; 27.1] mm2 for inter-rater. In general, LOA as a proportion of mean values gradually decreased with increasing size of the measured structures. Agreement was compromised by difficulties in identifying the vertebral corners, the anterior and posterior boundaries of the intervertebral disc and the dural sac posterior boundary. With two exceptions, ICCs were above 0.81. Conclusions Length measurements and calculated CSAs of disc morphology and dural sac diameter from MRIs showed acceptable intra- and inter-rater agreement and reliability. However, caution should be taken when measuring very small structures and defining anatomical landmarks. PMID:23953197

  18. The Relation Between Sacral Angle and Vertical Angle of Sacral Curvature and Lumbar Disc Degeneration

    PubMed Central

    Ghasemi, Ahmad; Haddadi, Kaveh; Khoshakhlagh, Mohammad; Ganjeh, Hamid Reza

    2016-01-01

    Abstract The purpose of this study is to determine the reliability and validity of a goniometric measurement of the vertical angle of the sacrum and sacral angle (SA), and their relationships to lumbar degeneration. A herniated lumbar disc is one of the most frequent medical issues. Investigators in a number of studies have reported associated risk factors for prevalent disc degeneration. Atypical lumbosacral angles and curvature are thought to contribute to the degradation of the spine by many researchers. This study analyzed 360 patients referred to our clinic from 2013 to 2015 due to low back pain. A cross-sectional case–control study was designed in order to compare the sagittal alignment of the lumbosacral area in 3 groups of patients suffering from LBP. A total 120 patients were in a control group with a normal lumbar magnetic resonance imaging (MRI), 120 patients had lumbar disk herniation (LDH), and 120 patients had spinal stenosis. From the sagittal plan of lumbar MRI, SA and vertical angle of sacral curvature (VASC) were determined and then analyzed. The means of VASC in these groups were: 38.98 (SD: 6.36 ± 0.58), 40.89 (SD: 7.69 ± 0.69), and 40.54 (SD: 7.13 ± 0.92), respectively (P = 0.089). Moreover, studies of SA in 3 groups showed that the means of SA were: 39.30 (SD: 6.69 ± 0.63), 40.52 (SD: 7.47 ± 0.65), and 35.63 (SD: 6.07 ± 0.79), respectively. Relation between SA and spinal stenosis was just statistically significant (P ≤ 0.05). One significant limitation of our study is the lack of standing MRI for increased accuracy of measurement. However, we were reluctant to give patients needless exposure to radiation from conventional X-ray, and instead used MRI scans. We did not find any significant correlation between the VASC and LDH in lumbar MRI. Also, SA is not an independent risk factor for LDH in men and women. We suggested that there are several biomechanical factors involved in LDH. PMID:26871821

  19. Theory of Black Hole Accretion Discs

    NASA Astrophysics Data System (ADS)

    Abramowicz, Marek A.; Bjrnsson, Gunnlaugur; Pringle, James E.

    2010-08-01

    Part I. Observations of Black Holes: 1. Black holes in our Galaxy: observations P. Charles; 2. Black holes in Active Galactic Nuclei: observations G. M. Madejski; Part II. Physics Close to a Black Hole: 3. Physics of black holes I. D. Novikov; 4. Physics of black hole accretion M. A. Abramowicz; Part III. Turbulence, Viscosity: 5. Disc turbulence and viscosity A. Brandenburg; Part IV. Radiative Processes: 6. The role of electron-positron pairs in accretion flows G. Bjrnsson; 7. Accretion disc-corona models and X/Y-ray spectra of accreting black holes J. Poutanen; 8. Emission lines: signatures of relativistic rotation A. C. Fabian; Part V. Accretion Discs: 9. Spectral tests of models for accretion disks around black holes J. H. Krolik; 10. Advection-dominated accretion around black holes R. Narayan, R. Mahadevan and E. Quataert; 11. Accretion disc instabilities and advection dominated accretion flows J.-P. Lasota; 12. Magnetic field and multi-phase gas in AGN A. Celotti and M. J. Rees; Part V. Discs in Binary Black Holes: 13. Supermassive binary black holes in galaxies P. Artymowicz; Part VI. Stability of Accretion Discs: 14. Large scale perturbation of an accretion disc by a black hole binary companion J. C. B. Papaloizou, C. Terquem and D. N. C. Lin; 15. Stable oscillations of black hole accretion discs M. Nowak and D. Lehr; Part VI. Coherant Structures: 16. Spotted discs A. Bracco, A. Provenzale, E. A. Spiegel and P. Yecko; Self-organized critically in accretion discs P. Wiita and Y. Xiong; Summary: old and new advances in black hole accretion disc theory R. Svensson.

  20. The properties of discs around planets and brown dwarfs as evidence for disc fragmentation

    NASA Astrophysics Data System (ADS)

    Stamatellos, Dimitris; Herczeg, Gregory J.

    2015-06-01

    Direct imaging searches have revealed many very low mass objects, including a small number of planetary-mass objects, as wide-orbit companions to young stars. The formation mechanism of these objects remains uncertain. In this paper, we present the predictions of the disc fragmentation model regarding the properties of the discs around such low-mass objects. We find that the discs around objects that have formed by fragmentation in discs hosted by Sun-like stars (referred to as parent discs and parent stars) are more massive than expected from the Mdisc-M* relation (which is derived for stars with masses M* > 0.2 M?). Accordingly, the accretion rates on to these objects are also higher than expected from the dot{M}_*-M_* relation. Moreover, there is no significant correlation between the mass of the brown dwarf or planet with the mass of its disc nor with the accretion rate from the disc on to it. The discs around objects that form by disc fragmentation have larger than expected masses as they accrete gas from the disc of their parent star during the first few kyr after they form. The amount of gas that they accrete and therefore their mass depend on how they move in their parent disc and how they interact with it. Observations of disc masses and accretion rates on to very low mass objects are consistent with the predictions of the disc fragmentation model. Future observations (e.g. by Atacama Large Millimeter/submillimeter Array) of disc masses and accretion rates on to substellar objects that have even lower masses (young planets and young, low-mass brown dwarfs), where the scaling relations predicted by the disc fragmentation model diverge significantly from the corresponding relations established for higher mass stars, will test the predictions of this model.

  1. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Interarticular disc prosthesis (interpositional... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices 872.3970 Interarticular disc prosthesis (interpositional implant). (a) Identification. An interarticular disc...

  2. Use NASA GES DISC Data in ArcGIS

    NASA Technical Reports Server (NTRS)

    Yang, Wenli; Pham, Long B.; Kempler, Steve

    2015-01-01

    This presentation describes GIS relevant data at NASA Goddard Earth Sciences Data and Information Services Center (GES DISC), GES DISC Services and Support for GIS Users, and use cases of GES DISC data in ArcGIS.

  3. Counterrotating stars in simulated galaxy discs

    NASA Astrophysics Data System (ADS)

    Algorry, David G.; Navarro, Julio F.; Abadi, Mario G.; Sales, Laura V.; Steinmetz, Matthias; Piontek, Franziska

    2014-02-01

    Counterrotating stars in disc galaxies are a puzzling dynamical feature whose origin has been ascribed to either satellite accretion events or to disc instabilities triggered by deviations from axisymmetry. We use a cosmological simulation of the formation of a disc galaxy to show that counterrotating stellar disc components may arise naturally in hierarchically clustering scenarios even in the absence of merging. The simulated disc galaxy consists of two coplanar, overlapping stellar components with opposite spins: an inner counterrotating bar-like structure made up mostly of old stars surrounded by an extended, rotationally supported disc of younger stars. The opposite-spin components originate from material accreted from two distinct filamentary structures which at turn around, when their net spin is acquired, intersect delineating a `V'-like structure. Each filament torques the other in opposite directions; the filament that first drains into the galaxy forms the inner counterrotating bar, while material accreted from the other filament forms the outer disc. Mergers do not play a substantial role and most stars in the galaxy are formed in situ; only 9 per cent of all stars are contributed by accretion events. The formation scenario we describe here implies a significant age difference between the co- and counterrotating components, which may be used to discriminate between competing scenarios for the origin of counterrotating stars in disc galaxies.

  4. Rapid radiative clearing of protoplanetary discs

    NASA Astrophysics Data System (ADS)

    Haworth, Thomas J.; Clarke, Cathie J.; Owen, James E.

    2016-04-01

    The lack of observed transition discs with inner gas holes of radii greater than ˜50 au implies that protoplanetary discs dispersed from the inside out must remove gas from the outer regions rapidly. We investigate the role of photoevaporation in the final clearing of gas from low mass discs with inner holes. In particular, we study the so-called `thermal sweeping' mechanism which results in rapid clearing of the disc. Thermal sweeping was originally thought to arise when the radial and vertical pressure scalelengths at the X-ray heated inner edge of the disc match. We demonstrate that this criterion is not fundamental. Rather, thermal sweeping occurs when the pressure maximum at the inner edge of the dust heated disc falls below the maximum possible pressure of X-ray heated gas (which depends on the local X-ray flux). We derive new critical peak volume and surface density estimates for rapid radiative clearing which, in general, result in rapid dispersal happening less readily than in previous estimates. This less efficient clearing of discs by X-ray driven thermal sweeping leaves open the issue of what mechanism (e.g. far-ultraviolet heating) can clear gas from the outer disc sufficiently quickly to explain the non-detection of cold gas around weak line T Tauri stars.

  5. On the reliability of protostellar disc mass measurements and the existence of fragmenting discs

    NASA Astrophysics Data System (ADS)

    Dunham, Michael M.; Vorobyov, Eduard I.; Arce, Hctor G.

    2014-10-01

    We couple non-magnetic, hydrodynamical simulations of collapsing protostellar cores with radiative transfer evolutionary models to generate synthetic observations. We then use these synthetic observations to investigate the extent to which a simple method for measuring protostellar disc masses used in the literature recovers the intrinsic masses of the discs formed in the simulations. We evaluate the effects of contamination from the surrounding core, partially resolving out the disc, optical depth, fixed assumed dust temperatures, inclination, and the dust opacity law. We show that the combination of these effects can lead to disc mass underestimates by up to factors of 2-3 at millimetre wavelengths and up to an order of magnitude or larger at submillimetre wavelengths. The optically thin portions of protostellar discs are generally cooler in the Class I stage than the Class 0 stage since Class I discs are typically larger and more optically thick, and thus more shielded. The observed disc mass distribution closely resembles the intrinsic distribution if this effect is taken into account, especially at millimetre wavelengths where optical depth effects are minimized. Approximately 50-70 per cent of protostellar discs observed to date with this method are consistent with the masses of the gravitationally unstable discs formed in the simulations, suggesting that at least some protostellar discs are likely sufficiently massive to fragment. We emphasize key future work needed to confirm these results, including assembling larger, less biased samples, and using molecular line observations to distinguish between rotationally supported, Keplerian discs and magnetically supported pseudodiscs.

  6. ISABELLE vacuum systems

    SciTech Connect

    Halama, H J

    1980-01-01

    The Intersecting Storage Accelerator (ISABELLE) consists of two rings having a circumference of 3.8 km each. In these rings superconducting magnets, held at 4 K, bend and focus the proton beam which is accelerated up to 400 GeV. Due to very different pressure requirements, ISABELLE has two completely independent vacuum systems. One, which operates at 1 x 10/sup -11/ Torr, provides a very clean environment for the circulating proton beam. Here only ion and titanium sublimation pumps are used to provide the vacuum. The other system maintains superconducting magnet vessels at a pressure below 1 x 10/sup -4/ Torr, since at this pressure the gas conduction becomes negligible. In this so-called insulating vacuum system, turbomolecular pumps pump the inadvertent small helium leaks. Other gases are cryocondensed on the cold surfaces of the cryogenic system. The basic element of ISABELLE known as Full Cell containing 45 meters of beam tube, 8 pumping stations, 8 superconducting magnets and complete instrumentation has been constructed, leak checked and tested. All design parameters have been achieved in both vacuum systems. The two vacuum systems are described with particular emphasis on the influence of superconducting magnets in the selection of materials and UHV components.

  7. Radiographic Markers of Femoroacetabular Impingement: Correlation of Herniation Pit and Femoral Bump with a Positive Cross-Over Ratio

    PubMed Central

    Scheyerer, Max J.; Copeland, Carol E.; Stromberg, Jeffrey; Ruckstuhl, Thomas; Werner, Clment M. L.

    2014-01-01

    Introduction. The goal of this study was to research the association of femoral bumps and herniation pits with the overlap-ratio of the cross-over sign. Methods. Pelvic X-rays and CT-scans of 2925 patients with good assessment of the anterior and the posterior acetabular wall and absence of neutral pelvic tilt were enrolled in the investigation. Finally pelvic X-rays were assessed for the presence of a positive cross-over sign, and CT-scans for a femoral bump or a herniation pit. Additionally, if a positive cross-over sign was discovered, the overlap-ratio was calculated. Results. A femoral bump was found in 53.3% (n = 1559), and a herniation pit in 27.2% (n = 796) of all hips. The overlap-ratio correlated positively with the presence of a femoral bump, while a negative correlation between the overlap-ratio and the presence of a herniation pit was found. The latter was significantly more often combined with a femoral bump than without. Conclusions. We detected an increased prevalence of femoral bump with increasing overlap-ratios of the cross-over sign indicating a relation to biomechanical stress. The observed decreased prevalence of herniation pits with increasing overlap-ratios could be explained by reduced mechanical stress due to nontightened iliofemoral ligament in the presence of retroversion of the acetabulum. PMID:24876972

  8. Pressure transduction and fluid evacuation during conventional negative pressure wound therapy of the open abdomen and NPWT using a protective disc over the intestines

    PubMed Central

    2012-01-01

    Background Negative pressure wound therapy (NPWT) has gained acceptance among surgeons, for the treatment of open abdomen, since very high closure rates have been reported with this method, compared to other kinds of wound management for the open abdomen. However, the method has occasionally been associated with increased development of fistulae. We have previously shown that NPWT induces ischemia in the underlying small intestines close to the vacuum source, and that a protective disc placed between the intestines and the vacuum source prevents the induction of ischemia. In this study we compare pressure transduction and fluid evacuation of the open abdomen with conventional NPWT and NPWT with a protective disc. Methods Six pigs underwent midline incision and the application of conventional NPWT and NPWT with a protective disc between the intestines and the vacuum source. The pressure transduction was measured centrally beneath the dressing, and at the anterior abdominal wall, before and after the application of topical negative pressures of -50, -70 and -120 mmHg. The drainage of fluid from the abdomen was measured, with and without the protective disc. Results Abdominal drainage was significantly better (p < 0. 001) using NPWT with the protective disc at -120 mmHg (439 25 ml vs. 239 31 ml), at -70 mmHg (341 27 ml vs. 166 9 ml) and at -50 mmHg (350 50 ml vs. 151 21 ml) than with conventional NPWT. The pressure transduction was more even at all pressure levels using NPWT with the protective disc than with conventional NPWT. Conclusions The drainage of the open abdomen was significantly more effective when using NWPT with the protective disc than with conventional NWPT. This is believed to be due to the more even and effective pressure transduction in the open abdomen using a protective disc in combination with NPWT. PMID:22443416

  9. Improving Vacuum Cleaners

    NASA Technical Reports Server (NTRS)

    1997-01-01

    Under a Space Act Agreement between the Kirby company and Lewis Research Center, NASA technology was applied to a commercial vacuum cleaner product line. Kirby engineers were interested in advanced operational concepts, such as particle flow behavior and vibration, critical factors to improve vacuum cleaner performance. An evaluation of the company 1994 home care system, the Kirby G4, led to the refinement of the new G5 and future models. Under the cooperative agreement, Kirby had access to Lewis' holography equipment, which added insight into how long a vacuum cleaner fan would perform, as well as advanced computer software that can simulate the flow of air through fans. The collaboration resulted in several successes including fan blade redesign and continuing dialogue on how to improve air-flow traits in various nozzle designs.

  10. Electrostatic Levitator Vacuum Chamber

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Optical ports ring the Electrostatic Levitator (ESL) vacuum chamber to admit light from the heating laser (beam passes through the window at left), positioning lasers (one port is at center), and lamps to allow diagnostic instruments to view the sample. The ESL uses static electricity to suspend an object (about 2-3 mm in diameter) inside a vacuum chamber while a laser heats the sample until it melts. This lets scientists record a wide range of physical properties without the sample contacting the container or any instruments, conditions that would alter the readings. The Electrostatic Levitator is one of several tools used in NASA's microgravity materials science program.

  11. VACUUM SEALING MEANS FOR LOW VACUUM PRESSURES

    DOEpatents

    Milleron, N.

    1962-06-12

    S>A vacuum seal is designed in which the surface tension of a thin layer of liquid metal of low vapor pressure cooperates with adjacent surfaces to preclude passages of gases across pressure differentials as low as 10/sup -8/ mm Hg. Mating contiguous surfaces composed of copper, brass, stainless steel, nickel, molybdenum, tungsten, tantalum, glass, quartz, and/or synthetic mica are disposed to provide a maximum tolerance, D, expressed by 2 gamma /P/sub 1/, where gamma is the coefflcient of the surface tension of the metal sealant selected in dynes/cm/sub 2/. Means for heating the surfaces remotely is provided where temperatures drop below about 250 deg C. A sealant consisting of an alloy of gallium, indium, and tin, among other combinations tabulated, is disposed therebetween after treating the surfaces to improve wettability, as by ultrasonic vibrations, the surfaces and sealants being selected according to the anticipated experimental conditions of use. (AEC)

  12. K-130 Cyclotron vacuum system

    NASA Astrophysics Data System (ADS)

    Yadav, R. C.; Bhattacharya, S.; Bhole, R. B.; Roy, Anindya; Pal, Sarbajit; Mallik, C.; Bhandari, R. K.

    2012-11-01

    The vacuum system for K-130 cyclotron has been operational since 1977. It consists of two sub-systems, main vacuum system and beam line vacuum system. The main vacuum system is designed to achieve and maintain vacuum of about 1 10-6 mbar inside the 23 m3 volume of acceleration chamber comprising the Resonator tank and the Dee tank. The beam line vacuum system is required for transporting the extracted beam with minimum loss. These vacuum systems consist of diffusion pumps backed by mechanical pumps like roots and rotary pumps. The large vacuum pumps and valves of the cyclotron vacuum system were operational for more than twenty five years. In recent times, problems of frequent failures and maintenance were occurring due to aging and lack of appropriate spares. Hence, modernisation of the vacuum systems was taken up in order to ensure a stable high voltage for radio frequency system and the extraction system. This is required for efficient acceleration and transportation of high intensity ion beam. The vacuum systems have been upgraded by replacing several pumps, valves, gauges and freon units. The relay based control system for main vacuum system has also been replaced by PLC based state of the art control system. The upgraded control system enables inclusion of additional operational logics and safety interlocks into the system. The paper presents the details of the vacuum system and describes the modifications carried out for improving the performance and reliability of the vacuum system.

  13. Difficult diagnosis: internal herniation of the terminal ileum through the foramen of Winslow into the lesser sac.

    PubMed

    Nazarian, Scarlet; Clegg, Daisy; Chang, Sebastian; Kuriakose, John

    2015-01-01

    Herniation of the bowel through the foramen of Winslow is rare and accounts for 8% of all internal herniae. It typically presents clinically and biochemically as small bowel obstruction. It carries a high mortality as diagnosis is often delayed, despite bowel strangulation, as clinical signs are not typical and imaging may not be diagnostic. In the case presented here, a healthy 25-year-old man was admitted with sudden onset right-sided abdominal and back pain. He denied vomiting, and had opened his bowels. His bloods were normal and venous lactate <2; CT was not diagnostic. At laparotomy, he was found to have internal herniation of the terminal ileum through the foramen of Winslow, which was gangrenous and required resection. This paper discusses the difficulty in diagnosing internal herniation and poses the question as to whether we are too dependent on CT findings in the setting of an acute abdomen. PMID:26682837

  14. Cervical radiculopathy caused by neural foraminal migration of a herniated calcified intervertebral disk in childhood: a case report.

    PubMed

    Park, Sung Min; Kim, Eun-Sang; Sung, Duk Hyun

    2005-11-01

    Childhood intervertebral disk calcification is a rare clinical entity. Although its clinical course is usually benign, nerve root irritation or spinal cord compression can occasionally occur. We present the clinical and radiologic findings of a 9-year-old boy with cervical radiculopathy due to a herniated calcified intervertebral disk, which developed suddenly after swimming for 1 hour. Radiologic findings indicated that a calcified nucleus pulposus at the C6-7 level herniated into the spinal canal and migrated far into the right C6-7 neural foramen. Surgical management was performed 8 weeks after the onset of symptoms, because the initial presenting symptoms persisted despite conservative treatment. In children, calcified intervertebral disks can cause cervical radiculopathy that requires surgical management when they herniate and migrate far into the neural foramen. PMID:16271574

  15. Enhancing tissue repair in annulus fibrosus defects of the intervertebral disc: analysis of a bio-integrative annulus implant in an in-vivo ovine model.

    PubMed

    Hegewald, Aldemar Andres; Medved, Fabian; Feng, Daxiong; Tsagogiorgas, Charalambos; Beierfu, Anja; Schindler, Genevieve Ama Kyremaa; Trunk, Marcus; Kaps, Christian; Mern, Demissew Shenegelegn; Thom, Claudius

    2015-04-01

    Annulus fibrosus repair techniques for the intervertebral disc (IVD) address the unsolved problem of reherniation after IVD herniation and might facilitate the development of nucleus pulposus replacement techniques for IVD diseases. This study investigates the suitability of a bio-integrative annulus implant.Standardized box defects were applied to the annulus L3/4 and L4/5 of 16 sheep, followed by randomized insertion of the textile polyglycolic acid/polyvinylidene fluoride annulus implant in one of the defects. Explantation was conducted after 2, 6 and 12 weeks, followed by provocative pressure testing and histological analysis. At 2 weeks' follow-up, all specimens of the control defect group demonstrated uncontained herniated nucleus pulposus tissue in the annulus defects. For the treated specimens, the annulus implant consistently provided an effective barrier for herniating nucleus pulposus tissue, with no implant dislocation at all time-points. After 2 weeks, a homogeneous cell infiltration of the annulus implant was observed, leading to a progressive directional matrix build-up. Repair tissue thickness was significantly stronger with the annulus implant at all follow-ups (p < 0.01). No pronounced foreign body reaction and no difference in the amount of supra-annular scar tissue over the defect sites were observed. The implantation procedure inflicted annulus damage adjacent to the defect. At later time-points, however, no difference in comparison with the control defect group was evident. The investigated biointegrative annulus implant showed promising results with regard to biointegration, enhancement of repair tissue and function as a mechanical barrier in an ovine model. PMID:24227682

  16. Effect of sustained loading on the water content of intervertebral discs: implications for disc metabolism.

    PubMed Central

    McMillan, D W; Garbutt, G; Adams, M A

    1996-01-01

    OBJECTIVE: To examine regional changes in the fluid content of human intervertebral discs by comparing sagittal plane "profiles" of hydration before and after mechanical loading. METHODS: Cadaveric lumbar intervertebral discs were loaded to simulate a typical day's loading in vivo. Ten motion segments were subjected to a 1500 N compressive load for a period of 6 h with the superior vertebrae inclined by 4-8 degrees to simulate a slightly flexed posture. Immediately after loading the discs were frozen at -80 degrees C. Subsequently they were cut into slices perpendicular to the sagittal midline of the disc, and each slice was weighed before and after freeze drying. This enabled a profile of fluid content across the disc to be constructed. Fluid loss due to loading was estimated by comparing the water content of each loaded disc with that of an adjacent unloaded disc from the same spine. RESULTS: After 6 h of creep loading, disc height approached, but did not quite reach, an equilibrium. The mean fluid loss from all discs was 18%. All regions except the outer 2 mm experienced a significant loss of fluid (P < 0.01). The posterior mid-annulus showed the greatest fluid loss (30%), while the nucleus lost 15%. CONCLUSIONS: A comparison with previously published work suggests that fluid exchange of this magnitude will have a considerable effect on disc cell metabolism and on metabolite transport. PMID:9014581

  17. Sorption vacuum trap

    NASA Technical Reports Server (NTRS)

    Barrington, A. E.; Caruso, A. J.

    1970-01-01

    Modified sorption trap for use in high vacuum systems contains provisions for online regeneration of sorbent material. Trap is so constructed that it has a number of encapsulated resistance heaters and a valving and pumping device for removing gases from heated sorbing material. Excessive downtime is eliminated with this trap.

  18. Langmuir vacuum and superconductivity

    SciTech Connect

    Veklenko, B. A.

    2012-06-15

    It is shown that, in the 'jelly' model of cold electron-ion plasma, the interaction between electrons and the quantum electromagnetic vacuum of Langmuir waves involves plasma superconductivity with an energy gap proportional to the energy of the Langmuir quantum.

  19. The vacuum conservation theorem

    NASA Astrophysics Data System (ADS)

    Minguzzi, E.

    2015-03-01

    A version of the vacuum conservation theorem is proved which does not assume the existence of a time function nor demands stronger properties than the dominant energy condition. However, it is shown that a stronger stable version plays a role in the study of compact Cauchy horizons.

  20. Topics in vacuum decay

    NASA Astrophysics Data System (ADS)

    Masoumi, Ali

    2013-12-01

    If a theory has more than one classically stable vacuum, quantum tunneling and thermal jumps make the transition between the vacua possible. The transition happens through a first order phase transition started by nucleation of a bubble of the new vacuum. The outward pressure of the truer vacuum makes the bubble expand and consequently eat away more of the old phase. In the presence of gravity this phenomenon gets more complicated and meanwhile more interesting. It can potentially have important cosmological consequences. Some aspects of this decay are studied in this thesis. Solutions with different symmetry than the generically used O(4) symmetry are studied and their actions calculated. Vacuum decay in a spatial vector field is studied and novel features like kinky domain walls are presented. The question of stability of vacua in a landscape of potentials is studied and the possible instability in large dimension of fields is shown. Finally a compactification of the Einstein-Maxwell theory is studied which can be a good lab to understand the decay rates in compactification models of arbitrary dimensions.

  1. Vacuum ultraviolet holography

    NASA Technical Reports Server (NTRS)

    Bjorklund, G. C.; Harris, S. E.; Young, J. F.

    1974-01-01

    The authors report the first demonstration of holographic techniques in the vacuum ultraviolet spectral region. Holograms were produced with coherent 1182 A radiation. The holograms were recorded in polymethyl methacrylate and read out with an electron microscope. A holographic grating with a fringe spacing of 836 A was produced and far-field Fraunhofer holograms of sub-micron particles were recorded.

  2. Vacuum Kundt waves

    NASA Astrophysics Data System (ADS)

    McNutt, David; Milson, Robert; Coley, Alan

    2013-03-01

    We discuss the invariant classification of vacuum Kundt waves using the Cartan-Karlhede algorithm and determine the upper bound on the number of iterations of the Karlhede algorithm to classify the vacuum Kundt waves (Collins (1991 Class. Quantum Grav. 8 1859-69), Machado Ramos (1996 Class. Quantum Grav. 13 1589)). By choosing a particular coordinate system we partially construct the canonical coframe used in the classification to study the functional dependence of the invariants arising at each iteration of the algorithm. We provide a new upper bound, q ? 4, and show that this bound is sharp by analyzing the subclass of Kundt waves with invariant count beginning with (0, 1,) to show that the class with invariant count (0, 1, 3, 4, 4) exists. This class of vacuum Kundt waves is shown to be unique as the only set of metrics requiring the fourth covariant derivatives of the curvature. We conclude with an invariant classification of the vacuum Kundt waves using a suite of invariants.

  3. A vacuum chamber feedthrough

    NASA Technical Reports Server (NTRS)

    Brown, V. D.

    1973-01-01

    Simple and inexpensive microwave feedthrough has been designed which transfers 130 ns, 5kV pulse into vacuum chamber. Feedthrough may be used over wide range and is adaptable to most coaxial cables, since either multistrand or single strand center conductor cable can be used.

  4. The advantages of Blu-ray disc

    NASA Astrophysics Data System (ADS)

    Chen, Dayu; Chen, Dianyong; Wang, Bei

    2005-09-01

    Blu-ray Disc format is required by the forthcoming of High Definition TV era which calls for a brand new generation of optical storage after DVD. It is such a technology with wavelength short as 405nm and numerical aperture high as 0.85. The format is designed to have an even wider disc tolerances than those of DVD. Thanks for those more innovative concepts Blu-ray Disc is the most economical storage solution in terms of cost per giga byte. And it is expected to be a long-term optical storage standard rather than an interim solution.

  5. DISC1 genetics, biology and psychiatric illness

    PubMed Central

    THOMSON, Pippa A.; MALAVASI, Elise L.V.; GRNEWALD, Ellen; SOARES, Dinesh C.; BORKOWSKA, Malgorzata; MILLAR, J. Kirsty

    2012-01-01

    Psychiatric disorders are highly heritable, and in many individuals likely arise from the combined effects of genes and the environment. A substantial body of evidence points towards DISC1 being one of the genes that influence risk of schizophrenia, bipolar disorder and depression, and functional studies of DISC1 consequently have the potential to reveal much about the pathways that lead to major mental illness. Here, we review the evidence that DISC1 influences disease risk through effects upon multiple critical pathways in the developing and adult brain. PMID:23550053

  6. Spectroscopic Parameters of Lumbar Intervertebral Disc Material

    NASA Astrophysics Data System (ADS)

    Terbetas, G.; Kozlovskaja, A.; Varanius, D.; Graziene, V.; Vaitkus, J.; Vaitkuviene, A.

    2009-06-01

    There are numerous methods of investigating intervertebral disc. Visualization methods are widely used in clinical practice. Histological, imunohistochemical and biochemical methods are more used in scientific research. We propose that a new spectroscopic investigation would be useful in determining intervertebral disc material, especially when no histological specimens are available. Purpose: to determine spectroscopic parameters of intervertebral disc material; to determine emission spectra common for all intervertebral discs; to create a background for further spectroscopic investigation where no histological specimen will be available. Material and Methods: 20 patients, 68 frozen sections of 20 ?m thickness from operatively removed intervertebral disc hernia were excited by Nd:YAG microlaser STA-01-TH third harmonic 355 nm light throw 0, 1 mm fiber. Spectrophotometer OceanOptics USB2000 was used for spectra collection. Mathematical analysis of spectra was performed by ORIGIN multiple Gaussian peaks analysis. Results: In each specimen of disc hernia were found distinct maximal spectral peaks of 4 types supporting the histological evaluation of mixture content of the hernia. Fluorescence in the spectral regions 370-700 nm was detected in the disc hernias. The main spectral component was at 494 nm and the contribution of the components with the peak wavelength values at 388 nm, 412 nm and 4355 nm were varying in the different groups of samples. In comparison to average spectrum of all cases, there are 4 groups of different spectral signatures in the region 400-500 nm in the patient groups, supporting a clinical data on different clinical features of the patients. Discussion and Conclusion: besides the classical open discectomy, new minimally invasive techniques of treating intervertebral disc emerge (PLDD). Intervertebral disc in these techniques is assessed by needle, no histological specimen is taken. Spectroscopic investigation via fiber optics through the needle can give additional information of needle position, assuring the needle tip is directed into intervertebral disc material. Spectroscopic analysis of intervertebral disc removed during open surgery, creates background for further investigation on intervertebral disc degeneration spectral classification.

  7. Intracranial hydatid cyst is a rare cause of midbrain herniation: A case report and literature review.

    PubMed

    Duransoy, Yusuf Kurtulu?; Mete, Mesut; Barutuo?lu, Mustafa; Unsal, Ulkn nl; Seluki, Mehmet

    2013-09-01

    Hydatid disease is a parasitic infection affecting the brain in about 2% of the cases. Brain involvement is most commonly observed in children. Here, we report a 13-year-old male patient who presented with headache, nausea, and vomiting. Before cranial computed tomography (CT) was performed, the patient had generalized epileptic seizures. He was disoriented, and had anisocoria with dilatation of the right pupilla. CT showed a cystic lesion of 10-cm diameter in the right temporoparietal region that had caused a shift of the midline structures to the contralateral side; an urgent operation was performed as there were signs of midbrain herniation. PMID:24470819

  8. Intracranial hydatid cyst is a rare cause of midbrain herniation: A case report and literature review

    PubMed Central

    Duransoy, Yusuf Kurtulu?; Mete, Mesut; Barutuo?lu, Mustafa; nsal, lkn nl; Seluki, Mehmet

    2013-01-01

    Hydatid disease is a parasitic infection affecting the brain in about 2% of the cases. Brain involvement is most commonly observed in children. Here, we report a 13-year-old male patient who presented with headache, nausea, and vomiting. Before cranial computed tomography (CT) was performed, the patient had generalized epileptic seizures. He was disoriented, and had anisocoria with dilatation of the right pupilla. CT showed a cystic lesion of 10-cm diameter in the right temporoparietal region that had caused a shift of the midline structures to the contralateral side; an urgent operation was performed as there were signs of midbrain herniation. PMID:24470819

  9. Mesenteric Defect with Internal Herniation: A Rare Cause of Bowel Obstruction in Newborn.

    PubMed

    Adnen, Hakim; Aida, Borgi; Serra, Belhadj; Narjess, Ghali; Asma, Hamdi; Ammar, Khaldi; Khaled, Menif; Said, Jlidi; Nejla, Ben Jaballah

    2015-01-01

    Herniation through a congenital mesenteric defect is a rare cause of intestinal obstruction in the newborn. Early diagnosis and surgical treatment improves the prognosis. We present a case of a full-term infant who presented with respiratory distress at birth. Enteral feeding was not started because abdominal distension and delayed passage of meconium. Bowel obstruction was suspected. Radiological investigation did not provide a clear diagnosis. Surgical exploration revealed transmesenteric congenital hernia. After surgical repair, enteral feeding was tolerated and patient was discharged with an uneventful outcome. Diagnostic difficulties were discussed. PMID:25978102

  10. Massive Renal Intratubular Hemorrhage With Herniations into Renal Veins: Report of a Case

    PubMed Central

    Almosa, Mohammad A.; Alturki, Mohamad A.; Almuzeni, Ali A.; Alamri, Naif H.

    2014-01-01

    A 30-year-old woman suffered intractable gross hematuria of renal origin, which required nephrectomy after failed conservative management. Pathological examination revealed massive intratubular hemorrhage and frequent deposition of an amorphous and homogenous material positive for Periodic Acid-Schiff (PAS) stain in the corticomedullary junction. This substance is frequently herniated into the lumen of thin-walled veins of arcuate size. There was no apparent cause for the bleeding. To the best of our knowledge this is the fourth reported case with these peculiar histopathological findings associated with hematuria. We discuss some hypotheses as to the etiopathogenesis of this rare and interesting condition. PMID:26793486

  11. Management of post-goniopuncture iris herniation: a two-step procedure.

    PubMed

    Martn-Moro, Julio Gonzlez; Miguel, Yolanda Fernndez

    2014-06-01

    A 38-year-old male presented to the emergency room suffering acute pain in his left eye. Two months before he had been submitted to uneventful non-penetrating deep sclerectomy and one month before to YAG-laser goniopuncture. Examination showed iris herniation into the trabeculo-descemet's window. Surgical reduction was carried out through a peripheral corneal incision, and a large air bubble was injected into the anterior chamber. Four days later a wide laser peripheral iridotomy was performed. This technique can transform a non-penetrating technique into a full-trabeculectomy, without reopening the superficial flap. PMID:23740144

  12. Gastric outlet obstruction secondary to paraesophageal herniation of gastric antrum after laparoscopic fundoplication.

    PubMed

    Coskun, Selcuk; Soylu, Lutfi; Sahin, Mahir; Demiray, Taylan

    2015-04-01

    The most common causes of acute gastric outlet obstruction (GOO) are duodenal and type 3 gastric ulcers. However, mechanical or functional causes may also lead to this pathology. Acute GOO is characterized by delayed gastric emptying, anorexia, or nausea accompanied by vomiting. Herein we report a 56-year-old man diagnosed with GOO secondary to paraesophageal hiatal herniation of gastric antrum after laparoscopic fundoplication. Because of the rarity of this disease, common gastrointestinal complaints may mislead the emergency physician to diagnose a nonsurgical gastrointestinal disease if a detailed history and physical examinations are not obtained. PMID:25813602

  13. Demonstrations with a Vacuum: Old Demonstrations for New Vacuum Pumps.

    ERIC Educational Resources Information Center

    Greenslade, Thomas B., Jr.

    1989-01-01

    Explains mechanisms of 19th-century vacuum pumps. Describes demonstrations using the pump including guinea and feather tube, aurora tube, electric egg, Gassiots cascade, air mill, bell in vacuum, density and buoyancy of air, fountain in vacuum, mercury shower, palm and bladder glasses, Bacchus demonstration, pneumatic man-lifter, and Magdeburg

  14. Optical effects related to Keplerian discs orbiting Kehagias-Sfetsos naked singularities

    NASA Astrophysics Data System (ADS)

    Stuchlík, Zdeněk; Schee, Jan

    2014-10-01

    We demonstrate possible optical signatures of the Kehagias-Sfetsos (KS) naked singularity spacetimes representing a spherically symmetric vacuum solution of the modified Hořava gravity. In such spacetimes, accretion structures significantly different from those present in standard black hole spacetimes occur due to the ‘antigravity’ effect, which causes an internal static sphere surrounded by Keplerian discs. We focus our attention on the optical effects related to the Keplerian accretion discs, constructing the optical appearance of the Keplerian discs, the spectral continuum due to their thermal radiation, and the spectral profiled lines generated in the innermost parts of such discs. The KS naked singularity signature is strongly encoded in the characteristics of predicted optical effects, especially in cases where the spectral continuum and spectral lines are profiled by the strong gravity of the spacetimes due to the vanishing region of the angular velocity gradient influencing the effectiveness of the viscosity mechanism. We can conclude that optical signatures of KS naked singularities can be well distinguished from the signatures of standard black holes.

  15. Tritium handling in vacuum systems

    SciTech Connect

    Gill, J.T.; Coffin, D.O.

    1986-10-01

    This report provides a course in Tritium handling in vacuum systems. Topics presented are: Properties of Tritium; Tritium compatibility of materials; Tritium-compatible vacuum equipment; and Tritium waste treatment.

  16. Evolution of solids in protoplanetary discs

    NASA Astrophysics Data System (ADS)

    Kornet, K.

    2006-10-01

    1d code designed to track the evolution of solids in protoplanetary discs from an early stage, when all solids are in the dust form, to the stage when most solids are in the form of a planetesimal swarm.

  17. A radiation hard vacuum switch

    DOEpatents

    Boettcher, G.E.

    1988-07-19

    A vacuum switch with an isolated trigger probe which is not directly connected to the switching electrodes. The vacuum switch within the plasmatron is triggered by plasma expansion initiated by the trigger probe which travels through an opening to reach the vacuum switch elements. The plasma arc created is directed by the opening to the space between the anode and cathode of the vacuum switch to cause conduction. 3 figs.

  18. Archival-grade optical disc design and international standards

    NASA Astrophysics Data System (ADS)

    Fujii, Toru; Kojyo, Shinichi; Endo, Akihisa; Kodaira, Takuo; Mori, Fumi; Shimizu, Atsuo

    2015-09-01

    Optical discs currently on the market exhibit large variations in life span among discs, making them unsuitable for certain business applications. To assess and potentially mitigate this problem, we performed accelerated degradation testing under standard ISO conditions, determined the probable disc failure mechanisms, and identified the essential criteria necessary for a stable disc composition. With these criteria as necessary conditions, we analyzed the physical and chemical changes that occur in the disc components, on the basis of which we determined technological measures to reduce these degradation processes. By applying these measures to disc fabrication, we were able to develop highly stable optical discs.

  19. Investigation of cryogenic rupture disc design

    NASA Technical Reports Server (NTRS)

    Keough, J. B.; Oldland, A. H.

    1973-01-01

    Rupture disc designs of both the active (command actuated) and passive (pressure ruptured) types were evaluated for performance characteristics at cryogenic temperatures and for capability to operate in a variety of cryogens, including gaseous and liquid fluorine. The test results, coupled with information from literature and industry searches, were used to establish a statement of design criteria and recommended practices for application of rupture discs to cryogenic rocket propellant feed and vent systems.

  20. Mach disc formation in cylindrical recovery systems

    SciTech Connect

    Morris, C.E.; McQueen, R.G.; Marsh, S.P.

    1983-01-01

    Cylindrical recovery systems have been used to shock-load polymers to pressures exceeding 50 GPa. In order to determine the pressures generated in these recovery systems the formation of the Mach disc on axis and its approach to steady state was monitored. The relation of the Mach disc diameter to the lateral dimension of the high explosive used to compress the polymer samples was also investigated.

  1. Disc valve for sampling erosive process streams

    DOEpatents

    Mrochek, John E. (Oak Ridge, TN); Dinsmore, Stanley R. (Norris, TN); Chandler, Edward W. (Knoxville, TN)

    1986-01-01

    A four-port disc valve for sampling erosive, high temperature process streams. A rotatable disc defining opposed first and second sampling cavities rotates between fired faceplates defining flow passageways positioned to be alternatively in axial alignment with the first and second cavities. Silicon carbide inserts and liners composed of .alpha. silicon carbide are provided in the faceplates and in the sampling cavities to limit erosion while providing lubricity for a smooth and precise operation when used under harsh process conditions.

  2. Bakeout Chamber Within Vacuum Chamber

    NASA Technical Reports Server (NTRS)

    Taylor, Daniel M.; Soules, David M.; Barengoltz, Jack B.

    1995-01-01

    Vacuum-bakeout apparatus for decontaminating and measuring outgassing from pieces of equipment constructed by mounting bakeout chamber within conventional vacuum chamber. Upgrade cost effective: fabrication and installation of bakeout chamber simple, installation performed quickly and without major changes in older vacuum chamber, and provides quantitative data on outgassing from pieces of equipment placed in bakeout chamber.

  3. Surge-damping vacuum valve

    DOEpatents

    Bullock, Jack C. (Pleasanton, CA); Kelly, Benjamin E. (Tracy, CA)

    1980-01-01

    A valve having a mechanism for damping out flow surges in a vacuum system which utilizes a slotted spring-loaded disk positioned adjacent the valve's vacuum port. Under flow surge conditions, the differential pressure forces the disk into sealing engagement with the vacuum port, thereby restricting the flow path to the slots in the disk damping out the flow surge.

  4. Portable vacuum object handling device

    DOEpatents

    Anderson, Gordon H. (Los Alamos, NM)

    1983-08-09

    The disclosure relates to a portable device adapted to handle objects which are not to be touched by hand. A piston and bore wall form a vacuum chamber communicating with an adaptor sealably engageable with an object to be lifted. The piston is manually moved and set to establish vacuum. A valve is manually actuatable to apply the vacuum to lift the object.

  5. Integrated structure vacuum tube

    NASA Technical Reports Server (NTRS)

    Dimeff, J.; Kerwin, W. J. (inventors)

    1976-01-01

    High efficiency, multi-dimensional thin film vacuum tubes suitable for use in high temperature, high radiation environments are described. The tubes are fabricated by placing thin film electrode members in selected arrays on facing interior wall surfaces of an alumina substrate envelope. Cathode members are formed using thin films of triple carbonate. The photoresist used in photolithography aids in activation of the cathodes by carbonizing and reacting with the reduced carbonates when heated in vacuum during forming. The finely powdered triple carbonate is mixed with the photoresist used to delineate the cathode locations in the conventional solid state photolithographic manner. Anode and grid members are formed using thin films of refractory metal. Electron flow in the tubes is between grid elements from cathode to anode as in a conventional three-dimensional tube.

  6. Vacuum tool manipulator

    DOEpatents

    Zollinger, William T. (3927 Almon Dr., Martinez, GA 30907)

    1993-01-01

    Apparatus for manipulating a vacuum hose in a reactor vessel comprises a housing with two opposing openings, an arm carried by the housing and deployable from a stowed position essentially completely within the housing to an extended position where the arm extends through the two openings in a generally horizontal position. The arm preferably has a two-fingered gripping device for gripping the vacuum hose but may carry a different end effector such as a grinding wheel. The fingers are opened and closed by one air cylinder. A second air cylinder extends the device. A third air cylinder within the housing pivotally pulls the opposing end of the arm into the housing via a pivoting member pivotally connected between the third air cylinder shaft and the arm.

  7. An automated vacuum system

    SciTech Connect

    Atkins, W.H. ); Vaughn, G.D. ); Bridgman, C. )

    1991-01-01

    Software tools available with the Ground Test Accelerator (GTA) control system provide the capability to express a control problem as a finite state machine. System states and transitions are expressed in terms of accelerator parameters and actions are taken based on state transitions. This is particularly useful for sequencing operations which are modal in nature or are unwieldy when implemented with conventional programming. State diagrams are automatically translated into code which is executed by the control system. These tools have been applied to the vacuum system for the GTA accelerator to implement automatic sequencing of operations. With a single request, the operator may initiate a complete pump-down sequence. He can monitor the progress and is notified if an anomaly occurs requiring intervention. The operator is not required to have detailed knowledge of the vacuum system and is protected from taking inappropriate actions. 1 ref., 6 figs.

  8. Vacuum tool manipulator

    DOEpatents

    Zollinger, W.T.

    1993-11-23

    Apparatus for manipulating a vacuum hose in a reactor vessel comprises a housing with two opposing openings, an arm carried by the housing and deployable from a stowed position essentially completely within the housing to an extended position where the arm extends through the two openings in a generally horizontal position. The arm preferably has a two-fingered gripping device for gripping the vacuum hose but may carry a different end effector such as a grinding wheel. The fingers are opened and closed by one air cylinder. A second air cylinder extends the device. A third air cylinder within the housing pivotally pulls the opposing end of the arm into the housing via a pivoting member pivotally connected between the third air cylinder shaft and the arm. 6 figures.

  9. Electrostatic Levitator Vacuum Chamber

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Optical prots ring the Electrostatic Levitator (ESL) vacuum chamber to admit light from the heating laser (the beam passes through the window at left), poisitioning lasers (one port is at center), and lamps (arc lamp at right), and to allow diagnostic instruments to view the sample. The ESL uses static electricity to suspend an object (about 2-3 mm in diameter) inside a vacuum chamber while a laser heats the sample until it melts. This lets scientists record a wide range of physical properties without the sample contacting the container or any instruments, conditions that would alter the readings. The Electrostatic Levitator is one of several tools used in NASA's microgravity materials science program.

  10. Electrostatic Levitator Vacuum Chambers

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Optical prots ring the Electrostatic Levitator (ESL) vacuum chamber to admit light from the heating laser (the beam passes through the window at left), poisitioning lasers (one port is at center), and lamps (such as the deuterium arc lamp at right), and to allow diagnostic instruments to view the sample. The ESL uses static electricity to suspend an object (about 2-3 mm in diameter) inside a vacuum chamber while a laser heats the sample until it melts. This lets scientists record a wide range of physical properties without the sample contacting the container or any instruments, conditions that would alter the readings. The Electrostatic Levitator is one of several tools used in NASA's microgravity materials science program.

  11. Edison's vacuum technology patents

    NASA Astrophysics Data System (ADS)

    Waits, Robert K.

    2003-07-01

    During 1879 Thomas Edison's Menlo Park, New Jersey laboratory developed the means to evacuate glass lamp globes to less than a mTorr in 20 min and in mid-1880 began production of carbon-filament incandescent lamps. Among Edison's nearly 1100 U.S. patents are five for vacuum pump improvements, and at least eight others that are vacuum-related; all applied for between 1880 and 1886. Inspired by an 1878 article by De La Rue and Mller [Philos. Trans. R. Soc. London, Ser. A 169, 155 (1878)] on studies of glow discharges, Edison devised a combination pump using the Geissler pump as a rough pump and the Sprengel pump for continuous exhaustion. Edison's patents described means to control the mercury flow and automate the delivery of the mercury to banks of up to a hundred pumps. Other patents described various means to remove residual gases during lamp processing.

  12. Dry vacuum pumps

    NASA Astrophysics Data System (ADS)

    Sibuet, R.

    2008-05-01

    For decades and for ultimate pressure below 1 mbar, oil-sealed Rotary Vane Pumps have been the most popular solution for a wide range of vacuum applications. In the late 80ies, Semiconductor Industry has initiated the development of the first dry roughing pumps. Today SC applications are only using dry pumps and dry pumping packages. Since that time, pumps manufacturers have developed dry vacuum pumps technologies in order to make them attractive for other applications. The trend to replace lubricated pumps by dry pumps is now spreading over many other market segments. For the Semiconductor Industry, it has been quite easy to understand the benefits of dry pumps, in terms of Cost of Ownership, process contamination and up-time. In this paper, Technology of Dry pumps, its application in R&D/industries, merits over conventional pumps and future growth scope will be discussed.

  13. Compact vacuum insulation embodiments

    DOEpatents

    Benson, David K.; Potter, Thomas F.

    1992-01-01

    An ultra-thin compact vacuum insulation panel is comprised of two hard, but bendable metal wall sheets closely spaced apart from each other and welded around the edges to enclose a vacuum chamber. Glass or ceramic spacers hold the wall sheets apart. The spacers can be discrete spherical beads or monolithic sheets of glass or ceramic webs with nodules protruding therefrom to form essentially "point" or "line" contacts with the metal wall sheets. In the case of monolithic spacers that form "line" contacts, two such spacers with the line contacts running perpendicular to each other form effectively "point" contacts at the intersections. Corrugations accommodate bending and expansion, tubular insulated pipes and conduits, and preferred applications are also included.

  14. Compact vacuum insulation embodiments

    DOEpatents

    Benson, D.K.; Potter, T.F.

    1992-04-28

    An ultra-thin compact vacuum insulation panel is comprised of two hard, but bendable metal wall sheets closely spaced apart from each other and welded around the edges to enclose a vacuum chamber. Glass or ceramic spacers hold the wall sheets apart. The spacers can be discrete spherical beads or monolithic sheets of glass or ceramic webs with nodules protruding therefrom to form essentially point' or line' contacts with the metal wall sheets. In the case of monolithic spacers that form line' contacts, two such spacers with the line contacts running perpendicular to each other form effectively point' contacts at the intersections. Corrugations accommodate bending and expansion, tubular insulated pipes and conduits, and preferred applications are also included. 26 figs.

  15. Compact vacuum insulation

    DOEpatents

    Benson, David K.; Potter, Thomas F.

    1993-01-01

    An ultra-thin compact vacuum insulation panel is comprised of two hard, but bendable metal wall sheets closely spaced apart from each other and welded around the edges to enclose a vacuum chamber. Glass or ceramic spacers hold the wall sheets apart. The spacers can be discrete spherical beads or monolithic sheets of glass or ceramic webs with nodules protruding therefrom to form essentially "point" or "line" contacts with the metal wall sheets. In the case of monolithic spacers that form "line" contacts, two such spacers with the line contacts running perpendicular to each other form effectively "point" contacts at the intersections. Corrugations accommodate bending and expansion, tubular insulated pipes and conduits, and preferred applications are also included.

  16. Compact vacuum insulation

    DOEpatents

    Benson, D.K.; Potter, T.F.

    1993-01-05

    An ultra-thin compact vacuum insulation panel is comprised of two hard, but bendable metal wall sheets closely spaced apart from each other and welded around the edges to enclose a vacuum chamber. Glass or ceramic spacers hold the wall sheets apart. The spacers can be discrete spherical beads or monolithic sheets of glass or ceramic webs with nodules protruding therefrom to form essentially point'' or line'' contacts with the metal wall sheets. In the case of monolithic spacers that form line'' contacts, two such spacers with the line contacts running perpendicular to each other form effectively point'' contacts at the intersections. Corrugations accommodate bending and expansion, tubular insulated pipes and conduits, and preferred applications are also included.

  17. Tidally distorted accretion discs in binary stars

    NASA Astrophysics Data System (ADS)

    Ogilvie, G. I.

    2002-03-01

    The non-axisymmetric features observed in the discs of dwarf novae in outburst are usually considered to be spiral shocks, which are the non-linear relatives of tidally excited waves. This interpretation suffers from a number of problems. For example, the natural site of wave excitation lies outside the Roche lobe, the disc must be especially hot, and most treatments of wave propagation do not take into account the vertical structure of the disc. In this paper I construct a detailed semi-analytical model of the non-linear tidal distortion of a thin, three-dimensional accretion disc by a binary companion on a circular orbit. The analysis presented here allows for vertical motion and radiative energy transport, and introduces a simple model for the turbulent magnetic stress. The m=2 inner vertical resonance has an important influence on the amplitude and phase of the tidal distortion. I show that the observed patterns find a natural explanation if the emission is associated with the tidally thickened sectors of the outer disc, which may be irradiated from the centre. According to this hypothesis, it may be possible to constrain the physical parameters of the disc through future observations.

  18. Angular momentum transport in protostellar discs

    NASA Astrophysics Data System (ADS)

    Salmeron, Raquel; Knigl, Arieh; Wardle, Mark

    2007-02-01

    Angular momentum transport in protostellar discs can take place either radially, through turbulence induced by the magnetorotational instability (MRI), or vertically, through the torque exerted by a large-scale magnetic field that threads the disc. Using semi-analytic and numerical results, we construct a model of steady-state discs that includes vertical transport by a centrifugally driven wind as well as MRI-induced turbulence. We present approximate criteria for the occurrence of either one of these mechanisms in an ambipolar diffusion-dominated disc. We derive `strong field' solutions in which the angular momentum transport is purely vertical and `weak field' solutions that are the stratified-disc analogues of the previously studied MRI channel modes; the latter are transformed into accretion solutions with predominantly radial angular momentum transport when we implement a turbulent-stress prescription based on published results of numerical simulations. We also analyse `intermediate field strength' solutions in which both modes of transport operate at the same radial location; we conclude, however, that significant spatial overlap of these two mechanisms is unlikely to occur in practice. To further advance this study, we have developed a general scheme that incorporates also the Hall and Ohm conductivity regimes in discs with a realistic ionization structure.

  19. Electroweak vacuum geometry

    NASA Astrophysics Data System (ADS)

    Lepora, Nathan F.; Kibble, Tom W. B.

    1999-04-01

    We analyse symmetry breaking in the Weinberg-Salam model paying particular attention to the underlying geometry of the theory. In this context we find two natural metrics upon the vacuum manifold: an isotropic metric associated with the scalar sector, and a squashed metric associated with the gauge sector. Physically, the interplay between these metrics gives rise to many of the non-perturbative features of Weinberg-Salam theory.

  20. Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature

    PubMed Central

    Sasani, Mehdi; Ozer, Ali F; Vural, Metin; Sarioglu, Ali C

    2009-01-01

    Background: Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy frequently present in Brown-Séquard syndrome. Preoperative diagnosis can be made with magnetic resonance imaging (MRI). Many surgical techniques have been applied by various authors and are usually reversible by surgical treatment. Methods: Case report and review of the literature. Findings: A 45-year-old woman with Brown-Séquard syndrome underwent thoracic MRI, which revealed transdural spinal cord herniation at T8 vertebral body level. During surgery the spinal cord was reduced and the ventral dural defect was restorated primarily and reinforced with a thin layer of subdermal fat. The dural defect was then closed with interrupted stitches. Results: Although neurologic status improved postoperatively, postsurgical MRI demonstrated swelling and abnormal T2-signal intensity in the reduced spinal cord. Review of the English language literature revealed 100 ISCH cases. Conclusions: ISCH is a rare clinical entity that should be considered in differential diagnosis of Brown-Séquard syndrome, especially among women in their fifth decade of life. Outcome for patients who initially had Brown-Séquard syndrome was significantly better than for patients who presented with spastic paralysis. Although progression of neurologic deficits can be very slow, reduction of the spinal cord and repair of the defect are crucial in stopping or reversing the deterioration. PMID:19264054

  1. Differentiation of idiopathic spinal cord herniation from CSF-isointense intraspinal extramedullary lesions displacing the cord.

    PubMed

    Haber, Marc D; Nguyen, Dustin D; Li, Shan

    2014-01-01

    Focal spinal cord displacement can be caused by idiopathic spinal cord herniation (ISCH), in which the cord protrudes through a dural defect into the epidural space, causing cord displacement and tethering. ISCH is uncommon and often is misdiagnosed initially, which results in delayed management. ISCH can be mimicked by space-occupying cerebrospinal fluid (CSF)-isointense intraspinal extramedullary lesions, such as epidermoid cysts or teratomas, intradural arachnoid cysts, epidural hematomas or abscesses, cystic nerve sheath tumors, synovial or Tarlov cysts, meningoceles, and pseudomeningoceles. Initial computed tomography (CT) and unenhanced magnetic resonance (MR) imaging studies may depict focal cord displacement and a widened CSF space but often are not sufficient to identify the underlying cause. High-resolution thin-section MR imaging can delineate the exact location of the dural defect and the protrusion of the herniated cord through this defect into the epidural space. At imaging, unimpeded CSF pulsation artifacts seen within a widened CSF space exclude a space-occupying lesion. A filling defect seen at conventional or CT myelography can help confirm a CSF-isointense space-occupying lesion; intravenous contrast agent administration can help exclude a rim-enhancing cystic extramedullary lesion. The clinical presentation usually is nonspecific, but symptom acuity, fever, and trauma can guide the imaging evaluation and help narrow the differential diagnosis. A multimodality imaging approach is essential to differentiate ISCH from space-occupying CSF-isointense intraspinal extramedullary lesions. PMID:24617681

  2. Differentiation of idiopathic spinal cord herniation from CSF-isointense intraspinal extramedullary lesions displacing the cord.

    TOXLINE Toxicology Bibliographic Information

    Haber MD; Nguyen DD; Li S

    2014-03-01

    Focal spinal cord displacement can be caused by idiopathic spinal cord herniation (ISCH), in which the cord protrudes through a dural defect into the epidural space, causing cord displacement and tethering. ISCH is uncommon and often is misdiagnosed initially, which results in delayed management. ISCH can be mimicked by space-occupying cerebrospinal fluid (CSF)-isointense intraspinal extramedullary lesions, such as epidermoid cysts or teratomas, intradural arachnoid cysts, epidural hematomas or abscesses, cystic nerve sheath tumors, synovial or Tarlov cysts, meningoceles, and pseudomeningoceles. Initial computed tomography (CT) and unenhanced magnetic resonance (MR) imaging studies may depict focal cord displacement and a widened CSF space but often are not sufficient to identify the underlying cause. High-resolution thin-section MR imaging can delineate the exact location of the dural defect and the protrusion of the herniated cord through this defect into the epidural space. At imaging, unimpeded CSF pulsation artifacts seen within a widened CSF space exclude a space-occupying lesion. A filling defect seen at conventional or CT myelography can help confirm a CSF-isointense space-occupying lesion; intravenous contrast agent administration can help exclude a rim-enhancing cystic extramedullary lesion. The clinical presentation usually is nonspecific, but symptom acuity, fever, and trauma can guide the imaging evaluation and help narrow the differential diagnosis. A multimodality imaging approach is essential to differentiate ISCH from space-occupying CSF-isointense intraspinal extramedullary lesions.

  3. The LHC Vacuum System

    NASA Astrophysics Data System (ADS)

    Grbner, O.

    1997-05-01

    The Large Hadron Collider (LHC) at CERN, involves two proton storage rings with colliding beams of 7 TeV. The machine will be housed in the existing LEP tunnel and requires 16 m long superconducting bending magnets. The vacuum chamber will be the inner wall of the cryostat and hence at the temperature of the magnet cold bore, i.e. at 1.9 K and therefore a very good cryo-pump. To reduce the cryogenic power consumption, the heat load from synchrotron radiation and from the image currents in the vacuum chamber will be absorbed on a 'beam screen', which operates between 5 and 20 K, inserted in the magnet cold bore. The design pressure necessary for operation must provide a lifetime of many days and a stringent requirement comes from the power deposition in the superconducting magnet coils due to protons scattered on the residual gas which could lead to a magnet quench. Cryo-pumping of gas on the cold surfaces provides the necessary low gas densities but it must be ensured that the vapour pressure of cryo-sorbed molecules, of which H2 and He would be the most critical species, remains within acceptable limits. The room temperature sections of the LHC, specifically in the experiments, the vacuum must be stable against ion induced desorption and ISR-type 'pressure bumps'.

  4. The ITER vacuum systems

    NASA Astrophysics Data System (ADS)

    Day, C.; Murdoch, D.

    2008-05-01

    ITER is a large vacuum facility which comprises many service, diagnostic and monitoring vacuum sub-systems as well as three large cryogenic pumping systems for evacuation and maintenance of the required pressure levels. Control of the gas throughput is one of the key issues affecting the performance and achievable burn time of a fusion reactor. The main pumping systems are the torus exhaust pumping, the cryopumps for the neutral beam injection systems for plasma heating, and the cryopumps for the ITER cryostat. All customized cryosorption pumps are force-cooled with supercritical helium and share a similar modular design of cryosorption pumping panels. For regeneration of the cryopumps as well as for roughing down the system volumes prior to operation, four identical sets of forepump trains are used. This paper will focus on the areas of the ITER vacuum systems which require customized developments and cannot rely on commercial solutions. The complex pumps have been tailored for the very specific applications and requirements at ITER, especially characterised by the need to be tritium compatible. An outline of the development path which was needed to come up with a sound design for the ITER cryopumps is given. The way of development is culminating in the manufacturing of 1:1 scale prototypes, which will be extensively tested in dedicated test facilities to ensure compatibility with all design requirements.

  5. Adverse effects of stromal vascular fraction during regenerative treatment of the intervertebral disc: observations in a goat model.

    PubMed

    Detiger, Suzanne E L; Helder, Marco N; Smit, Theodoor H; Hoogendoorn, Roel J W

    2015-09-01

    Stromal vascular fraction (SVF), an adipose tissue-derived heterogeneous cell mixture containing, among others, multipotent adipose stromal cells (ASCs) and erythrocytes, has proved beneficial for a wide range of applications in regenerative medicine. We sought to establish intervertebral disc(IVD) regeneration by injecting SVF intradiscally during a one-step surgical procedure in an enzymatically (Chondroitinase ABC; cABC) induced goat model of disc degeneration. Unexpectedly, we observed a severe inflammatory response that has not been described before, including massive lymphocyte infiltration, neovascularisation and endplate destruction. A second study investigated two main suspects for these adverse effects: cABC and erythrocytes within SVF. The same destructive response was observed in healthy goat discs injected with SVF, thereby eliminating cABC as a cause. Density gradient removal of erythrocytes and ASCs purified by culturing did not lead to adverse effects. Following these observations, we incorporated an extra washing step in the SVF harvesting protocol. In a third study, we applied this protocol in a one-step procedure to a goat herniation model, in which no adverse responses were observed either. However, upon intradiscal injection of an identically processed SVF mixture into our goat IVD degeneration model during a fourth study, the adverse effects surprisingly occurred again. Despite our quest for the responsible agent, we eventually could not identify the mechanism through which the observed destructive responses occurred. Although we cannot exclude that the adverse effects are species-dependent or model-specific, we advertise caution with the clinical application of autologous SVF injections into the IVD until the responsible agent(s) are identified. PMID:25682272

  6. Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial.

    PubMed

    Arts, Mark; Brand, Ronald; van der Kallen, Bas; Lycklama Nijeholt, Geert; Peul, Wilco

    2011-01-01

    The concept of minimally invasive lumbar disc surgery comprises reduced muscle injury. The aim of this study was to evaluate creatine phosphokinase (CPK) in serum and the cross-sectional area (CSA) of the multifidus muscle on magnetic resonance imaging as indicators of muscle injury. We present the results of a double-blind randomized trial on patients with lumbar disc herniation, in which tubular discectomy and conventional microdiscectomy were compared. In 216 patients, CPK was measured before surgery and at day 1 after surgery. In 140 patients, the CSA of the multifidus muscle was measured at the affected disc level before surgery and at 1 year after surgery. The ratios (i.e. post surgery/pre surgery) of CPK and CSA were used as outcome measures. The multifidus atrophy was classified into three grades ranging from 0 (normal) to 3 (severe atrophy), and the difference between post and pre surgery was used as an outcome. Patients' low-back pain scores on the visual analogue scale (VAS) were documented before surgery and at various moments during follow-up. Tubular discectomy compared with conventional microdiscectomy resulted in a nonsignificant difference in CPK ratio, although the CSA ratio was significantly lower in tubular discectomy. At 1 year, there was no difference in atrophy grade between both groups nor in the percentage of patients showing an increased atrophy grade (14% tubular vs. 18% conventional). The postoperative low-back pain scores on the VAS improved in both groups, although the 1-year between-group mean difference of improvement was 3.5 mm (95% CI; 1.4-5.7 mm) in favour of conventional microdiscectomy. In conclusion, tubular discectomy compared with conventional microdiscectomy did not result in reduced muscle injury. Postoperative evaluation of CPK and the multifidus muscle showed similar results in both groups, although patients who underwent tubular discectomy reported more low-back pain during the first year after surgery. PMID:20556439

  7. Cervical myelopathy due to single level prolapsed disc and spondylosis: a comparative study on outcome between two groups.

    PubMed

    Ryu, Jong-Seon; Chae, Jong-Woo; Cho, Woo-Jin; Chang, Han; Moon, Myung-Sang; Kim, Sung-Soo

    2010-10-01

    This article describes a retrospective study on myelopathy, induced by monosegmental prolapsed disc and spondylosis. To assess pre- and postoperative clinical and radiological findings related to myelopathy, and factors influencing the outcome, 20 disc herniation (group A) and 11 spondylosis patients (group B) were studied. Average duration of myelopathy in groups A and B were 3 and 8.7months, respectively. Anterior decompression and fusion were performed. Pre- and postoperative clinical and radiological findings and outcomes were assessed. Average preoperative disc heights were 85.9% of normal in group A and 72.7% in group B. Average anteroposterior canal diameter and Pavlov ratio at diseased level were 13.9mm and 0.81 in group A, respectively, and 12.1mm and 0.78 in group B. Five group A (25.0%) and four group B cases (36.4%) had radiculopathy. Cord compressions among 20 group A patients were median in seven and paramedian in 13. In the 11 group B patients, nine were median and two were paramedian. High signal intensity was observed in 19 group A and ten group B patients. Postoperative regression of T(2)-weighted high signal intensity in 14 group A (73.7%) and two group B patients (20.0%) was observed. Preoperative JOA scores in groups A and B were 10.3 and 12.8, respectively, which became 66.2 and 22.5 postoperatively. Neurological recovery was poorer in group B than in group A. Outcome was influenced by chronicity of myelopathy. PMID:20108087

  8. Stellar irradiated discs and implications on migration of embedded planets. I. Equilibrium discs

    NASA Astrophysics Data System (ADS)

    Bitsch, B.; Crida, A.; Morbidelli, A.; Kley, W.; Dobbs-Dixon, I.

    2013-01-01

    Context. The strength and direction of migration of embedded low mass planets depends on the disc's thermodynamic state. It has been shown that, in discs where the viscous heating is balanced by radiative transport, the migration can be directed outwards, a process which extends the lifetime of growing planetary embryos. Aims: We investigate the influence of opacity and stellar irradiation on the disc thermodynamics. We focus on equilibrium discs, which have no net mass flux. Utilizing the resulting disc structure, we determine the regions of outward migration in the disc. Methods: We performed two-dimensional numerical simulations of equilibrium discs with viscous heating, radiative cooling, and stellar irradiation. We used the explicit/implicit hydrodynamical code NIRVANA that includes a full tensor viscosity and stellar irradiation, as well as a two temperature solver that includes radiation transport in the flux-limited diffusion approximation. The migration of embedded planets was studied by using torque formulae. Results: In the constant opacity case, our code reproduces the analytical results corresponding to a black-body disc: the stellar irradiation dominates in the outer regions - leading to flaring (H/r ? r2/7) - while the viscous heating dominates close to the star. In particular, we find that the inner edge of the disc should not be significantly puffed-up by the stellar irradiation. If the opacity depends on the local density and temperature, the structure of the disc is different, and several bumps in the aspect ratio H/r appear, due to transitions between different opacity regimes. The bumps in the disc structure are very important, as they can shield the outer disc from stellar irradiation. Conclusions: Stellar irradiation is an important factor for determining the disc structure and has dramatic consequences for the migration of embedded planets. Compared to discs with only viscous heating and radiative cooling, a stellar irradiated disc features a much smaller region of outward migration for a range of planetary masses. This suggests that the region where the formation of giant planet cores takes place is smaller, which in turn might lead to a shorter growth phase.

  9. Stem Cell Approaches to Intervertebral Disc Regeneration: Obstacles from the Disc Microenvironment.

    PubMed

    Wang, Feng; Shi, Rui; Cai, Feng; Wang, Yun-Tao; Wu, Xiao-Tao

    2015-11-01

    Intervertebral disc (IVD) degeneration results in segmental instability and irritates neural compressive symptoms, such as low back pain and motor deficiency. The transplanting of stem cell into degenerative discs has attracted increasing clinical attention, as a new and proven approach to alleviating disc degeneration and to relieving discogenic pains. Aside from supplementation with stem cells, the IVD itself already contains a pool of stem and progenitor cells. Since the resident disc stem cells are incapable of reversing the pathologic changes that occur during aging and disc degeneration, it has been debated as to whether transplanted stem cells are capable of providing an efficient and durable therapeutic effect, even though there have been positive outcomes in both animal models and in clinical trials. This review aims to decipher the interactions between the stem cell and the disc microenvironment. Within their new niches in the IVD, the exogenous stem cell shows metabolic adaptation to the low-glucose supply, hypoxia, and compressive loadings, but demonstrates little tolerance to the disc-like acidity and hypertonicity. Similarly, the survival of endogenous stem cells is threatened as well by the harsh disc microenvironment, which may exhaust the stem cell resources and restrict the self-repair capacity of a degenerating IVD. To eliminate the intrinsic obstacles within the stressful disc niches, stem cells should be delivered with an injectable scaffold that provides both survival and mechanical support. Quick healing or concretion of the injection injuries, which minimizes stem cell leakage and disturbance to disc homeostasis, is of equal importance toward achieving efficient stem cell-based disc regeneration. PMID:26228642

  10. Air bearing vacuum seal assembly

    DOEpatents

    Booth, Rex

    1978-01-01

    An air bearing vacuum seal assembly capable of rotating at the speed of several thousand revolutions per minute using an air cushion to prevent the rotating and stationary parts from touching, and a two stage differential pumping arrangement to maintain the pressure gradient between the air cushion and the vacuum so that the leak rate into the vacuum is, for example, less than 1 .times. 10.sup.-4 Pa m.sup.3 /s. The air bearing vacuum seal has particular application for mounting rotating targets to an evacuated accelerator beam tube for bombardment of the targets with high-power charged particle beams in vacuum.

  11. Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum: A case report and review of the literature

    PubMed Central

    Jäger, Tarkan; Neureiter, Daniel; Nawara, Clemens; Dinnewitzer, Adam; Öfner, Dietmar; Lamadé, Wolfram

    2013-01-01

    Transhiatal herniation of the pancreas is an extremely rare condition. In the published literature we found only eleven cases reported in the period of 1958 to 2011. A coincidental hiatal herniation of the duodenum is described in two cases only. To our knowledge, we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis. A 72-year-old Caucasian woman was admitted to our department with a hiatal hernia grade IV for further evaluation. According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum, we had to respect the declared intention of the patient for a conservative procedure. So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition. We discuss the therapeutic decision making process and a complete literature review of this rare entity. PMID:23805366

  12. Gastrocnemius muscle herniation as a rare differential diagnosis of ankle sprain: case report and review of the literature

    PubMed Central

    2012-01-01

    Background Muscle herniation of the leg is a rare clinical entity. Yet, knowing this condition is necessary to avoid misdiagnosis and delayed treatment. In the extremities, muscle herniation most commonly occurs as a result of an acquired fascial defect, often due to trauma. Different treatment options for symptomatic extremity muscle herniation in the extremities, including conservative treatment, fasciotomy and mesh repair have been described. Case presentation We present the case of a patient who presented with prolonged symptoms after an ankle sprain. The clinical picture showed a fascial insufficiency with muscle bulging under tension. Ultrasound and MRI imaging confirmed the diagnosis of muscle hernia of the medial gastrocnemius on the right leg. Conservative treatment did not lead to success. Therefore, the fascial defect was treated surgically by repairing the muscle herniation using a synthetic vicryl propylene patch. Conclusions Muscle hernias should be taken into consideration as a rare differential diagnosis whenever patients present with persisting pain or soft tissue swelling after ankle sprain. Diagnosis is mainly based on clinical aspect and physical examination, but can be confirmed by radiologic imaging techniques, including (dynamic) ultrasound and MRI. If conservative treatment fails, we recommend the closure with mesh patches for large fascial defects. PMID:22417228

  13. Reoperations Following Cervical Disc Replacement

    PubMed Central

    Skovrlj, Branko; Lee, Dong-Ho; Caridi, John Michael

    2015-01-01

    Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%-3.1%), revision (mean, 0.2%; range, 0%-0.5%), and removal (mean, 1.2%; range, 0%-1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%-3.4%), revision (mean, 1.5%; range, 0%-4.7%), and removal (mean, 2.0%; range, 0%-3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates. PMID:26097667

  14. Understand vacuum-system fundamentals

    SciTech Connect

    Martin, G.R. ); Lines, J.R. ); Golden, S.W. )

    1994-10-01

    Crude vacuum unit heavy vacuum gas-oil (HVGO) yield is significantly impacted by ejector-system performance, especially at conditions below 20 mmHg absolute pressure. A deepcut vacuum unit, to reliably meet the yields, calls for proper design of all the major pieces of equipment. Ejector-system performance at deepcut vacuum column pressures may be independently or concurrently affected by: atmospheric column overflash, stripper performance or cutpoint; vacuum column top temperature and heat balance; light vacuum gas-oil (LVGO) pumparound entrainment to the ejector system; cooling-water temperature; motive steam pressure; non-condensible loading, either air leakage or cracked light-end hydrocarbons; condensible hydrocarbons; intercondenser or aftercondenser fouling ejector internal erosion or product build-up; and system vent back pressure. The paper discusses gas-oil yields; ejector-system fundamentals; condensers; vacuum-system troubleshooting; process operations; and a case study of deepcut operations.

  15. DENVER DISC FILTER IN CO91107, SHOWING FIVE DOUBLESIDED DISCS AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    DENVER DISC FILTER IN CO-91-107, SHOWING FIVE DOUBLE-SIDED DISCS AND DRIVE MOTOR. NOTE FOUR VERTICAL SLURRY FEED PIPES FROM OVERHEAD MANIFOLD AND SUCTION PIPE IN FOREGROUND. - Shenandoah-Dives Mill, 135 County Road 2, Silverton, San Juan County, CO

  16. Preparation of ormetoprim-sulfadimethoxine-medicated discs for disc diffusion assay

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Romet ( a blend of ormetoprim and sulfadimethoxine) is a type A medicated article for the manufacture of medicated feed in the catfish industry. Recently, the commercial manufacture of ormetoprim-sulfadimethoxine susceptibility discs was discontinued. Ormetoprim-sulfadimethoxine discs were prepare...

  17. Modeling and optimization of an elastic arthroplastic disc for a degenerated disc

    NASA Astrophysics Data System (ADS)

    Ghouchani, Azadeh; Ravari, Mohammad; Mahmoudi, Farid

    2011-10-01

    A three-dimensional finite element model (FEM) of the L3-L4 motion segment using ABAQUS v 6.9 has been developed. The model took into account the material nonlinearities and is imposed different loading conditions. In this study, we validated the model by comparison of its predictions with several sets of experimental data. Disc deformation under compression and segmental rotational motions under moment loads for the normal disc model agreed well with the corresponding in vivo studies. By linking ABAQUS with MATLAB 2010.a, we determined the optimal Young s modulus as well as the Poisson's ratio for the artificial disc under different physiologic loading conditions. The results of the present study confirmed that a well-designed elastic arthroplastic disc preferably has an annulus modulus of 19.1 MPa and 1.24 MPa for nucleus section and Poisson ratio of 0.41 and 0.47 respectively. Elastic artificial disc with such properties can then achieve the goal of restoring the disc height and mechanical function of intact disc under different loading conditions and so can reduce low back pain which is mostly caused due to disc degeneration.

  18. Only marginal alignment of disc galaxies

    NASA Astrophysics Data System (ADS)

    Andrae, Ren; Jahnke, Knud

    2011-12-01

    Testing theories of angular-momentum acquisition of rotationally supported disc galaxies is the key to understanding the formation of this type of galaxies. The tidal-torque theory aims to explain this acquisition process in a cosmological framework and predicts positive autocorrelations of angular-momentum orientation and spiral-arm handedness, i.e. alignment of disc galaxies, on short distance scales of 1 Mpc h-1. This disc alignment can also cause systematic effects in weak-lensing measurements. Previous observations claimed discovering these correlations but are overly optimistic in the reported level of statistical significance of the detections. Errors in redshift, ellipticity and morphological classifications were not taken into account, although they have a significant impact. We explain how to rigorously propagate all the important errors through the estimation process. Analysing disc galaxies in the Sloan Digital Sky Survey (SDSS) data base, we find that positive autocorrelations of spiral-arm handedness and angular-momentum orientations on distance scales of 1 Mpc h-1 are plausible but not statistically significant. Current data appear not good enough to constrain parameters of theory. This result agrees with a simple hypothesis test in the Local Group, where we also find no evidence for disc alignment. Moreover, we demonstrate that ellipticity estimates based on second moments are strongly biased by galactic bulges even for Scd galaxies, thereby corrupting correlation estimates and overestimating the impact of disc alignment on weak-lensing studies. Finally, we discuss the potential of future sky surveys. We argue that photometric redshifts have too large errors, i.e. PanSTARRS and LSST cannot be used. Conversely, the EUCLID project will not cover the relevant redshift regime. We also discuss the potentials and problems of front-edge classifications of galaxy discs in order to improve the autocorrelation estimates of angular-momentum orientation.

  19. Reconstructing the star formation history of the Milky Way disc(s) from chemical abundances

    NASA Astrophysics Data System (ADS)

    Snaith, O.; Haywood, M.; Di Matteo, P.; Lehnert, M. D.; Combes, F.; Katz, D.; Gómez, A.

    2015-06-01

    We develop a chemical evolution model to study the star formation history of the Milky Way. Our model assumes that the Milky Way has formed from a closed-box-like system in the inner regions, while the outer parts of the disc have experienced some accretion. Unlike the usual procedure, we do not fix the star formation prescription (e.g. Kennicutt law) to reproduce the chemical abundance trends. Instead, we fit the abundance trends with age to recover the star formation history of the Galaxy. Our method enables us to recover the star formation history of the Milky Way in the first Gyrs with unprecedented accuracy in the inner (R < 7-8 kpc) and outer (R > 9-10 kpc) discs, as sampled in the solar vicinity. We show that half the stellar mass formed during the thick-disc phase in the inner galaxy during the first 4-5 Gyr. This phase was followed by a significant dip in star formation activity (at 8-9 Gyr) and a period of roughly constant lower-level star formation for the remaining 8 Gyr. The thick-disc phase has produced as many metals in 4 Gyr as the thin-disc phase in the remaining 8 Gyr. Our results suggest that a closed-box model is able to fit all the available constraints in the inner disc. A closed-box system is qualitatively equivalent to a regime where the accretion rate maintains a high gas fraction in the inner disc at high redshift. In these conditions the SFR is mainly governed by the high turbulence of the interstellar medium. By z ~ 1 it is possible that most of the accretion takes place in the outer disc, while the star formation activity in the inner disc is mostly sustained by the gas that is not consumed during the thick-disc phase and the continuous ejecta from earlier generations of stars. The outer disc follows a star formation history very similar to that of the inner disc, although initiated at z ~ 2, about 2 Gyr before the onset of the thin-disc formation in the inner disc.

  20. Production of optically thin free-standing oil films from the edge of a rotating disc

    SciTech Connect

    Cramer, J.G.; Burch, D.F.; Rodenberg, R.; Cramer, P.B.

    1980-01-01

    A method is described for forming thin free-standing oil films which are spun from the edge of a sharp-edged rotating disc. The films can be made thin enough to show strong optical interference colors when viewed in white light. The thinnest films have areal densities down to about 10 to 20 ..mu..gm/cm/sup 2/. A stable roughly triangular film with an area of about 10 cm/sup 2/ and fairly uniform thickness can be readily produced. Much larger films having either greater thickness or less stability are also possible. Films have been produced both in air and in vacuum.

  1. Polymers in a Vacuum

    SciTech Connect

    Deutsch, J. M.

    2007-12-07

    In a variety of situations, isolated polymer molecules are found in a vacuum, and here we examine their properties. Angular momentum conservation is shown to significantly alter the average size of a chain and its conservation is only broken slowly by thermal radiation. For an ideal chain, the time autocorrelation for monomer position oscillates with a period proportional to chain length. The oscillations and damping are analyzed in detail. Short-range repulsive interactions suppress oscillations and speed up relaxation, but stretched chains still show damped oscillatory correlations.

  2. Design concepts in lumbar total disc arthroplasty

    PubMed Central

    Bellini, Chiara M.; Zweig, Thomas; Ferguson, Stephen; Raimondi, Manuela T.; Lamartina, Claudio; Brayda-Bruno, Marco; Fornari, Maurizio

    2008-01-01

    The implantation of lumbar disc prostheses based on different design concepts is widely accepted. This paper reviews currently available literature studies on the biomechanics of TDA in the lumbar spine, and is targeted at the evaluation of possible relationships between the aims of TDA and the geometrical, mechanical and material properties of the various available disc prostheses. Both theoretical and experimental studies were analyzed, by a PUBMED search (performed in February 2007, revised in January 2008), focusing on single level TDA. Both semi-constrained and unconstrained lumbar discs seem to be able to restore nearly physiological IAR locations and ROM values. However, both increased and decreased ROM was stated in some papers, unrelated to the clinical outcome. Segmental lordosis alterations after TDA were reported in most cases, for both constrained and unconstrained disc prostheses. An increase in the load through the facet joints was documented, for both semi-constrained and unconstrained artificial discs, but with some contrasting results. Semi-constrained devices may be able to share a greater part of the load, thus protecting the surrounding biological structure from overloading and possible early degeneration, but may be more susceptible to wear. The next level of development will be the biomechanical integration of compression across the motion segment. All these findings need to be supported by long-term clinical outcome studies. PMID:18946684

  3. MMPs and ADAMTSs in intervertebral disc degeneration.

    PubMed

    Wang, Wen-Jun; Yu, Xiao-Hua; Wang, Cheng; Yang, Wei; He, Wen-Si; Zhang, Shu-Jun; Yan, Yi-Guo; Zhang, Jian

    2015-08-25

    Intervertebral disc degeneration (IDD) is the most common diagnosis in patients with low back pain, a leading cause of musculoskeletal disability worldwide. The major components of extracellular matrix (ECM) within the discs are type II collagen (Col II) and aggrecan. Excessive destruction of ECM, especially loss of Col II and aggrecan, plays a critical role in promoting the occurrence and development of IDD. Matrix metalloproteinases (MMPs) and a disintegrin and metalloprotease with thrombospondin motifs (ADAMTSs) are primary enzymes that degrade collagens and aggrecan. There is a large and growing body of evidence that many members of MMPs and ADAMTSs are highly expressed in degenerative IVD tissue and cells, and are closely involved in ECM breakdown and the process of disc degeneration. In contrast, targeting these enzymes has shown promise for promoting ECM repair and mitigating disc regeneration. In the current review, after a brief description regarding the biology of MMPs and ADAMTSs, we mainly focus on their expression profiles, roles and therapeutic potential in IDD. A greater understanding of the catabolic pathways involved in IDD will help to develop potential prophylactic or regenerative biological treatment for degenerative disc disease in the future. PMID:26162271

  4. Stem cell horizons in intervertebral disc degeneration.

    PubMed

    Ciacci, Joseph; Ho, Allen; Ames, Christopher P; Jandial, Rahul

    2009-01-01

    Intervertebral disc degeneration remains a pervasive and intractable disease arising from a combination of aging and stress on the back and spine. The growing field of regenerative medicine brings the promise of stem cells in the treatment of disc disease. Scientists and physicians hope to employ stem cells not only to stop, but also reverse degeneration. However, there are many important outstanding issues, including the hostile avascular, apoptotic physiological environment of the intervertebral disc, and the difficulty of obtaining mesenchymal stem cells, and directing them towards chondrocytic differentiation and integration within the nucleus pulposus of the disc. Given the recent advances in minimally invasive spine surgery, and developing body of work on stem cell manipulation and transplantation, stem cells are uniquely poised to bring about large-scale improvements in treatment and outcomes for degenerative disc disease. In this review we will first discuss the cellular and molecular factors influencing degeneration, and then examine the efficacy and difficulties of stem cell transplantation. PMID:24198503

  5. Debris Discs: Modeling/theory review

    NASA Astrophysics Data System (ADS)

    Thbault, P.

    2012-03-01

    An impressive amount of photometric, spectroscopic and imaging observations of circumstellar debris discs has been accumulated over the past 3 decades, revealing that they come in all shapes and flavours, from young post-planet-formation systems like Beta-Pic to much older ones like Vega. What we see in these systems are small grains, which are probably only the tip of the iceberg of a vast population of larger (undetectable) collisionally-eroding bodies, leftover from the planet-formation process. Understanding the spatial structure, physical properties, origin and evolution of this dust is of crucial importance, as it is our only window into what is going on in these systems. Dust can be used as a tracer of the distribution of their collisional progenitors and of possible hidden massive pertubers, but can also allow to derive valuable information about the disc's total mass, size distribution or chemical composition. I will review the state of the art in numerical models of debris disc, and present some important issues that are explored by current modelling efforts: planet-disc interactions, link between cold (i.e. Herschel-observed) and hot discs, effect of binarity, transient versus continuous processes, etc. I will finally present some possible perspectives for the development of future models.

  6. Vacuum vapor deposition

    NASA Technical Reports Server (NTRS)

    Poorman, Richard M. (inventor); Weeks, Jack L. (inventor)

    1995-01-01

    A method and apparatus is described for vapor deposition of a thin metallic film utilizing an ionized gas arc directed onto a source material spaced from a substrate to be coated in a substantial vacuum while providing a pressure differential between the source and the substrate so that, as a portion of the source is vaporized, the vapors are carried to the substrate. The apparatus includes a modified tungsten arc welding torch having a hollow electrode through which a gas, preferably inert, flows and an arc is struck between the electrode and the source. The torch, source, and substrate are confined within a chamber within which a vacuum is drawn. When the arc is struck, a portion of the source is vaporized and the vapors flow rapidly toward the substrate. A reflecting shield is positioned about the torch above the electrode and the source to ensure that the arc is struck between the electrode and the source at startup. The electrode and the source may be confined within a vapor guide housing having a duct opening toward the substrate for directing the vapors onto the substrate.

  7. MOLECULAR VACUUM PUMP

    DOEpatents

    Eckberg, E.E.

    1960-09-27

    A multiple molecular vacuum pump capable of producing a vacuum of the order of 10/sup -9/ mm Hg is described. The pump comprises a casing of an aggregate of paired and matched cylindrical plates, a recessed portion on one face of each plate concentrically positioned formed by a radially extending wall and matching the similarly recessed portion of its twin plate of that pair of plates and for all paired and matched plates; a plurality of grooves formed in the radially extending walls of each and all recesses progressing in a spiral manner from their respective starting points out at the periphery of the recess inwardly to the central area; a plurality of rotors rotatably mounted to closely occupy the spaces as presented by the paired and matched recesses between all paired plates; a hollowed drive-shaft perforated at points adjacent to the termini of all spiral grooves; inlet ports at the starting points of all grooves and through all plates at common points to each respectively; and a common outlet passage presented by the hollow portion of the perforated hollowed drive-shaft of the molecular pump. (AEC)

  8. The vacuum arc centrifuge

    NASA Astrophysics Data System (ADS)

    Krishnan, M.; Hirshfield, J. L.

    The separation of elements and isotopes by means of rotating magnetized plasma columns using a laser-triggered vacuum arc centrifuge is described. This vacuum arc centrifuge is sustained by the erosion and ionization of the cathode material, thus producing relatively pure, highly ionized, rotating plasma columns of the cathode material. Any solid metal, or mixture of metals, can be converted into plasma, and the constituent isotopes partially separated in the centrifuge, by fabricating the arc cathode out of the desired metals. The device also offers the possibility of operation with nonconducting solid elements or compounds by imbedding the desired substance in a conducting matrix. A wide variety of metals and combinations of metals were studied, ranging from C through Cu to Cd/Sn. Typical angular rotation frequencies of approx. 100,000 rad/sec were measured, with concomitant enrichments up to a factor of two for Cu 65. The device in its present form is not a viable source of partially enriched stable isotopes at a competitive cost.

  9. R&D ERL: Vacuum

    SciTech Connect

    Mapes, M.; Smart, L.; Weiss, D.; Steszyn, A.; Todd, R.

    2010-01-01

    The ERL Vacuum systems are depicted in a figure. ERL has eight vacuum volumes with various sets of requirements. A summary of vacuum related requirements is provided in a table. Five of the eight volumes comprise the electron beamline. They are the 5-cell Superconducting RF Cavity, Superconducting e-gun, injection, loop and beam dump. Two vacuum regions are the individual cryostats insulating the 5-cell Superconducting RF Cavity and the Superconducting e-gun structures. The last ERL vacuum volume not shown in the schematic is the laser transport line. The beamline vacuum regions are separated by electropneumatic gate valves. The beam dump is common with loop beamline but is considered a separate volume due to geometry and requirements. Vacuum in the 5-cell SRF cavity is maintained in the {approx}10{sup -9} torr range at room temperature by two 20 l/s ion pumps and in the e-gun SRF cavity by one 60 l/s ion pump. Vacuum in the SRF cavities operated at 2{sup o}K is reduced to low 10{sup -11} torr via cryopumping of the cavity walls. The cathode of the e-gun must be protected from poisoning, which can occur if vacuum adjacent to the e-gun in the injection line exceeds 10-11 torr range in the injection warm beamline near the e-gun exit. The vacuum requirements for beam operation in the loop and beam dump are 10-9 torr range. The beamlines are evacuated from atmospheric pressure to high vacuum level with a particulate free, oil free turbomolecular pumping cart. 25 l/s shielded ion pumps distributed throughout the beamlines maintain the vacuum requirement. Due to the more demanding vacuum requirement of the injection beamline proximate to the e-gun, a vacuum bakeout of the injection beamline is required. In addition, two 200 l/s diode ion pumps and supplemental pumping provided by titanium sublimation pumps are installed in the injection line just beyond the exit of the e-gun. Due to expected gas load a similar pumping arrangement is planned for the beam dump. The cryostat vacuum thermally insulating the SRF cavities need only reduce the convective heat load such that heat loss is primarily radiation through several layers of multi-layer insulation and conductive end-losses which are contained by 5{sup o}K thermal transitions. Prior to cool down rough vacuum {approx}10{sup -5} torr range is established and maintained by a dedicated turbomolecular pump station. Cryopumping by the cold mass and heat shields reduces the insulating vacuum to 10{sup -7} torr range after cool down.

  10. Cervical Spinal Canal Stenosis and Central Disc Herniation C3/4 in a Man with Primary Complaint of Thigh Pain

    PubMed Central

    Akhavan-Sigari, R.; Rohde, V.; Alaid, A.

    2013-01-01

    Purpose?The purpose of this report is to describe the clinical course of a patient who had a primary complaint of isolated right lateral thigh pain 3 years prior that was nonresponsive to conservative measures. Hypoesthesia in the lateral side of the right forearm, deltoid and biceps, as well as triceps paresis, was also diagnosed. Results?Immediately after surgery, the patient reported substantial improvement in his right thigh symptoms. The signs and symptoms associated with the right C6 and C7 radiculopathy did improve. Conclusion?Although the presentation described in this case is somewhat unique, the eventual myelopathic signs and symptoms were not. It was these myelopathic signs and symptoms that led to cervical magnetic resonance imaging, the diagnosis of cervical cord compressive myelopathy, and surgical management. PMID:24303344

  11. Does hard work prevent disc protrusion?

    PubMed

    Porter, R W

    1987-11-01

    This study compares the prevalence of coal miners attending hospital with three defined back pain syndromes, with the number of miners in the working population. Of the men who attended hospital with back pain there were more miners than would be expected (278% of the miners compared with 199% of the non-miners). 032% of the miners had criteria of disc protrusion compared with 04% of non-miners; significantly more had syndromes associated with degenerative change. Relatively few men requiring disc excision were miners, whilst there were many who had decompressive surgery. This is compatible with the concept that heavy manual work strengthens the spine, restraining encroachment of a disc protrusion into the vertebral canal. PMID:23915754

  12. Moving Groups in the Galactic Disc

    NASA Astrophysics Data System (ADS)

    Ramya, P.; Reddy, B. E.

    2014-01-01

    We present results of chemical abundance study of a few representative stellar streams of Galactic thick and thin discs. Arcturus stream, which was proposed to have an extragalactic origin, and a recently detected stream called AF06 were studied. Results show a range of metallicity, age and abundance pattern that are consistent with those of Galactic thick disc component. We found similar results for AF06. The abundance and age results unambiguously rule out the possibility that the member stars are vestiges of open clusters. Abundance results of a sample of stars of Sirius and Hercules streams combined with the kinematics show that both the streams belong to the thin disc component. Also, results rule out these are remnants of open clusters. It is likely these streams formed insitu due to perturbations caused by non-axisymmetric components such as bar or spirals.

  13. The Relation Between Sacral Angle and Vertical Angle of Sacral Curvature and Lumbar Disc Degeneration: A Case-Control Study.

    PubMed

    Ghasemi, Ahmad; Haddadi, Kaveh; Khoshakhlagh, Mohammad; Ganjeh, Hamid Reza

    2016-02-01

    The purpose of this study is to determine the reliability and validity of a goniometric measurement of the vertical angle of the sacrum and sacral angle (SA), and their relationships to lumbar degeneration.A herniated lumbar disc is one of the most frequent medical issues. Investigators in a number of studies have reported associated risk factors for prevalent disc degeneration. Atypical lumbosacral angles and curvature are thought to contribute to the degradation of the spine by many researchers. This study analyzed 360 patients referred to our clinic from 2013 to 2015 due to low back pain. A cross-sectional case-control study was designed in order to compare the sagittal alignment of the lumbosacral area in 3 groups of patients suffering from LBP. A total 120 patients were in a control group with a normal lumbar magnetic resonance imaging (MRI), 120 patients had lumbar disk herniation (LDH), and 120 patients had spinal stenosis. From the sagittal plan of lumbar MRI, SA and vertical angle of sacral curvature (VASC) were determined and then analyzed.The means of VASC in these groups were: 38.98 (SD: 6.36??0.58), 40.89 (SD: 7.69??0.69), and 40.54 (SD: 7.13??0.92), respectively (P?=?0.089). Moreover, studies of SA in 3 groups showed that the means of SA were: 39.30 (SD: 6.69??0.63), 40.52 (SD: 7.47??0.65), and 35.63 (SD: 6.07??0.79), respectively. Relation between SA and spinal stenosis was just statistically significant (P???0.05).One significant limitation of our study is the lack of standing MRI for increased accuracy of measurement. However, we were reluctant to give patients needless exposure to radiation from conventional X-ray, and instead used MRI scans. We did not find any significant correlation between the VASC and LDH in lumbar MRI. Also, SA is not an independent risk factor for LDH in men and women. We suggested that there are several biomechanical factors involved in LDH. PMID:26871821

  14. Herniated disk

    MedlinePLUS

    ... diet and exercise are very important for improving back pain. Physical therapy is important for nearly everyone with ... with treatment. But you may have long-term back pain even after treatment. It may take several months ...

  15. Assessing the Effect of Spaceflight on the Propensity for Astronauts to Develop Disk Herniation

    NASA Technical Reports Server (NTRS)

    Feiveson, Alan H.; Mendez, C. M.; Somers, J. T.

    2015-01-01

    A previous study [1] reported the instantaneous risk of developing a Herniated Nucleus Pulosus (HNP) was higher in astronauts who had flown at least one mission, as compared with those in the corps who had not yet flown. However, the study only analyzed time to HNP after the first mission (if any) and did not account for the possible effects of multiple missions. While many HNP's occurred well into astronauts' careers or in some cases years after retirement, the higher incidence of HNPs relatively soon after completion of space missions appears to indicate that spaceflight may lead to an increased risk of HNP. The purpose of this study was to support the Human System Risk Boards assessment of back pain, assess the risk of injury due to dynamic loads, and update the dataset analyzed which contained data through December 31, 2006.

  16. Mechanical response of the herniated human abdomen to the placement of different prostheses.

    PubMed

    Hernndez-Gascn, Beln; Pea, Estefana; Grasa, Jorge; Pascual, Gemma; Belln, Juan M; Calvo, Begoa

    2013-05-01

    This paper describes a method designed to model the repaired herniated human abdomen just after surgery and examine its static mechanical response to the maximum intra-abdominal pressure provoked by a physiological movement (standing cough). The model is based on the real geometry of the human abdomen bearing a large incisional hernia with several anatomical structures differentiated by MRI. To analyze the outcome of hernia repair, the surgical procedure was simulated by modeling a prosthesis placed over the hernia. Three surgical meshes with different mechanical properties were considered: an isotropic heavy-weight mesh (Surgipro), a slightly anisotropic light-weight mesh (Optilene), and a highly anisotropic medium-weight mesh (Infinit). Our findings confirm that anisotropic implants need to be positioned such that the most compliant axis of the mesh coincides with the craneo-caudal direction of the body. PMID:24231960

  17. Amniotic Sac Herniation Through a Prior Cornual Scar in The Third Trimester

    PubMed Central

    Saad, Antonio F.; Costantine, Maged M.; Saade, George; Makhlouf, Michel

    2015-01-01

    Introduction?Uterine rupture occurs in less than 0.1% of pregnancies. This complication can be detrimental to mother and fetus if not detected and managed in a timely manner. We report an unusual presentation of uterine scar rupture that was diagnosed on ultrasound in a completely stable patient with reassuring fetal status. Case Report?A 24-year-old Gravida 5, Para 3 with history of cornual resection for ectopic pregnancy and two previous uterine ruptures presented at 30 weeks' gestation with worsening abdominal pain. Ultrasound identified herniation of the amniotic sac with fetal parts. The patient underwent cesarean delivery and cornual defect repair. Conclusion?Close observation and early delivery remain vital to the patient's management. PMID:26495171

  18. Portable vacuum object handling device

    DOEpatents

    Anderson, G.H.

    1983-08-09

    The disclosure relates to a portable device adapted to handle objects which are not to be touched by hand. A piston and bore wall form a vacuum chamber communicating with an adaptor sealably engageable with an object to be lifted. The piston is manually moved and set to establish vacuum. A valve is manually actuatable to apply the vacuum to lift the object. 1 fig.

  19. Magnetically driven accretion in protoplanetary discs

    NASA Astrophysics Data System (ADS)

    Simon, Jacob B.; Lesur, Geoffroy; Kunz, Matthew W.; Armitage, Philip J.

    2015-11-01

    We characterize magnetically driven accretion at radii between 1 and 100 au in protoplanetary discs, using a series of local non-ideal magnetohydrodynamic (MHD) simulations. The simulations assume a minimum mass solar nebula (MMSN) disc that is threaded by a net vertical magnetic field of specified strength. Confirming previous results, we find that the Hall effect has only a modest impact on accretion at 30 au, and essentially none at 100 au. At 1-10 au the Hall effect introduces a pronounced bimodality in the accretion process, with vertical magnetic fields aligned to the disc rotation supporting a strong laminar Maxwell stress that is absent if the field is anti-aligned. In the anti-aligned case, we instead find evidence for bursts of turbulent stress at 5-10 au, which we tentatively identify with the non-axisymmetric Hall-shear instability. The presence or absence of these bursts depends upon the details of the adopted chemical model, which suggests that appreciable regions of actual protoplanetary discs might lie close to the borderline between laminar and turbulent behaviour. Given the number of important control parameters that have already been identified in MHD models, quantitative predictions for disc structure in terms of only radius and accretion rate appear to be difficult. Instead, we identify robust qualitative tests of magnetically driven accretion. These include the presence of turbulence in the outer disc, independent of the orientation of the vertical magnetic fields, and a Hall-mediated bimodality in turbulent properties extending from the region of thermal ionization to 10 au.

  20. Disc in flames: Roles of TNF-? and IL-1? in intervertebral disc degeneration.

    PubMed

    Johnson, Z I; Schoepflin, Z R; Choi, H; Shapiro, I M; Risbud, M V

    2015-01-01

    The intervertebral disc is an important mechanical structure that allows range of motion of the spinal column. Degeneration of the intervertebral disc--incited by aging, traumatic insult, genetic predisposition, or other factors--is often defined by functional and structural changes in the tissue, including excessive breakdown of the extracellular matrix, increased disc cell senescence and death, as well as compromised biomechanical function of the tissue. Intervertebral disc degeneration is strongly correlated with low back pain, which is a highly prevalent and costly condition, significantly contributing to loss in productivity and health care costs. Disc degeneration is a chronic, progressive condition, and current therapies are limited and often focused on symptomatic pain relief rather than curtailing the progression of the disease. Inflammatory processes exacerbated by cytokines tumour necrosis factor-? (TNF-?) and interleukin-1? (IL-1?) are believed to be key mediators of disc degeneration and low back pain. In this review, we describe the contributions of TNF-? and IL-1? to changes seen during disc degeneration at both cellular and tissue level, as well as new evidence suggesting a link between infection of the spine and low back pain, and the emerging therapeutic modalities aimed at combating these processes. PMID:26388614