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1

Herniated Cervical Disc  

MedlinePLUS

... are sometimes prescribed for more severe arm and neck pain because of their very powerful anti-inflammatory effect. ... caused by a herniated cervical disc. However, some neck pain may persist. Most patients respond well to discectomy; ...

2

Lumbar Disc Herniation in Adolescence  

Microsoft Academic Search

Lumbar disc herniation very rarely occurs in adolescence. The aim of this study was to assess the radiological, clinical and surgical features and case outcomes for adolescents with lumbar disc herniation, and to compare with adult cases. The cases of 17 adolescents (7 girls and 10 boys, age range 13–17 years) who were surgically treated for lumbar disc herniation in

Serdar Ozgen; Deniz Konya; O. Zafer Toktas; Adnan Dagcinar; M. Memet Ozek

2007-01-01

3

Radicular interdural lumbar disc herniation.  

PubMed

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

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

2010-07-01

4

Intraradicular disc herniations in the lumbar spine and a new classification of intradural disc herniations  

Microsoft Academic Search

Study design: A case report of intraradicular disc herniation. Intraradicular disc herniation is a special type of intradural disc hernations. In this report, we present the tenth case of intraradicular lumbar disc herniation and suggest a new classification for intradural disc herniations.Case Report: A 32-year-old male was admitted to hospital having experienced pain in the lower back and right leg

M Mut; M Berker; S Palao?lu

2001-01-01

5

Thoracic disc herniation: a diagnostic challenge  

Microsoft Academic Search

An unusual case of lower thoracic disc herniation combined with shoulder pain is presented in this case report, A literature search showed that shoulder pain associated with a lower thoracic disc herniation has not yet been reported. An acromioplasty for chronic impingement syndrome was performed to relieve the patient's shoulder symptoms. An unsatisfactory outcome plus a progressive but incomplete paraplegia,

Axel Wilke; Udo Wolf; Peter Lageard; Peter Griss

2000-01-01

6

A patient with thoracic intradural disc herniation  

Microsoft Academic Search

Intradural disc herniation is a rare disease that occurs most commonly in the lumbar region, while fewer than 5% occur in the thoracic and cervical regions. We report a patient with thoracic intradural disc herniation at T12–L1 who presented with radiculopathy and motor weakness. The preoperative MRI did not demonstrate an intradural lesion, and it was identified intraoperatively by inspection

Robert G. Whitmore; Brian J. Williams; Bradley C. Lega; Matthew R. Sanborn; Paul Marcotte

7

Minimally invasive treatment of thoracic disc herniations.  

PubMed

In the past, treatment of thoracic disc herniations has not been seen as a minimally invasive procedure. This article evaluates the progression of minimally invasive techniques for the treatment of thoracic disc herniations. Discussion of the advantages and disadvantages of the approaches is noted so that surgeons may consider them while incorporating these techniques in their practice. PMID:24703446

Snyder, Laura A; Smith, Zachary A; Dahdaleh, Nader S; Fessler, Richard G

2014-04-01

8

Spontaneous cervical intradural disc herniation.  

PubMed

Cervical intradural disc herniation (IDH) is a rare condition with very few case reports in the literature. We report a 64-year-old man who presented with sudden onset neck pain and rapidly progressing weakness in the left upper and lower limb. There was no history of trauma. MRI of the cervical spine showed a C6-C7 disc prolapse, for which he underwent a C6-C7 discectomy and fusion with bone graft through an anterior cervical approach. To our knowledge, all patients with a cervical IDH reported in the literature have a traumatic etiology. To the best of our knowledge, we report the first patient with a spontaneous cervical IDH. PMID:24210799

Warade, Abhijit G; Misra, Basant K

2014-05-01

9

Butterfly vertebra with lumbar intervertebral disc herniation.  

PubMed

A butterfly vertebra is a rare congenital anomaly that is usually asymptomatic. The authors, however, describe a novel case involving a butterfly vertebra overlapping with disc herniation that presented as radiculopathy. A butterfly vertebra is characterized by a symmetrical fusion defect resulting in a sagittal cleft vertebra. Only a few cases of butterfly vertebrae have been reported as incidental findings. This spinal anomaly may be associated with other congenital conditions such as Pfeiffer, Crouzon, Jarcho-Levin, and Alagille syndromes. Moreover, there is no previous report of a case associated with symptomatic disc herniation from the sagittal cleft. The authors excised the herniated disc fragment. They performed intraoperative discography after exposure of the corresponding intervertebral space via a conventional interlaminar approach. Histological examination of a tissue specimen showed scattered chondrocytes in the myxohyaline stroma, which indicated the nucleus pulposus. PMID:21819182

Cho, Hyung-Lea; Kim, Jin-Sung; Paeng, Sung Suk; Lee, Sang-Ho

2011-11-01

10

Spontaneous regression of herniated lumbar discs.  

PubMed

The spontaneous regression of a lumbar herniated disc is a common occurrence. Studies using imaging techniques as well as immunohistologic analyses have attempted to explain the mechanism for regression. However, the exact mechanism remains elusive. Understanding the process by which herniated discs disappear in the absence of surgery may better guide treatment. Recent case reports, radiographic and immunohistologic studies show that the extent of extrusion of the nucleus pulposus is related to a higher likelihood of regression. To our knowledge, Patient 3 is the first report of spontaneous regression occurring within 2 months. This occurrence was discovered intraoperatively. We present three illustrative patients. Patient 1, a 53-year-old man, presented with a large L2-L3 disc herniation. His 2 year follow-up MRI revealed a complete regression of the extruded fragment. Patient 2, a 58-year-old man, presented with an L3-L4 disc herniation with cephalad migration of a free fragment. MRI 9 months later showed no free fragment but progression of a disc bulge. Intraoperative exploration during the L3-L4 microdiscectomy confirmed the absence of the free fragment. Patient 3, a 58-year-old woman, presented with a large L2-L3 disc extrusion with cephalad migration. An imaging study performed 2 months after the initial study revealed an absence of the free fragment. Our case reports demonstrate the temporal variance in disc regression. While the time course and extent of regression vary widely, the rapid time in which regression can occur should caution surgeons contemplating discectomy based on an MRI performed a significant period prior to surgery. PMID:24316264

Kim, Eric S; Oladunjoye, Azeem O; Li, Jay A; Kim, Kee D

2014-06-01

11

Risk Factors for Recurrent Lumbar Disc Herniations  

PubMed Central

The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future.

2014-01-01

12

Disc degeneration after disc herniation: are we accelerating the process?  

PubMed

Study design: ?Systematic review. Study rationale: ?Disc degeneration is a common process starting early in life. Often disc herniation is an early step in disc degeneration, which may cause pain or stenosis. How quickly this subsequent disc degeneration occurs following a disc herniation and subsequent surgical treatment and whether certain spinal procedures increase the rate of degeneration remain unclear. Objectives: ?To investigate the risk of subsequent radiographic disc degeneration following discectomy, discography, and conservative care in patients with a first-time diagnosed herniated nucleus pulpous (HNP) and to ascertain whether this risk in these defined groups changes over time. Methods: ?A systematic review of pertinent articles published up to June 2012. Key articles were searched to identify studies evaluating the risk of subsequent radiographic disc degeneration following treatment for HNP. Studies that included patients undergoing secondary surgery for disc herniation or that did not use a validated classification system to measure the severity of disc degeneration were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results: ?From a total of 147 possible citations, three cohort studies (class of evidence III) met our inclusion criteria and form the basis for this report. The risk of subsequent lumbar disc degeneration following standard discectomy was significantly greater compared with both microdiscectomy (48.7% vs 9.1%) and asymptomatic controls (90% vs 68%) in two studies with mean follow-ups of 5.5 and 25.3 years, respectively. Following conservative care for first-time HNP in the third study, the risk of progression of lumbar disc degeneration was 47.6% over the first 2 years of follow-up and 95.2% over the next 6 years of follow-up. In the same study, the risk of lumbar disc degeneration was shown to increase incrementally over the course of the 8-year follow-up, with all patients showing signs of degeneration at final examination. Conclusion: ?Standard discectomy in first-time lumbar HNP may increase the risk of subsequent same-level lumbar disc degeneration compared with microdiscectomy as seen in one low-quality study. However, disc degeneration is likely a natural, temporal consequence following HNP, as demonstrated in a second low-quality study. The overall strength of evidence for the conclusions is very low. PMID:23526910

Schroeder, Josh E; Dettori, Joseph R; Brodt, Erika D; Kaplan, Leon

2012-11-01

13

Disc degeneration after disc herniation: are we accelerating the process?  

PubMed Central

Study design:?Systematic review. Study rationale:?Disc degeneration is a common process starting early in life. Often disc herniation is an early step in disc degeneration, which may cause pain or stenosis. How quickly this subsequent disc degeneration occurs following a disc herniation and subsequent surgical treatment and whether certain spinal procedures increase the rate of degeneration remain unclear. Objectives:?To investigate the risk of subsequent radiographic disc degeneration following discectomy, discography, and conservative care in patients with a first-time diagnosed herniated nucleus pulpous (HNP) and to ascertain whether this risk in these defined groups changes over time. Methods:?A systematic review of pertinent articles published up to June 2012. Key articles were searched to identify studies evaluating the risk of subsequent radiographic disc degeneration following treatment for HNP. Studies that included patients undergoing secondary surgery for disc herniation or that did not use a validated classification system to measure the severity of disc degeneration were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results:?From a total of 147 possible citations, three cohort studies (class of evidence III) met our inclusion criteria and form the basis for this report. The risk of subsequent lumbar disc degeneration following standard discectomy was significantly greater compared with both microdiscectomy (48.7% vs 9.1%) and asymptomatic controls (90% vs 68%) in two studies with mean follow-ups of 5.5 and 25.3 years, respectively. Following conservative care for first-time HNP in the third study, the risk of progression of lumbar disc degeneration was 47.6% over the first 2 years of follow-up and 95.2% over the next 6 years of follow-up. In the same study, the risk of lumbar disc degeneration was shown to increase incrementally over the course of the 8-year follow-up, with all patients showing signs of degeneration at final examination. Conclusion:?Standard discectomy in first-time lumbar HNP may increase the risk of subsequent same-level lumbar disc degeneration compared with microdiscectomy as seen in one low-quality study. However, disc degeneration is likely a natural, temporal consequence following HNP, as demonstrated in a second low-quality study. The overall strength of evidence for the conclusions is very low.

Schroeder, Josh E.; Dettori, Joseph R.; Brodt, Erika D.; Kaplan, Leon

2012-01-01

14

Intradural disc herniations pathogenesis, clinical picture, diagnosis and treatment  

Microsoft Academic Search

Summary The relatively rare occurrence and uncertainty about pathogenesis of intradurally displaced disc herniations stimulated an anatomico-pathological study into intradural disc herniations. The relation between the ventral dura and posterior longitudinal ligament in the cervical, thoracic, lumbar and sacral regions were examined macroscopically and microscopically, and ventral and dorsal durai thickness was compared in 20 adult autopsies on patients who

A. Yildizhan; A. Pa?ao?lu; T. Okten; N. Ekinci; K. Aycan; Ö. Aral

1991-01-01

15

Risk factors for recurrent lumbar disc herniations.  

PubMed

The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future. PMID:24761206

Shin, Byung-Joon

2014-04-01

16

Imaging findings in dogs with caudal intervertebral disc herniation.  

PubMed

The radiographic and magnetic resonance imaging (MRI) findings for four dogs with herniation of the Cd1-Cd2 intervertebral disc are described. All dogs were 7 years of age at the time of presentation, with one neutered male and three neutered females. Breeds included one Beagle, one Bassett hound, and two large, mixed breed dogs. All dogs had tail pain on manipulation, two had pain during defecation, and two maintained an abnormal tail position. Three dogs had radiographs in which mineralization within the disc space was apparent. Two of these dogs also had mineralization within the vertebral canal. Three dogs underwent MRI, which was characterized by varying degrees of disc herniation and nerve root compression at Cd1-Cd2. Mobility may be a factor predisposing to disc herniation in the cranial aspect of the caudal spine. We documented that caudal disc herniation does occur occasionally in dogs and that radiography and MRI may be used to identify this disease. Caudal intervertebral disc herniation should be considered as a differential for dogs with caudal vertebral pain, pain with tail manipulation, pain during defecation, or abnormal tail carriage. PMID:21689201

Lawson, Caitlin M; Reichle, Jean K; McKlveen, Tori; Smith, Mary O

2011-01-01

17

Spontaneous regression of sequestrated lumbar disc herniations: Literature review.  

PubMed

Lumbar disc herniations (LDH) may regress with conservative management; however, this phenomenon is poorly understood for the sequestrated subtype of LDH. We present one of the first comprehensive literature reviews specifically addressing the spontaneous regression of sequestrated intervertebral discs. We reviewed all publications with lumbar disc herniations, sequestrated subtype. Our results were then narrowed to patients who experienced spontaneous regression of the sequestration. Based on our literature review of 53 cases, patients with sequestrated lumbar disc herniations experienced symptomatic resolution in a mean of 1.33±1.34 months and radiographic resolution in 9.27±13.32 months. Symptomatic patients with sequestrated discs present similarly to those with other types of lumbar disc herniations. Sequestrations may have the highest likelihood to radiographically regress in the shortest time frame in comparison to the remaining subtypes of LDH. The most likely mechanism for regression is an inflammatory response elicited against the free fragment. Patients with disc sequestrations may be managed conservatively, in the absence of intractable pain, inability to walk, weakness or symptoms suggestive of cauda equina syndrome. PMID:24630494

Macki, Mohamed; Hernandez-Hermann, Marta; Bydon, Mohamad; Gokaslan, Aaron; McGovern, Kelly; Bydon, Ali

2014-05-01

18

Cervical disc herniation producing acute brown-sequard syndrome.  

PubMed

Brown-Sequard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. This syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has been rarely reported as a cause of this syndrome. We present a case of a 28-year-old male patient diagnosed as large C3-C4 disc herniation with spinal cord compression. He presented with left hemiparesis and diminished sensation to pain and temperature in the right side below the C4 dermatome. Microdiscectomy and anterior cervical fusion with carbon fiber cage containing a core of granulated coralline hydroxyapatite was performed. After the surgery, rapid improvement of the neurologic deficits was noticed. We present a case of cervical disc herniation producing acute Brown-Sequard syndrome with review of pertinent literature. PMID:19516953

Kim, Jong-Tae; Bong, Ho-Jin; Chung, Dong-Sup; Park, Young-Sup

2009-05-01

19

Percutaneous Thoracic Intervertebral Disc Nucleoplasty: Technical Notes from 3 Patients with Painful Thoracic Disc Herniations  

PubMed Central

Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief. Post-procedural pain relief was maintained up to an average of 10 months after nucleoplasty. One patient with preoperative neurological signs improved postoperatively. There were no reported complications in all three patients. In view of the reduced morbidity and shorter operating time, thoracic intervertebral disc nucleoplasty can be considered in patients with pain due to thoracic disc herniation, with no calcification of the herniated disc, and in patients who may be otherwise be unfit for conventional surgery.

Gultuna, Ismail; Riezebos, Patricia; Beems, Tjemme; Vissers, Kris C.

2011-01-01

20

Relationship between physical work load and lumbar disc herniation.  

PubMed

Lumbar disc herniation (LDH) is a disabling problem. This retrospective case control study was done to evaluate the possible relevance of physical work load with Lumbar Disc Herniation. We have performed this study in the Spinal Surgery Unit of Department of Orthopaedic Surgery at BSMMU, Dhaka from July 2007 to June 2010 where 200 cases with Lumbar Disc Herniation and 200 control subjects matched by age, gender and area of residence were taken and analyzed. Chi-square test was computed for sex, area of residence, type of physical work and effort at work, whereas Odds ratio was computed for physical work load, stress at work and daily working period. The highest odds ratio (OR) was with the physical work load (OR: 03.48, CI: 01.84-06.59), hard work (OR: 03.14, CI: 01.74-05.65) and working period of >8 hours (OR: 01.34, CI: 0.75-02.38). Odds ratio for heavy load carrying at work was 03.48 and less job satisfaction or stress at work was 02.45. There was a statistically significant positive association between cumulative exposure of physical work load and lumbar disc herniation indicating an increased occurrence of herniation in heavy physical work load and occupation requiring harder efforts. PMID:23982545

Ahsan, M K; Matin, T; Ali, M I; Ali, M Y; Awwal, M A; Sakeb, N

2013-07-01

21

Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy.  

PubMed

Herniated lumbar disc may be asymptomatic or associated with lower limb radiculopathy. Most spinal surgeons would offer surgery following a period of conservative measures if the radiological and clinical findings correlate. However, the existing dictum that lumbar radiculopathy should correlate with ipsilateral lumbar disc herniation may not be accurate as it can rarely present with contralateral sciatica. Literature regarding this phenomenon is scarce. Therefore, we report a patient with herniated lumbar disc presenting with predominantly contralateral motor weakness radiculopathy, which resolved after discectomy. PMID:24811105

Abdul Jalil, Muhammad Fahmi; Lam, Miu Fei; Wang, Yi Yuen

2014-01-01

22

Lumbar Intervertebral Disc Herniation Following Experimental Intradiscal Pressure Increase  

Microsoft Academic Search

Summary  ?An experimental biomechanical model of overload and rupture of the annulus fibrosus (AF) and lumbar disc herniation was achieved\\u000a by increasing intradiscal pressure while keeping disc height constant in 69 motion segments at the L4–L5 level excised from\\u000a cadaveric spines. The experiments were made on 53 specimens in neutral posture and on 16 specimens in flexion posture.\\u000a \\u000a ?The values found

2000-01-01

23

Back extensor muscle fatigue in patients with lumbar disc herniation  

Microsoft Academic Search

We investigated back muscle fatigue and endurance in patients with lumbar disc herniation before and after surgery, and established the degree of association between perceived fatigue and objectively measured fatigue. Additionally, the relationships between muscle fatigue and endurance time on the one hand, and activity, participation, self-efficacy and health on the other, were investigated to clarify the grades of association

Åsa Dedering; Karin Harms-Ringdahl; Gunnar Nèmeth

2006-01-01

24

Thoracic venous congestion caused by thoracic disc herniation  

PubMed Central

We present what is to our knowledge the first reported case of thoracic disc herniation leading to venous congestive myelopathy (VCM), which was clinically and radiographically suggestive of Foix–Alajouanine syndrome (angiodysgenetic necrotizing myelopathy). In addition, we review current concepts in evaluating the etiology of VCM and discuss indications for surgery.

Roger, Eric P; Chamczuk, Andrea J; Hagan, Marygrace C

2013-01-01

25

Recovery of motor deficits after microdiscectomy for lumbar disc herniation  

Microsoft Academic Search

e have studied, prospectively, 116 patients with motor deficits associated with herniation of a lumbar disc who underwent microdiscectomy. They were studied during the first six months and at a mean of 6.4 years after surgery. Before operation, muscle weakness was mild (grade 4) in 67% of patients, severe (grade 3) in 21% and very severe (grade 2 or 1)

F. Postacchini; G. Giannicola; G. Cinotti

2002-01-01

26

[Nerve root compression by gas containing lumbar disc herniation--case report].  

PubMed

The radiographic appearance of gas collection in the intervertebral disc represents the so-called "vacuum phenomenon." Incidence of the vacuum phenomenon on plain radiographs is reported to be 1-20%, whereas gas-containing disc herniations are rarely observed. We present a case report involving a patient with L4/5 gas-containing disc herniation, which was demonstrated by CT and MRI scans and was also surgically documented. A 48-year-old man with no previous back trauma presented with a 14-day history of left leg pain. On neurologic examination, the straight leg raising test was positive at 60degrees. Leg muscle strength was weak on the extensor hallucis longus. Sensory disturbances and abnormalities in deep-tendon reflexes were not observed. Lumbar roentogenograms showed "vacuum phenomenon" at L2/3, L4/5 and the L5/S disc space. MRI indicated a herniated disc at L4/5 displacing the dural sac and a focal low intensity in the lesion. Administration of an epidural block relieved the patient's symptoms. Ten months later, the patient reported a gradual return of similar left leg pain. His symptoms did not respond to conservative management. Lumbar spine films indicated abnormalities identical to the original results. MRI showed an enlarged area of low intensity with compression of the left L5 nerve root. In addition to recurrent pain, discography with metrizamide injections confirmed the presence of intradiscal gas and compression of the left L5 nerve root. During surgery, a gray-bluish air mass compressing the L5 nerve root was identified. Manipulation of the mass resulted in rupture and the release of gas. The displaced nerve root immediately relaxed to its normal position. Seven months after the operation, the patient remains free of pain. PMID:19526837

Yasuoka, Hiroki; Nemoto, Osamu; Kawaguchi, Masahisa; Naitou, Satoko; Yamamoto, Kouji; Ukegawa, You

2009-06-01

27

Cervical disc herniation manifesting as a Brown-Sequard syndrome  

PubMed Central

Brown-Sequard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm. The clinical picture reflects hemisection of the spinal cord. We report a rare case of Brown-Sequard syndrome caused by a large cervical herniated disc. A 63-year-old man presented with progressive right hemiparesis and disruption of pain and temperature sensation on the left side of the body. Magnetic resonance imaging showed large C3-C4 disc herniation compressing the spinal cord at that level, with severe canal stenosis from C4 through C7. Decompressive cervical laminoplasty was performed. After surgery, complete sensory function was restored and a marked improvement in motor power was obtained.

Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Kuroiwa, Toshihiko

2012-01-01

28

Cervical disc herniation manifesting as a Brown-Sequard syndrome.  

PubMed

Brown-Sequard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm. The clinical picture reflects hemisection of the spinal cord. We report a rare case of Brown-Sequard syndrome caused by a large cervical herniated disc. A 63-year-old man presented with progressive right hemiparesis and disruption of pain and temperature sensation on the left side of the body. Magnetic resonance imaging showed large C3-C4 disc herniation compressing the spinal cord at that level, with severe canal stenosis from C4 through C7. Decompressive cervical laminoplasty was performed. After surgery, complete sensory function was restored and a marked improvement in motor power was obtained. PMID:22865973

Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Kuroiwa, Toshihiko

2012-05-01

29

Foraminal disc herniation Th9-Th10 mimicking abdominal pain  

Microsoft Academic Search

Thoracic disc herniations (TDH) requiring surgery are rare. They usually present with pain and\\/or myelopathy. Only 6% are wide lateral, either intraforaminal or extraforaminal. A 52-year-old patient presented with chronic mid-thoracic pain, radiating along the left 9th and 10th ribs. After nephrologic and pancreatic diseases had been exclud - ed, a CT-scan showed a far-lateral calcified TDH in the left

Patrick FRANSEN; Frédéric COLLIGNON; Bernard VAN DEN HEULE

2008-01-01

30

Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation  

PubMed Central

Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors’ clinic and treated by PCN. The patients’ gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 ± 10.2 years). The levels of involvement were 21 cases at C3–4, 30 cases at C4–5, 40 cases at C5–6, and 35 cases at C6–7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) ?11° or horizontal displacement (HD) ?3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.

Li, Jian; Zhang, Zai-Heng

2008-01-01

31

Cervical intradural disc herniation and cerebrospinal fluid leak.  

PubMed

Cervical intradural disc herniation (IDH) is a rare condition and only 25 cases of cervical have been reported. We report a 45-year-old male who presented with sudden onset right lower limb weakness after lifting heavy weight. Magnetic resonance imaging of the cervical spine showed C5/6 disc prolapse with intradural extension. The patient underwent C5/6 discectomy through anterior cervical approach. Postoperatively, the patient improved in stiffness but developed cerebrospinal fluid leak and the leak resolved with multiple lumbar punctures. PMID:21743181

Kansal, Ritesh; Mahore, Amit; Kukreja, Sanjay

2011-01-01

32

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

NASA Astrophysics Data System (ADS)

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%.

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

2010-03-01

33

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

NASA Astrophysics Data System (ADS)

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.

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

2004-09-01

34

Redundant Nerve Roots of Cauda Equina Mimicking Intradural Disc Herniation: A Case Report  

PubMed Central

Redundant Nerve Roots (RNRs) is an uncommon clinical condition characterized by a tortuous, serpentine, large and elongated nerve root of the cauda equina. To our knowledge, most cases of RNRs are associated with lumbar stenosis, and RNRs associated with lumbar disc herniation has not been reported until now. Here we present a rare case of unusual RNRs associated with lumbar disc herniation mimicking intradural disc herniation.

Yang, Sang Mi; Park, Hyung Ki; Cho, Sung Jin

2013-01-01

35

Brown-Sequard syndrome revealing intradural thoracic disc herniation.  

PubMed

Brown-Sequard syndrome (BSS) is a rare form of severe myelopathy characterised by a clinical picture reflecting hemisection of the spinal cord. This syndrome is mostly due to a penetrating injury to the spine but many other non-traumatic causes have been described. Intradural thoracic disc herniation (TDH) is one of the rare aetiologies of this syndrome. Despite progress in imaging techniques, diagnosis and treatment remain difficult. We retrospectively reviewed one of the largest reported series of six patients with BSS revealing intradural TDH between 2003 and 2007. There was a marked female predominance and the mean age was 44 years. Before surgery, half of the patients had a severe neurological deficit. The mean duration of symptoms until surgery was 8.5 months (range 0.5-24 months). Spine magnetic resonance imaging (MRI) or spine computer tomography scan showed calcified TDH between T5-T6 and T9-T10. The intradural location of the thoracic herniation was strongly suspected from the clinical data. All the patients underwent posterolateral transpedicular surgery with an operative microscope to open the dura mater. The intradural location of the herniation was overlooked in one case and the patient underwent a second procedure. The dura mater was carefully closed. Two patients' condition worsened immediately after the surgery before slowly improving. All the other patients improved their neurological status immediately after the surgery and at 12 months follow-up. BSS with TDH on the spine MRI scan may be a warning symptom of the intradural location of the herniated disc. In such cases, spine surgeons are advised to use an operative magnification and to open the dura mater to avoid missing this potentially curable cause of severe myelopathy. PMID:20589517

Diabira, S; Henaux, P-L; Riffaud, L; Hamlat, A; Brassier, G; Morandi, X

2011-01-01

36

Occupational risk factors for symptomatic lumbar disc herniation; a case-control study  

PubMed Central

Background: Previous studies mostly did not separate between symptomatic disc herniation combined with osteochondrosis/spondylosis of the lumbar spine and symptomatic disc herniation in radiographically normal intervertebral spaces. This may at least in part explain the differences in the observed risk patterns. Aims: To investigate the possible aetiological relevance of physical and psychosocial workload to lumbar disc herniation with and without concomitant osteochondrosis/spondylosis. Methods: A total of 267 cases with acute lumbar disc herniation (in two practices and four clinics) and 197 control subjects were studied. Data were gathered in a structured personal interview and analysed using logistic regression to control for age, region, nationality, and diseases affecting the lumbar spine. Cases without knowledge about osteochondrosis/spondylosis (n=42) were excluded from analysis. Risk factors were examined separately for those cases with (n=131) and without (n=94) radiographically diagnosed concomitant osteochondrosis or spondylosis. Results: There was a statistically significant positive association between extreme forward bending and lumbar disc herniation with, as well as without concomitant osteochondrosis/spondylosis. There was a statistically significant relation between cumulative exposure to weight lifting or carrying and lumbar disc herniation with, but not without, concomitant osteochondrosis/spondylosis. Cases with disc herniation reported time pressure at work as well as psychic strain through contact with clients more frequently than control subjects. Conclusions: Further larger studies are needed to verify the concept of distinct aetiologies of lumbar disc herniation in relatively younger persons with otherwise normal discs and of disc herniation in relatively older persons with structurally damaged discs.

Seidler, A; Bolm-Audorff, U; Siol, T; Henkel, N; Fuchs, C; Schug, H; Leheta, F; Marquardt, G; Schmitt, E; Ulrich, P; Beck, W; Missalla, A; Elsner, G

2003-01-01

37

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

PubMed Central

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

Kazemi, Mohsen

1999-01-01

38

Catabolic cytokine expression in degenerate and herniated human intervertebral discs: IL1? and TNF? expression profile  

Microsoft Academic Search

Low back pain is a common and debilitating disorder. Current evidence implicates intervertebral disc (IVD) degeneration and herniation as major causes, although the pathogenesis is poorly understood. While several cytokines have been implicated in the process of IVD degeneration and herniation, investigations have predominately focused on Interleukin 1 (IL-1) and tumor necrosis factor alpha (TNF?). However, to date no studies

Christine Lyn Le Maitre; Judith Alison Hoyland; Anthony J Freemont

2007-01-01

39

Intradural Lumbar Disc Herniation Associated With Degenerative Spine Disease and Rheumatoid Arthritis.  

PubMed

Study Design. A case report by Kara Krajewski and Jan Regelsberger.Objective. To demonstrate a case of intradural lumbar disc herniation including imaging studies, intraoperative imaging and an intraoperative video.Summary of Background Data. The first case of lumbar intradural disc herniation was reported as early as 1942; since then over 150 cases have been reported, mostly in the lumbar spine. Gadolinium-enhanced MRI is considered the gold standard for diagnosing this entity, though it is rarely peformed routinely in lumbar disc disease and diagnosis is often made intraoperatively.Methods. A 70-year-old man presented to the emergency department as a referral complaining of lower back pain, loss of sensation in the right thigh and difficulty walking. On examination, he showed uneven gait, right-sided foot drop (1/5), hypesthesias in the right inguinal area and ventral thigh and a positive straight leg raise test on the right. Anal sphincter tone was within normal limits. An MRI of the lumbar spine showed a large mediolateral herniated disc at L3/4, with caudal displacement and unclear signal changes intradurally.Results. Intraoperatively, the herniated disc was found upon opening the dural sac.Conclusion. Intradural disc herniations are a rare entity. The opening and inspection of the dural sack should be considered when the correct spinal level can be confirmed and insufficient herniated disc material can be visualized extradurally. PMID:23462573

Krajewski, K; Regelsberger, J

2013-03-01

40

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

PubMed Central

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.

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

2013-01-01

41

CT of adult lumbar disc herniations mimicking posterior apophyseal ring fractures.  

PubMed

This report concerns 35 adult patients with lumbar or sciatic pain and axial CT findings reportedly associated with posterior apophyseal ring fractures. Review of the CT images suggested two pathophysiologic categories. (1) Posterior Schmorl--A posterior intravertebral disc herniation with posterior displacement of a fractured or remodelled vertebral margin. (2) Calcified subligamentous--Reactive annular and or posterior longitudinal ligament calcification at the periphery of a herniated disc with or without remodelling and anterior displacement of the posterior vertebral margin. PMID:1749472

Gomori, J M; Floman, Y; Liebergall, M

1991-01-01

42

Cervical Disc Herniation Causing Brown-S?quard's Syndrome: A Case Report and Literature Review  

PubMed Central

Brown-Séquard's syndrome (BSS) is caused by hemisection or hemicompression of the cord leading to ipsilateral motor deficit and contralateral sensory loss. Cervical disc herniation has been reported to be a rare cause of Brown-Séquard's syndrome. We describe a rare case of multilevel cervical disc herniation presenting as BSS. The condition was confirmed by MRI scan. Cervical corpectomy, decompression, and fusion gave a satisfying result. Pertinent literature has been reviewed.

Rustagi, Tarush; Badve, Siddharth; Maniar, Hemil; Parekh, Aseem N.

2011-01-01

43

Imaging dogs with suspected disc herniation: pros and cons of myelography, computed tomography, and magnetic resonance.  

PubMed

Myelography, computed tomography (CT), and magnetic resonance (MR) imaging are the diagnostic modalities currently used in the evaluation of dogs with suspected disc herniation. Where high-field MR imaging is available, it is considered the optimal modality for any myelopathy in dogs, including those with disc disease. CT myelography may be the next best option, particularly in nonchondrodystrophoid dogs. In chondrodystrophoid dogs, in which extrusion of mineralized disc material is common, plain CT will enable diagnosis in most cases. Myelography is still considered adequate for diagnosis of disc herniation when MR and CT are unavailable. PMID:21392160

Robertson, Ian; Thrall, Donald E

2011-01-01

44

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

NASA Astrophysics Data System (ADS)

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.

Koh, Jaehan; Chaudhary, Vipin; Dhillon, Gurmeet

2010-03-01

45

Clinical and radiographic characteristics of upper lumbar disc herniation: ten-year microsurgical experience.  

PubMed

Upper and lower lumbar disc herniation apparently have different background, symptoms, and operative results. This retrospective study reviewed the clinical records of 403 patients (409 discs) who underwent lumbar microdiscectomy performed by different surgeons at our institute between 1999 and 2009. The 290 male (72.0%) and 113 female (28.0%) patients were aged from 19 to 77 years (mean 44 years). Demographics, symptoms, and static and dynamic radiographic and magnetic resonance images obtained at the L1-2, L2-3, L3-4, L4-5, and L5-S1 intervertebral levels were analyzed. Of the 409 herniations, 3 were at L1-2, 9 at L2-3, 21 at L3-4, 166 at L4-5, and 210 at L5-S1. The mean age at herniation at L1-2 and L2-3 levels was 55.7 years. Patients with herniation of discs at L3-4 or above were significantly older than patients who suffered herniation at L4-5 or below (p < 0.0001), and the incidence of urinary disturbance was significantly higher in patients with herniation at L1-2 and L2-3 levels (p = 0.0013). The incidence of degenerative scoliosis was significantly higher in patients with herniation at L1-2 and L2-3 than in those with herniated discs at L3-4 or below (p < 0.0001). Patients with upper lumbar disc herniation were older and manifested a higher incidence of urinary disturbance. A high incidence of degenerative scoliosis was noted in the course of prolonged degenerative processes. PMID:21701105

Iwasaki, Motoyuki; Akino, Minoru; Hida, Kazutoshi; Yano, Shunsuke; Aoyama, Takeshi; Saito, Hisatoshi; Iwasaki, Yoshinobu

2011-01-01

46

Hemilaminoplasty for the treatment of lumbar disc herniation.  

PubMed

The aim of this study was to evaluate the clinical outcome of the hemilaminoplasty technique for the treatment of lumbar disc herniation (LDH). Forty-three cases of single-level LDH underwent a discectomy and hemilaminoplasty procedure. The preoperative JOA score and VAS of lower back and leg pain were 10.4+/-1.3, 7.8+/-2.1, and 8.6+/-1.7, respectively. The Cobb angle of lumbar sagittal alignment was 10.1+/-2.0. Twenty-five patients who agreed to lumbar discectomy through fenestration were enrolled as the control group. The postoperative JOA score and VAS of low back and leg pain of the hemilaminoplasty group were 19.4+/-1.3, 1.4+/-0.4, and 2.1+/-0.5, respectively. The Cobb angle was 29.2+/-1.9 degrees. There was no epidural scar observed in any of the patients. The Cobb angle of the hemilaminoplasty group was higher than that of the control group (p < 0.05), while the VAS was significantly lower (p < 0.05). Hemilaminoplasty is a useful method to improve clinical outcome, prevent epidural scar, and preserve the normal alignment of lumbar spine. PMID:18636258

Xinyu, Liu; Yanping, Zheng; Jianmin, Li; Liangtai, Gong

2009-10-01

47

Children Presenting with Calcified Disc Herniation: A Self-Limiting Process  

PubMed Central

We present two cases of disc herniation associated with juvenile intervertebral disc calcification, a rare, self-limiting process which typically resolves with conservative treatment. Recognition of this entity prevents unnecessary diagnostic workup and possible surgical intervention. A review of the literature for this rare entity is discussed.

Ho, Chang; Chang, Stanley; Fulkerson, Daniel; Smith, Jodi

2012-01-01

48

Thoracic disc herniation treated by video-assisted thoracoscopic surgery: case report.  

PubMed

Clinically, thoracic disc herniation occurs much less frequently than herniation in the cervical or lumbar regions, and accounts for only 0.15 to 1.8% of all intervertebral discs treated surgically. Classically, open thoracotomy is the standard procedure for thoracic disc herniation, but this type of surgery can cause prolonged postoperative wound pain that jeopardizes the mechanism of respiration and postoperative rehabilitation. We report the case of a 41-year-old woman with a symptomatic T11-T12 thoracic disc herniation and cord compression. Video-assisted thoracoscopic surgery (VATS) was performed to remove the herniated disc successfully. Intraoperatively, there was no injury to vital organs or the spinal cord. The total operating time was 3.5 hours, and the estimated blood loss was 400 ml. Postoperatively, the incisional pain was minimal, and no intercostal neuralgia was noted. At her 2-year follow-up examination, she was fully ambulatory and free of pain. This type of minimally invasive procedure is a good alternative to the classic thoracotomy and proved to be a safe and effective procedure for this patient. PMID:10074733

Lee, Y Y; Huang, T J; Liu, H P; Hsu, R W

1998-12-01

49

Simultaneous occurrence of herniated disc and mesothelial cyst in a 16-year-old male  

Microsoft Academic Search

The unusual, simultaneous occurrence of both a herniated disc and an intraspinal mesothelial cyst in an adolescent is reported. The patient was a 16-year-old white male who presented with sciatic pain in his left lower extremity. Myelography revealed evidence of a left L4–5 discal herniation, and a L5–S3 midline sacral lesion that proved to be a mesothelial cyst.

Nancy E. Epstein; Joseph A. Epstein; Robert Gould; Roger Hyman

1986-01-01

50

Comparison between cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs.  

PubMed

Cranial thoracic intervertebral disc herniations have been reported to be rare in dogs due to the presence of the intercapital ligament, however some studies have proposed they may not be uncommon in German Shepherd dogs. The purpose of this retrospective study was to compare cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs (control group). Medical records at the Ontario Veterinary College were searched for German Shepherd dogs and other large breed dogs that had magnetic resonance imaging studies including the T1-T9 region. For each dog and each disc space from T1-T9, three variables (compression, disc degeneration, and herniation) were recorded and graded based on review of sagittal T2-weighted images. Twenty-three German Shepherd dogs and 47 other large breed dogs met inclusion criteria. The German Shepherd dog group had higher scores than the control group for compression (P = 0.0099) and herniation (P < 0.001), but not disc degeneration (P = 0.97). In the German Shepherd dog group, intervertebral discs T2-T3 and T4-T5 had an increased risk for compression and T3-T4 had an increased risk for compression and herniation. Findings from this study indicated that German Shepherd dogs may be more likely than other large breed dogs to have spinal cord compression due to cranial thoracic disc herniations. Imaging of the cranial thoracic spine, including T2-T3, is recommended for German Shepherd dogs with T3-L3 neurological signs. PMID:23278950

Gaitero, Luis; Nykamp, Stephanie; Daniel, Rob; Monteith, Gabrielle

2013-01-01

51

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

PubMed Central

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.

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

2012-01-01

52

Cervical disc herniation as a cause of brown-séquard syndrome.  

PubMed

The possible causes of Brown-Séquard Syndrome (BSS) have been frequently observed with spinal trauma and extramedullary spinal tumors, but the cervical disc herniation to cause BSS is rare. The authors present five cases of patients who were diagnosed with BSS resulting from cervical disc herniation, and the results of the literature in view of their distinctive symptoms and clinical outcomes. Postoperatively, the patients showed complete or almost complete recovery from their motor and sensory deficits. On the basis of our cases, it is important to diagnose it early by cervical magnetic resonance imaging, especially in the absence of the typical symptoms of cervical disc herniation or other obvious etiology of extremity numbness. Immediate surgical treatment is also essential for a favorable functional neurological recovery. PMID:20041066

Choi, Kyeong Bo; Lee, Choon Dae; Chung, Dai-Jin; Lee, Sang-Ho

2009-11-01

53

Expression of neurotrophic factors in the dorsal root ganglion in a rat model of lumbar disc herniation  

Microsoft Academic Search

A variety of molecules released by inflammatory reactions in the dorsal root and dorsal root ganglion (DRG) may play important roles in the pathology of neuronal abnormalities in lumbar disc herniation. In order to elucidate the pathophysiological mechanisms of painful radiculopathy, secondary to lumbar disc herniation, we evaluated pain-related behavior and the change of nerve growth factor (NGF) and brain-derived

Koichi Obata; Hiroaki Tsujino; Hiroki Yamanaka; Dai Yi; Tetsuo Fukuoka; Norio Hashimoto; Kazuo Yonenobu; Hideki Yoshikawa; Koichi Noguchi

2002-01-01

54

Outpatient, awake, ultra-minimally invasive endoscopic treatment of lumbar disc herniations.  

PubMed

Background: Endoscopic discectomy is an ultra- minimally invasive outpatient surgical option for the treatment of lumbar herniated discs. The purpose of this study was to assess the benefit of tranforaminal versus interlaminar endoscopic discectomy in patients with single level Lumbar 5-Sacral 1(L5-S1) disc herniations and lumbar radiculopathy. Methods: After Institutional Review Board Approval, charts from 41 consecutive patients with complaints of lower back and radicular pain and an L5-S1 herniated disc who underwent an endoscopic procedure between 2007 and 2012 were reviewed. The transforaminal approach was used for patients with far lateral, foraminal, and paracentral disc herniations and the intralaminar approach was used for herniations that were more central. Results: The average pain relief 1-year postoperatively was 75.9% for the transforaminal group and 75.3% for the interlaminar group, both excellent results as defined by MacNab. The average preoperative visual analogue scale (VAS) scores were 8.2 and 8.4 for the transforaminal and interlaminar groups respectively, indicated in our questionnaire as severe and constant pain. The average 1-year postoperative VAS scores were 1.7 and 2.1, indicated in our questionnaire as mild and intermittent pain. There were no complications in the series of patients treated. Conclusions: The 1-year follow-up data presented here for transforaminal and intralaminar approaches to L5-S1 disc herniations appears to indicate that either approach can be used as determined to best suit the pathology without sacrificing the probability of postoperative pain improvement. [Full text available at http://rimed.org/rimedicaljournal-2014-06.asp, free with no login]. PMID:24905375

Jasper, Gabriele P; Francisco, Gina M; Telfeian, Albert

2014-06-01

55

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

PubMed Central

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 7.4±1.4, while the final follow-up VAS score was 1.4±0.7 (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.

Kim, Sung Chul; Cho, Ki Hong

2012-01-01

56

Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome  

PubMed Central

Centrally located lumbar disc herniations have been reported to be of predictive value for poor post-operative clinical outcome. One hundred and fifty patients undergoing lumbar disc herniation surgery were prospectively included. Herniation-related parameters, including the grading of contours, were assessed from pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) images using a new three-dimensional grading system. The radiological findings were compared with outcome parameters two years post-operatively (patient-assessed pain, function/health scores and evaluation by an independent observer). An intra- and inter-observer validation of the classification was performed in a subgroup of patients. High intra-observer and good inter-observer reliability for both CT and MRI was seen. In the study population, no relation between the distribution or size of the herniations and outcome at 2-year follow-up were found. The distribution and size of the lumbar disc herniations with the three-dimensional classification were not found to be of importance for the clinical outcome.

Lind, B.; Ronnberg, K.; Gothlin, J.; Gadeholt-Gothlin, G.; Zoega, B.; Brisby, H.

2008-01-01

57

Spontaneous intradural disc herniation with focal distension of the subarachnoid space in a dog.  

PubMed

Myelo-computed tomography of a paraparetic 14-year-old dog revealed subarachnoid distension with an intradural filling defect above the T13-L1 disc space. T12-L1 hemilaminectomy followed by durotomy allowed removal of a large piece of degenerated disc material that compressed the spinal parenchyma. Full return to function was achieved 10 days post-surgery. The distension was likely secondary to the intradural herniation, and is a rare and distinct finding. PMID:23633713

Barnoon, Itai; Chai, Orit; Srugo, Itai; Peeri, Dana; Konstantin, Lilach; Brenner, Ori; Shamir, Merav H

2012-11-01

58

Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation  

PubMed Central

Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery.

Nie, Hong-Fei; Liu, Kai-Xuan

2013-01-01

59

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?  

Microsoft Academic Search

Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treat- ment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome. Different factors may influence these results and poor adap- tation at work is one well-known cause of treatment failure.

Daniel Benzecry Almeida; Paola Hesse Poletto; Jerônimo Buzetti Milano; André Giacomelli Leal; Ricardo Ramina

2007-01-01

60

Retrolisthesis and lumbar disc herniation: a preoperative assessment of patient function  

Microsoft Academic Search

Background contextRetrolisthesis 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 preoperative back pain and dysfunction has been well studied.

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

2007-01-01

61

Influence of age on symptoms and signs in lumbar disc herniation  

Microsoft Academic Search

In a prospective and consecutive study we evaluated the prevalence of pain-related symptoms, the results of the strainght leg raising (SLR) test and neurological disturbances by age group in a total of 150 patients operated on due to lumbar disc herniation. On admission, all patients were interviewed, and pain at rest, at night and on coughing was recorded. Walking capacity

B. Jönsson; B. Strömqvist

1995-01-01

62

Myelopathy due to lumbar disc herniation in the presence of a tethered cord.  

PubMed

Study design:Single case report.Objectives:To present a case of lumbar disc herniation causing compression of a tethered cord that was successfully treated with lumbar decompression and fusion.Background:A tethered cord is a rare pathology associated with a congenital spinal malformation, spinal dysraphism. Furthermore, myelopathy due to lumbar disc herniation in the presence of a tethered cord is extremely rare.Methods:Single case report.Results:A 43-year-old male with a history of spina bifida presented to our clinic for an evaluation of a progressive spastic gait disturbance and numbness in the lower limbs. A neurological examination revealed muscle weakness and pyramidal tract signs in the lower limbs. Magnetic resonance imaging of the lumbar spine showed disc herniation at L2-3 causing compression of a low-lying cord. Surgical intervention, including herniotomy via a posterolateral approach and instrumented posterolateral fusion, was performed, and a good outcome was achieved 1 year after the surgery.Conclusion:The potential for lumbar disc herniation in the presence of a tethered cord should be taken into account in the differential diagnosis of spinal pathologies causing spastic gait disturbances. Furthermore, posterior decompression and fusion is a useful treatment option in such cases. PMID:24902642

Endo, F; Iizuka, H; Iizuka, Y; Kobayashi, R; Mieda, T; Takagishi, K

2014-06-01

63

Clinical Features and Surgical Results of Cervical Myelopathy Caused by Soft Disc Herniation  

PubMed Central

Objective There are many causes of cervical myelopathy including trauma, degenerative conditions, tumors and demyelinating disorders. However, myelopathy caused by soft disc herniation might be seen rarely than the spondylosis caused by hard disc. Here, authors retrospectively analyzed the clinical features and results of cervical myelopathy caused by soft disc herniation. Methods From March 2010 to December 2010, 134 patients with degenerative cervical spinal disease were treated with anterior cervical discectomy and interbody fusion. Among them, 21 patients with cervical myelopathy secondary to cervical soft disc herniation were analyzed. Their clinical features, preoperative and, postoperative clinical results were evaluated by Nurick Grade and Japanese Orthopaedic Association scale (JOA) retrospectively. Preoperative clinical features including duration of myelopathy, pain intensity and postoperative clinical results including improvement rate of myelopathy and radiculopathy were retrospectively analyzed by Nurick Grade and JOA scale. We also evaluated correlation between the duration of symptom, type of the disc herniation, pain intensity and clinical outcome. Results Mean age was 49.7 and male was predominant. Gait disturbance with mild to moderate pain was most common symptom in clinical features. Severe pain was shown in only 9 cases, and the other 12 cases experienced mild to moderate pain. Mean duration of myelopathy was 1.18 month. The mean JOA scores were 11.22 before surgery and 14.2 after surgery. The mean Nurick grades were 2.78 before treatment and 1.67 after treatment. Neurologic status of mild or moderate pain group on preoperative state is worse than that of severe pain group. The patients with duration of myelopathy symptom (<1 month) showed lower clinical improvement rate than the patients with myelopathy over 1 month. Patients with median type of disc herniation showed poorer neurological status than those with paramedian type of herniation in preoperative state. Conclusion Authors reviewed the clinical features and surgical outcome of the cervical myelopathy secondary to cervical soft disc herniation. We presumed that patients of more than one month of symptom duration, mild to moderate initial symptom would be related with better postoperative improvement rate.

Park, Sung Joo; Kim, Min Ki; Lee, Sung Ho; Oh, In Ho

2013-01-01

64

Clinical and Radiologic Analysis of Posterior Apophyseal Ring Separation Associated with Lumbar Disc Herniation  

PubMed Central

Objective We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. Methods We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. Results PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were 3.6±2.9 and 5.4±6.4 in the unresected PARS group, 5.8±2.1 and 11.3±7.1 in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. Conclusion The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.

Bae, Jung-Sik; Rhee, Woo-Tack; Kim, Woo-Jae; Ha, Seong-Il; Lim, Jae-Hyeon

2013-01-01

65

A novel microendoscopically assisted approach for the treatment of recurrent lumbar disc herniation: transosseous discectomy surgery.  

PubMed

Background and Object?Microendoscopic discectomy (MED) is still regarded as contraindicated for the treatment of recurrent lumbar disc herniation by many surgeons. Moreover, the presence of epidural scar tissue makes surgical manipulation difficult. To successfully remove the herniated disc in such cases, an open technique with a wide exposure may be required. We devised a new minimally invasive endoscopic approach, which is using a transosseous route. This is a retrospective review of a consecutive case series to examine the operative and clinical results of this new approach. Material and Methods?Fifty-seven patients who underwent surgery for recurrent lumbar disc herniation were divided into two groups based on the operative procedure. Thirty patients underwent microendoscopic transosseous discectomy (TD) and 27 underwent MED. We graded operative results and clinical outcomes using the Japanese Orthopaedic Association (JOA) score for low-back pain before surgery and 1?year after surgery and compared the scores of the two groups. Results?No conversion to open procedure was necessary in either group. The mean TD operative time was 89.2 minutes with a mean intraoperative blood loss of 16.5 mL. Mean MED operative time was 92.0 minutes with a mean blood loss of 19.3 mL. There were two dural tears in the MED group, and one tear was combined with a fracture of the inferior articular process. No dural tears occurred in the TD group. No patients in either group had experienced re-recurrence of lumbar disc herniation at the time of the last follow-up. The JOA score improved significantly after surgery in both groups (p?disc herniation. Operative time, intraoperative blood loss, and clinical results compare favorably with MED. PMID:23677684

Nomura, Kazunori; Yoshida, Munehito; Kawai, Masaki; Okada, Motohiro; Nakao, Shin-Ichi

2014-05-01

66

The Association of the Activation-Inducible Tumor Necrosis Factor Receptor and Ligand with Lumbar Disc Herniation  

PubMed Central

Purpose Herniated nucleus pulposus fragments are recognized by the immune system as a foreign-body, which results in an autoimmune reaction. Human activation-inducible tumor necrosis factor receptor (AITR) and its ligand, AITRL, are important costimulatory molecules in the pathogenesis of autoimmune diseases. Despite the importance of these costimulatory molecules in autoimmune disease, their role in the autoimmune reaction to herniated disc fragments has yet to be explored. The purpose of the present study is to investigate whether the overexpression of AITR and AITRL might be associated with lumbar disc herniation. Materials and Methods The study population consisted of 20 symptomatic lumbar disc herniation patients. Ten macroscopically normal control discs were obtained from patients with spinal fractures managed with anterior procedures that involved a discectomy. Peripheral blood samples from both the study patients and controls were collected. The expression levels of AITR and AITRL were investigated by flow cytometric analysis, confocal laser scanning microscopy, immunohistochemistry and by reverse transcriptase-polymerase chain reaction (RT-PCR). The soluble AITR and AITRL serum levels were measured by an enzyme-linked immunosorbent assay. Results Flow cytometric analysis revealed significantly higher levels of both AITR and AITRL in the lumbar disc herniation patients than in the controls. The AITRL expression levels were also increased in patients with lumbar disc herniation, shown by using confocal laser scanning microscopy, immunohistochemistry and RT-PCR. Finally, soluble AITR and AITRL were elevated in the patients with lumbar disc herniations. Conclusion The AITR and AITRL are increased in both the herniated disc tissue and the peripheral blood of patients with lumbar disc herniation.

Lee, Hwan-Mo; Hahn, Soo-Bong; Moon, Seong-Hwan; Kim, Yung-Tae; Lee, Choon-Sung; Jung, Hyo-Won; Kwon, Byoung-Se; Riew, K. Daniel

2007-01-01

67

Expression of the JAK/STAT3/SOCS3 signaling pathway in herniated lumbar discs.  

PubMed

The inflammatory cytokine interleukin-6 (IL-6) plays an important role in causing symptoms of lumbar disk herniation. The present study clarifies the expression of the signaling pathway of IL-6 in herniated discs. Homogenates prepared from lumbar herniated discs from 10 patients were assessed. The expression of janus kinase 1 (JAK1), signal transducer and activator of transcription 3 (STAT3), phosphorylated (p)-STAT3 at Tyr(705), suppressor of cytokine signaling 3 (SOCS3) and actin was examined by Western blot analysis. The expression of JAK1, STAT3, and p-STAT3 at Tyr(705) was also examined by immunostaining. JAK1, STAT3, p-STAT3 at Tyr(705) and SOCS3 were detected in almost all cases. Immunoreactivity against JAK1 and STAT3 was observed mainly in chondrocytes, whereas immunoreactivity against p-STAT3 at Tyr(705) was observed in the nuclei of chondrocytes. The JAK/STAT signaling pathway might be activated by IL-6 and transmit messages from the cell surface to the nucleus, and the pathway is negatively regulated by SOCS3. These JAK1, STAT3 and SOCS3 molecules might tightly regulate and play a role in the degeneration of chondrocytes within herniated discs. PMID:24686183

Osuka, Koji; Usuda, Nobuteru; Aoyama, Masahiro; Yamahata, Hitoshi; Takeuchi, Mikinobu; Yasuda, Muneyoshi; Takayasu, Masakazu

2014-05-21

68

Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report  

PubMed Central

Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

2012-01-01

69

Outcome of nucleoplasty in patients with radicular pain due to lumbar intervertebral disc herniation  

PubMed Central

Background: Nucleoplasty (percutaneous lumbar disc decompression) is a minimally invasive procedure that utilizes radiofrequency energy as a treatment for symptomatic lumbar disc herniation, against open microdiscectomy, which would be the mainstay treatment modality. The literature reports a favorable outcome in up to 77% of patients at 6 months. Aim: To evaluate the effectiveness of nucleoplasty in the management of discogenic radicular pain. Materials and Methods: The medical notes of 33 patients, admitted for nucleoplasty between June 2006 and September 2007, were reviewed retrospectively. All had radicular pain, and contained herniated disc as seen on magnetic resonance imaging (MRI) of lumbosacral spine. Patients were followed up at 1 and 3 months post-procedure. The outcome measures employed in this study were satisfaction with symptoms and self-reported improvement. Results: Thirty-three cases were examined (18 males and 15 females). Twenty-seven procedures were performed with no complications and six were abandoned due to anatomical reasons. There were 18 and 15 cases of disc herniation at L5/S1 and L4/5 levels, respectively. Four weeks following the procedure, 13 patients reported improvement in symptoms, and 14 remained symptomatically the same and subsequently had open microdiscectomy. Conclusion: Nucleoplasty has been shown to be a safe and minimal-access procedure. Less than half of our selected cohort of patients reported symptomatic improvement at 1-month follow-up. We no longer offer this procedure to our patients. Possible reasons are discussed.

Ogbonnaya, Sunny; Kaliaperumal, Chandrasekaran; Qassim, Abdulla; O'Sullivan, Michael

2013-01-01

70

Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations  

Microsoft Academic Search

BackgroundThe observed rate of recurrent disc herniation after limited posterior lumbar discectomy is highest in patients with posterior wide annular defects, according to the Carragee classification of type II (fragment-defect) disc hernia. Although the recurrent herniation rate is lower in both type III (fragment-contained) and type IV (no fragment-contained) patients, recurrent persistent sciatica is observed in both groups. A higher

Tuncay Kaner; Mehdi Sasani; Tunc Oktenoglu; Murat Cosar; Ali Fahir Ozer

2010-01-01

71

A rare case of Brown-Sequard syndrome caused by cervical disc herniation: a case report  

PubMed Central

Abstract: Brown-Sequard syndrome is a rare neurological disorder characterized by ipsilateral motor paralysis caused by a lesion through corticospinal tract and contralateral loss of pain and temperature sensation due to the involvement of spinothalamic tract. Cervical disc herniation has been reported to be a rare cause of Brown-Séquard's syndrome. This paper aims to report a case of Brown-Sequard syndrome that occurred in a patient suffering from CHD. In this case, using a rapid and urgent intervention we could prevent permanent neurologic deficit in the patient. Case: A 56-year-old woman complained about a sudden paresis in her right leg lasting for 4 days. Her pain was progressively worsening until she couldn’t walk without assistance. There was no history of trauma in the neck. Neurological examinations revealed right side spastic hemi-paresis as well as loss of pain and temperature sensation below T4 dermatome in the left side. The case was diagnosed as Brown-Sequard syndrome and cervical magnetic resonance imaging scan showed a disc herniation at C5/C6 and C6/C7 levels. Surgery was performed via anterior cervical microdiscectomy and fusion. After a 2-month period of follow-up, neurological assessments showed that motor and sensory functions of the patient returned to the normal condition. Although cervical disc herniation as a cause of Brown-Sequard syndrome is relatively rare, early diagnosis accompanied by an urgent treatment can prevent neurological complications in such cases. Keywords: Brown-Sequard Syndrome, Cervical Disc Herniation, Surgery, Ipsilateral motor paralysis

Ghasemi, Amir Abbas

2012-01-01

72

Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2.  

PubMed

A 54-year-old Caucasian woman presented with a 6?week history of periscapular pain and a T1 radiculopathy associated with Horner's syndrome. MRI of her cervicothoracic spine revealed an intervertebral disc herniation at the level of T1-2. During investigation she experienced some improvement in her symptoms and a conservative approach was pursued. At 6?months her pain and radiculopathy had resolved, and there was mild residual ptosis. PMID:24903729

Spacey, Kate; Dannawi, Zaher; Khazim, R; Dannawi, Z

2014-01-01

73

Imaging diagnosis-CT myelography in a dog with intramedullary intervertebral disc herniation.  

PubMed

A 5-year-old Chihuahua was examined for peracute pain and paraparesis. Neuroanatomic localization was consistent with a symmetric T3-L3 myelopathy. Computed tomography (CT) of the T9-L5 vertebrae was normal. Myelography disclosed attenuation of the subarachnoid space from T11 to L1, consistent with spinal cord swelling. CT following the myelogram disclosed a focal area of intramedullary iodinated contrast medium at T13-L1. At surgery, intervertebral disc material was removed from the spinal cord. Based on the findings in this patient, intramedullary disc herniation should be considered a cause for focal intramedullary contrast medium accumulation. PMID:21388471

Kent, Marc; Holmes, Shannon; Cohen, Eli; Sakals, Sharise; Roach, Wesley; Platt, Simon; Schatzberg, Scott; Howerth, Elizabeth

2011-01-01

74

Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations.  

PubMed

For disc herniations the use of open surgical approaches is reduced since new percutaneous methods allowing shrinkage of the disc and improvement of the radicular function are gaining interest. Studies on the spontaneous disappearance of disc fragments have demonstrated autoimmune responses with a chronic inflammatory reaction. Also radicular pain has been shown to be mostly due to biochemical mechanisms. Researchers in different fields surprisingly noticed that a brief, calculated, oxidative stress by ozone administration may correct a persistent imbalance due to excessive, chronic oxidative injury. Oxygen-ozone gas injection in painful patients has a dramatic effect on clinical symptoms. On these bases the intradiscal injection of oxygen-ozone gas has been conceived. We report the treatment on a series of patients affected by cervical disc pathology, treated by intradiscal injection of oxygen-ozone gas mixture. The effects both on pain and on radicular dysfunction are impressive. The morphological effect of the treatment was also evaluated by pathological examination. PMID:15830973

Alexandre, A; Corò, L; Azuelos, A; Buric, J; Salgado, H; Murga, M; Marin, F; Giocoli, H

2005-01-01

75

Dorsal Extradural Lumbar Disc Herniation Causing Cauda Equina Syndrome : A Case Report and Review of Literature  

PubMed Central

A 73-year-old male presented with a rare dorsally sequestrated lumbar disc herniation manifesting as severe radiating pain in both leg, progressively worsening weakness in both lower extremities, and urinary incontinence, suggesting cauda equina syndrome. Magnetic resonance imaging suggested the sequestrated disc fragment located in the extradural space at the L4-L5 level had surrounded and compressed the dural sac from the lateral to dorsal sides. A bilateral decompressive laminectomy was performed under an operating microscope. A large extruded disc was found to have migrated from the ventral aspect, around the thecal sac, and into the dorsal aspect, which compressed the sac to the right. After removal of the disc fragment, his sciatica was relieved and the patient felt strength of lower extremity improved.

Lee, Sang-Ho; Arbatti, Nikhil J.

2010-01-01

76

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

PubMed Central

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 L5–S1 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.

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

2008-01-01

77

Lower-extremity sensibility testing in patients with herniated lumbar intervertebral discs.  

PubMed

The significance of sensory changes determined by pinprick and light touch in individuals with a herniated lumbar disc has been questioned. Discrepancies may be related to the subjectiveness of the test, failure to use dermatome-specific testing sites, overlap of areas that are innervated by different nerve roots, anatomical variations, or lack of sensitivity of the testing technique. For this study, we assessed the results of sensory examinations of twenty-five patients with documented herniation of a lumbar disc. The examinations were done using Semmes-Weinstein monofilaments, vibrometry, pinprick, and light touch in the autonomous skin areas supplied by the fourth and fifth lumbar and first sacral-nerve roots. Right-left differences in Semmes-Weinstein pressure thresholds of more than fifteen milligrams per square millimeter enabled us to localize disc lesions to a specific root in 100 per cent of patients and differences in vibratory thresholds of more than 3.5 micrometers, to localize the correct level in 88 per cent. Lesser differences in thresholds did not help to identify the involved root. The mean sensory threshold on the side of the disc lesion was found to be significantly greater than that on the opposite side by both vibrometry and pressure aesthesiometry (p less than 0.005). These findings were not duplicated using light touch or pinprick testing. Even with the most sophisticated sensibility-testing techniques, correct identification of the nerve root that was compressed by a herniated lumbar disc was accurate in only 50 per cent of patients. PMID:2997232

Weise, M D; Garfin, S R; Gelberman, R H; Katz, M M; Thorne, R P

1985-10-01

78

Macrophage tissue infiltration, clinical symptoms, and signs in patients with lumbar disc herniation. A clinicopathological study on 179 patients.  

PubMed

It is postulated that in addition to nerve-root compression, an inflammatory stimulus of the herniated lumbar disc is responsible for sciatic pain and radiculopathy. The clinical relevance of the histologically described inflammatory infiltrates is, however, not clearly defined [8, 22]. It was the aim of this study to assess the clinical relevance of inflammatory cells in herniated lumbar disc specimens. The presence of inflammatory cells was examined immunohistochemically in routinely processed resection specimens of the lumbar disc. The histological results were compared to prospectively obtained clinical data. Disc specimens of 179 patients who underwent surgery for lumbar disc herniation were studied immunohistologically. Preoperatively each patient received a visual analogue scale for classification of the pain level and general clinical data were recorded prospectively. Varying amounts of inflammatory cells could be demonstrated in the resected disc tissue. In the statistical workup no statistically significant correlation between the histological evidence of macrophage infiltrates and the pain grading scale or the clinical data could be found. In our study there is no statistically significant correlation between macrophage infiltrates in herniated lumbar disc specimen and the obtained clinical data. PMID:9932124

Rothoerl, R; Woertgen, C; Holzschuh, M; Brehme, K; Rüschoff, J; Brawanski, A

1998-01-01

79

Use of CT-guided periradicular injection for the treatment of foraminal and extraforaminal disc herniations  

PubMed Central

Study design:?Retrospective case series. Evidence level IV. Objectives:?To evaluate surgical candidates with foraminal or extraforaminal lumbar disc herniation treated with CT-guided periradicular injection (CTGPI) as a valid treatment option for avoiding surgery. Methods:?We carried out a retrospective evaluation of 46 consecutive patients with foraminal or extraforaminal disc herniation treated with CTGPI. CTGPI was performed only when radicular pain could not be controlled, or in patients who continued requiring pain medication following an acute episode and whose radicular pain precluded them from resuming their daily activities. Forty-six patients with a minimum 2-year follow-up met the inclusion criteria. There were 21 women and 25 men, with a mean age of 47 years. Results:?At 1 month after injection, 41 (89%) patients experienced a decrease in radicular pain; 3 experienced no change; and 2 had received surgical treatment. At the final follow-up visit (mean, 74 months) 6 additional patients underwent surgery while 38 (83%) did not require surgery. Pain level comparison between pre-injection and last examination showed that low back pain had decreased a mean of 5 points and radicular pain diminished a mean of 7 points. Twenty-two (58%) of the 38 nonoperated patients had no pain at all and 35 patients had resumed their normal daily activities. No complications were recorded. Conclusion:?Based on these results, we consider that the use of CTGPI is a reliable alternative before surgery for patients with foraminal or extraforaminal disc herniation without severe motor deficit but with intractable radicular pain. Final Class of evidence (CoE)-treatment Yes Study design:  RCT  Cohort  Case control  Case series • Methods  Concealed allocation (RCT)  Intention to treat (RCT)  Blinded/independent evaluation of primary outcome  F/U ?85% •  Adequate sample size • Control for confounding Overall class of evidence IV The definiton of the different classes of evidence is available on page 59.

Gruenberg, Marcelo F.; Petracchi, Matias; Valacco, Marcelo; Sola, Carlos

2011-01-01

80

Application of Percutaneous Cervical Nucleoplasty Using the Navigable Disc Decompression Device in Patient of Cervical Herniated Intervertebral Disc: A Case Report  

PubMed Central

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.

Lim, Ji-Hoon; Lee, Hye-Jin

2013-01-01

81

The Impact of Psychiatric Comorbidity on the Return to Work in Patients Undergoing Herniated Disc Surgery  

Microsoft Academic Search

Introduction This study examines (1) return to work (RTW) and ability to work (ATW) rates, and the association with (2) psychiatric comorbidity\\u000a and (3) socio-demographic, illness-related, vocational and rehabilitation-related characteristics in herniated disc surgery\\u000a patients. Methods In this longitudinal observational study 305 consecutive patients took part in face-to-face interviews during hospital stay.\\u000a 277 patients also participated in a 3-month follow-up

Margrit Zieger; Melanie Luppa; Hans Jörg Meisel; Lutz Günther; Dirk Winkler; René Toussaint; Katarina Stengler; Matthias C. Angermeyer; Hans-Helmut König; Steffi G. Riedel-Heller

2011-01-01

82

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

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 18–70 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.

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

83

Paraplegia after Gastrectomy in a Patient with Cervical Disc Herniation: A Case Report and Review of Literature  

PubMed Central

Paraplegia is a rare postoperative complication. We present a case of acute paraplegia after elective gastrectomy surgery because of cervical disc herniation. The 73-year-old man has the medical history of cervical spondylitis with only symptom of temporary pain in neck and shoulder. Although the patient's neck was cautiously preserved by using the Discopo, an acute paraplegia emerged at about 10 hours after the operation. Severe compression of the spinal cord by herniation of the C4-C5 cervical disc was diagnosed and emergency surgical decompression was performed immediately. Unfortunately the patient showed limited improvement in neurologic deficits even after 11 months.

Zhang, Qingfu; Jiang, Wei; Zhou, Quanhong; Wang, Guangyan; Zhao, Linlin

2014-01-01

84

Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy  

PubMed Central

We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a posterolateral mass compressing the spinal cord at the T9-T10 level. The patient was treated with a discectomy through the posterior approach combined with posterior instrumentation. The patient's symptoms and myelopathy resolved completely after the discectomy and instrumented fusion. The thoracic disc herniation might have been caused by the increased motion and stress concentration at the adjacent segment.

Oh, In-Soo; Seo, Jun-Yeong; Kim, Yoon-Chung

2010-01-01

85

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

PubMed

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

Boucher, Pierre; Robidoux, Sébastien

2014-02-01

86

Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion  

PubMed Central

Between 2001 and 2005, 43 patients (average age 54.2, range 36–68 years) with recurrent lumbar disc herniation underwent reoperation with the transforaminal lumbar interbody fusion (TLIF) technique at our unit. All cases were followed up for 24–72 months (mean 45 months) and graded using the Japanese Orthopaedic Association (JOA) score system pre- and post-operation and during the follow-up period. The leg pain of all patients was relieved significantly within one month postoperatively. The mean JOA score was improved from 9.3 before surgery to 25.0 at the final follow-up visit (P<0.0001). The average recovery rate was 86.0% (range 52–100%). General clinical outcome was excellent in 23 (53.5%) patients, good in 14 (32.6%) and fair in 6 (13.9%). The fusion rate was 100% two years postoperatively. Three patients (7%) had transient neurological deficits, which resolved completely within 3 months. There were no major complications. We, therefore, believe the TLIF technique to be an effective procedure with satisfactory clinical results for the treatment of recurrent lumbar disc herniation.

Zhao, Jie; Liu, AiGang; Yuan, Jiandong; Li, Zhonghai

2008-01-01

87

Bilateral post-injection fibrosis of the gluteal region mimicking lumbar disc herniation: a case report  

PubMed Central

Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in children due to vaccinations and injections. Herein we report a case of post injection gluteal fibrosis that had undergone two unsuccessful lumbar discectomies to treat the symptoms of this disease. A 45 years old male patient was consulted to our clinic from the department of neurochirurgy with complaints of bilateral hip pain. The patient was operated on for lumbar disc herniation in L4–5 level twice but his complaints had not resolved. A third operation including L4–5 instrumentation and fusion was planned. His examination revealed nodules in his both hips. His x-rays, MRI and blood tests were normal. He underwent bilateral gluteal fascia excision and his complaints resolved totally. The clinical diagnosis of post-injection fibrosis is problematic, due to the difficulty of determining the etiology. In many patients the diagnosis comes from a history of injection. Pain in the gluteal region is not a frequently described clinical feature of this condition. Many reports in the literature emphasize a contracture rather than pain. Post-injection fibrosis in the gluteal region may mimic lumbar disc herniation and a detailed physical examination is the key for correct differential diagnosis. In refractory cases not responding to conservative treatment, surgical excision of the nodules may lead to a complete clinical recovery of the patient.

Kose, Kamil Cagri; Altinel, Levent; Isikb, Cengiz; Komurcuc, Erkam; Mutlud, Serhat; Ozdemire, Mustafa

2009-01-01

88

Balance Acupuncture: An Experimental Study on the Effectiveness of Treating Radicular Pain in a Lumbar Disc Herniation Rat Model  

Microsoft Academic Search

BackgroundLumbar disc herniation (LDH) is a common clinical disease accounting for lumbocrural pain in the majority of the patients. The incidence of LDH has risen quickly in the past years. The theory of balance acupuncture is a new method firstly established by Dr. Wang Wenyuan and further developed according to a large amount of clinical studies which have come to

Ying Wang; Hong Yuan; Danni Xu; Wang WY

2009-01-01

89

An epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical discs  

Microsoft Academic Search

The associations between participation in several spe cific sports, use of free weights, and use of weight lifting equipment and herniated lumbar or cervical inter vertebral discs were examined in a case-control epi demiologic study. Specific sports considered were baseball or softball, golf, bowling, swimming, diving, jogging, aerobics, and racquet sports. Included in the final analysis were 287 patients with

Diane J. Mundt; Jennifer L. Kelsey; Anne L. Golden; Manohar M. Panjabi; Harris Pastides; Anne T. Berg; Joseph Sklar; Timothy Hosea

1993-01-01

90

Nonmedical methods to relieve low back pain caused by lumbar disc herniation: a descriptive study in northeastern Turkey.  

PubMed

Low back pain due to the effects of lumbar disc herniation is a common complaint of patients who often subsequently seek help from medical professionals. It is also a significant health problem which is quite difficult to treat. This descriptive study was conducted to determine nonmedical methods used by patients with lumbar disc herniation to relieve low back pain; the patients' intensity of low back pain when they were admitted to the hospital was also explored. Ninety-two patients with lumbar disc herniation participated in this study, which was carried out at a university hospital in northeastern Turkey. Data were collected using a patient information form and the visual analog scale (VAS). When the patients were admitted to hospital, their mean VAS score was 6.56 ± 2.45. The study results showed that as a first choice nearly all of the patients (94.6%) with lumbar disc herniation preferred consulting with their physicians before to obtain relief for low back pain. However, in addition to seeing their physician, more than one-half of these patients (57.6%) also used nonmedical methods. The primary nonmedical methods were hot/cold compresses, wrapping various substances on the back, and herbal preparations. An increase in pain was noted by 17.0% of patients after using nonmedical methods. Findings indicated that more than two-thirds of patients experienced either no change or an increase in pain after using nonmedical methods to find relief. PMID:24882024

Cilingir, Dilek; Hintistan, Sevilay; Yigitbas, Cagla; Nural, Nesrin

2014-06-01

91

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

PubMed Central

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.

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

2013-01-01

92

Psoas Compartment Blockade in a Laterally Herniated Disc Compressing the Psoas Muscle -A Case Report-  

PubMed Central

A psoas compartment block has been used to provide anesthesia for orthopedic surgical procedures and analgesia for post-operative pain. Currently, this block is advocated for relieving pain in the lower extremity and pelvic area resulting from various origins. We report a case of a 69-year-old male patient who had gait abnormality with posterior pelvic and hip pain, which were both aggravated by hip extension. From the magnetic resonance image, the patient was found to have a laterally herniated intervertebral disc at the L2/3 level, which compressed the right psoas muscle. This was thought to be the origin of the pain, so a psoas compartment block was performed using 0.25% chirocaine with triamcinolone 5mg, and the pain in both the pelvis and hip were relieved.

Kim, Hye Young; Park, Jin Woo; Moon, Jee Youn; Shin, Jae Hyuck; Park, Sang Hyun

2012-01-01

93

Recurrence Rate after Herniotomy only versus Discectomy in Lumbar Disc Herniation  

PubMed Central

Objective Lumbar disc herniation (LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3-13%). The purpose of this study is to identify the rate of recurrent disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy. Methods This study is a retrospective case control study. The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Herniotomy group was 57 patients and conventional discectomy group was 57 patients that were selected from 631 patients using stratified randomization. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated according to Odom's criteria from three months to three years. Results Of the 114 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. There were no differences in the VAS and Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant. Conclusion There were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.

Park, Jong Soo; Choi, Sang Eun; Cho, Tae Koo; Kim, Sang-hyuk; Rhee, Wootack; Kim, Woo Jae; Ha, Seong Il; Jang, Il Tae

2013-01-01

94

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

PubMed Central

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.

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

95

A review of current treatment for lumbar disc herniation in children and adolescents  

PubMed Central

Lumbar disc herniation (LDH) is a common disorder among adults with degenerated lumbar intervertebral discs. However, its occurrence in childhood and adolescence is much less frequent mostly because children and adolescents tend to have a healthier lumbar spine as compared with adults. This difference indicates that children and adolescents are far from being just little adults. Over the years, there have constantly been published studies concerning this entity where the findings suggested that pediatric LDH is, in many ways, different from that in adults. To date, the prevalence, the etiological and the diagnostic features of pediatric LDH have been fully described in the literature whereas the characteristics regarding to the treatment is yet to be reviewed in details. The aim of the present review is to provide a collective opinion on the treatment of pediatric LDH as well as its outcome. It reviewed the relevant information available in the literature and compared the results among and within various treatments. It was found that pediatric patients responded less favorably to conservative treatment as compared with adults. In addition, the outcome of surgery remained to be satisfactory for at least 10 years after the initial operation, even though it appeared to deteriorate slightly. To the best of our knowledge, this is the first literature review focusing on the treatment of pediatric LDH.

Liu, Zhongjun

2009-01-01

96

Puncture of a Disc and Application of Nucleus Pulposus Induces Disc Herniation-Like Changes and Osteophytes. An Experimental Study in Rats  

PubMed Central

It has been observed that puncture of a lumbar disc may induce formation of a nodule on the surface of the disc and osteophytes. It is not known if this is based on the presence of a foreign tissue or specifically by the presence of nucleus pulposus or on the disc injury. In this study these mechanisms were separated by comparing disc puncture with application of nucleus pulposus without disc injury, with superficial disc injury without nucleus pulposus and with application of fat. Fifty rats underwent facetectomy of the left L4-5 facet. Ten additional rats were used as donor rats. The rats were exposed to disc puncture (n=10), application of homologous nucleus pulposus (n=10), application of homologous fat tissue (n=10), superficial disc injury (n=10) and ten rats served as control. After 3 weeks the rats were examined macroscopically regarding presence of disc nodules and osteophytes. A limited histological analysis was performed to obtain a microscopic overview of any observed changes. In rats with application of fat, superficial disc injury and in sham controls there were almost no changes observed. However, in rats with disc puncture and applied nucleus pulposus there were clear disc nodules and osteophytes noted. Microscopically the nodules comprised granulation tissue and the osteophytes cortical bone. In conclusion, the data indicate that the presence of nucleus pulposus is more likely to be responsible for the formation of disc nodules and osteophytes than disc injury or the presence of a foreign tissue. This may provide new insights in the mechanisms regarding the formation of disc herniations and osteophytes.

Olmarker, Kjell

2011-01-01

97

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

PubMed Central

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.

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

2014-01-01

98

Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients  

PubMed Central

A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients’ outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18–66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Pre- and 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen.

Lind, B.; Zoega, B.; Gadeholt-Gothlin, G.; Halldin, K.; Gellerstedt, M.; Brisby, H.

2008-01-01

99

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 ...

100

Postural control in patients with lumbar disc herniation in the early postoperative period  

PubMed Central

Chronic spinal disc disease leads to disorders in postural movement coordination. An incorrect asymmetrical movement pattern for the lower limbs loading impairs proprioception and deteriorates postural stability, particularly when the vision is occluded. The standard surgical treatment improves biomechanical conditions in the lumbar spine, reduces pain, yet does it reduce the stability deficit in the upright position? An answer to the latter question would help work out targeted therapy to improve postural stability. We hypothesized that the standard surgical treatment would improve postural stability reflected by decreased sway variability accounting for better use of proprioceptive inputs postoperatively. Thirty-nine patients with lumbar disc herniation participated in the study. Their postural sway was recorded in anterior/posterior and medial/lateral planes with their eyes open or closed (EC) before and after surgery. The variability, range, mean velocity of the recorded time series and the area of the ellipse enclosed by the statokinesiogram were used as measures of postural stability. Preoperatively, EC condition resulted in an increased variability and mean velocity of postural sway, while postoperatively it caused an increase in sway mean velocity and sway area only with no effect on sway variability and range. The comparison of the balance before and after the surgery in the EC condition showed significant decrease in all parameters. In the early postoperative period, the patients recover the ability to control their postural sway in EC within normal limits, however, at the expense of significantly increased frequency of corrective torques. It is probably a transient short-term strategy needed to compensate for the recovery phase when the normal weighting factors for all afferents are being reestablished. We propose that this transient postoperative period may be the best timing of therapeutic intervention targeted at facilitating and reinforcing the acquisition of correct motor patterns.

Chantsoulis, Marzena; Kuczynski, Michal

2009-01-01

101

Preoperative and postoperative evaluation of somatosensorial evoked potentials of upper extremities in cervical intervertebral disc herniation.  

PubMed

This study aims to determine the dysfunction caused by existing pathological condition in structures involved in the transfer of sensory functions of the neural system in cervical disc herniation, and to establish whether or not the level and degree of this anatomical damage can be anticipated by SEP (Somatosensorial Evoked Potentials). We compared the obtained SEP values for statistical significance using the Friedman Variation Analysis. In parameters with statistical significance, the Wilcoxon Signed Rank test was used to identify when significant improvements occurred. The study found that the statistical data of the latency of the N14 wave originating from the dorsal column nuclei of the medulla spinalis and dorsal column gray matter improved (p < 0.05) in the postoperative period compared with the preoperative values. Using the Wilcoxon Signed Rank test, we studied postoperative months separately in regard to the difference in the latency of the N14 wave, and found the statistically significant improvement to be marked particularly in months 3 and 6 postoperatively (p < 0.05). In conclusion, we suggest that SEP is a useful tool to check the functional condition of the dorsal spinal column. The benefit of the SEP utilization is the ability to determine the severity of the pathological condition preoperatively and follow the patient's functional postoperative improvement. PMID:23756968

Umur, Ahmet Sukru; Selcuki, Mehmet; Selcuki, Deniz; Temiz, Cuneyt; Akbasak, Aytac

2013-01-01

102

Long-Term Outcome of Patients who Underwent Percutaneous Nucleotomy for Lumbar Disc Herniation: Results after a Mean Follow-up of 5 Years  

Microsoft Academic Search

Summary   A total of 41 patients who had undergone percutaneous nucleotomy for a single level lumbar disc herniation were clinically\\u000a examined after a mean postoperative follow-up of 5 years (range 4 to 7 years). There were 14 (34%) male and 27 (66%) female\\u000a patients with a mean age of 49 years. By intra-operative discography, the herniation had been graded as

E. Kotilainen; S. Valtonen

1998-01-01

103

Targeted CT-guided epidural blood patch for treatment of spontaneous intracranial hypotension due to calcified intradural thoracic disc herniation.  

PubMed

Calcified thoracic intradural disc herniations have recently been reported as a cause of spontaneous intracranial hypotension (SIH). We report successful treatment of SIH with a targeted CT-guided epidural blood patch. A 57-year-old man presented to the emergency department with a two-week history of progressively debilitating headache. CT and MRI of the brain showed findings consistent with intracranial hypotension and MRI of the spine showed findings consistent with CSF leak. Subsequent CT myelogram of the thoracic spine confirmed the presence of CSF leak and calcified disc herniations at the T6-7, T7-8 and T8-9 levels indenting the ventral dura and spinal cord. The calcified disc herniation at T6-7 had an intradural component and was therefore the most likely site of the CSF leak. Under CT fluoroscopic guidance, a 20-gauge Tuohy needle was progressively advanced into the dorsal epidural space at T6-7. After confirmation of needle tip position, approximately 18cc of the patient's own blood was sterilely removed from an arm vein and slowly re-injected into the dorsal epidural space. With satisfactory achievement of clot formation, the procedure was terminated. The patient tolerated the procedure well. The next morning, his symptoms had completely resolved and he was neurologically intact. At five-week follow up, he was symptom-free. Targeted epidural blood patch at the site of presumed CSF leak can be carried out in a safe and effective manner using CT fluoroscopic guidance and can be an effective alternative to open surgical management in selected patients. PMID:23472734

Agarwal, V; Sreedher, G; Rothfus, W E

2013-03-01

104

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

PubMed Central

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.

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

2011-01-01

105

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

PubMed Central

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 18–70 years) presenting with sciatica due to lumbar disc herniation lasting more than 6–8 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.

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

2006-01-01

106

Comparison of the diagnosis of intervertebral disc herniation in dogs by CT before and after contrast enhancement of the subarachnoid space.  

PubMed

Eleven miniature dachshunds with a herniated intervertebral disc were examined by CT, first before and then after contrast enhancement of the subarachnoid space. The images were classified into three grades by three veterinarians. In four cases, lesions observed on the scans obtained after contrast enhancement had not been observed on the preliminary scans and in one case a lesion observed on the preliminary scan was not observed on the scan obtained after contrast enhancement. Hemilaminectomies were performed on the basis of the enhanced CT results, and a clinical improvement was observed in each of the dogs. Calcification was detected in all the samples of herniated intervertebral disc material. PMID:19684345

Shimizu, J; Yamada, K; Mochida, K; Kako, T; Muroya, N; Teratani, Y; Kishimoto, M; Lee, K; Iwasaki, T; Miyake, Y

2009-08-15

107

Treating thoracic-disc herniations: Do we always have to go anteriorly?  

PubMed Central

Study design:?Retrospective cohort study. Objective:?To determine if there is a difference in outcome and complications in surgically managed patients with thoracic-disc herniations (TDH) undergoing a modified transfacet pedicle-sparing decompression and fusion (posteriorly) compared to those undergoing anterior transthoracic discectomies (anteriorly). Methods:?Thirty-five consecutive operatively managed TDH underwent operative management between March 2003 and November 2009. Outcomes and complications were reviewed from patient records and x-rays assessing differences between those treated posteriorly and those treated anteriorly. Results:?Twenty-four patients underwent posterior management for 35 TDH and ten patients underwent anterior management for twelve TDH. Mean age was 50 years in both groups. Body mass index (BMI) averaged 28.8 in the anterior group and 32.0 in the posterior group. Follow-up averaged 38 weeks with four patients lost to follow-up (all posterior). Major complications secondary to surgery occurred in three patients (30%) in the anterior group (pulmonary embolus, pneumonia, and wrong level surgery) and in seven patients (35%) in the posterior group (seroma, misplaced instrumentation requiring revision, recurrence requiring an additional operation, and four infections). No neurological complications occurred and all patients noted improvement from baseline. Average length of stay was 7.3 days in the anterior group and 4.2 days in the posterior group (P < .003). Final pain as assessed by visual analog scale (VAS) improved from 6.7 to 4.3 in the anterior group and 6.9 to 2.3 in the posterior group (P?=?.05). Conclusions:?Complication rates are similar between groups and are approach related. Posteriorly managed patients had greater improvement in pain and shorter length of stay. Methods evaluation and class of evidence (CoE) Methodological principle: Study design:  Randomized controlled trial  Cohort study •  Case control  Case series Statement of concealed allocation* Intent to treat* Independent or blind assessment • Complete follow-up of ?85% Adequate sample size Controlling for possible confounding Evidence class: III *Applies to randomized controlled trials only. The definition of the different classes of evidence is available on page 83.

Bransford, Richard J.; Zhang, Fangyi; Bellabarba, Carlo; Lee, Michael J.

2010-01-01

108

[Discussion on the regular of acupoint selection of acupuncture and moxibustion for lumbar disc herniation during recent 10 years].  

PubMed

By taking "lumbar disc herniation", Chinese medicine", "acupuncture and moxibustion" as key words Chinese articles about acupuncture for lumbar disc herniation in recent 10 years were searched in three major Chinese databases of Wan fang database, VIP database and CNKI. Totally 546 relative articles were retrieved. After the elimination of invalid articles, 173 were included as valid articles with 49 main acupoints. The hierarchical clustering statistical method was used to analyze the possible rules among the former 20 acupoints. It turned out that there were 10 most common used acupoints on Bladder Meridian [Geshu (BL 17), Xiaochangshu (BL 27), Shenshu (BL 23), Dachangshu (BL 25), Pangguangshu (BL 28), Guanyuanshu (BL 26), Weizbong (BL 40), Zhibian (BL 54), Chengshan (BL 57), Kunlun (BL 60)], 2 on Gallbladder Meridian [Huantiao (GB 30), Yanglingquan (GB 34)], 2 on Governor Vessel [Yaoyangguan (GV 3), Shuigou (GV 26)], 2 on Stomach Meridian [Zusanli (ST 36), Juliao (ST 3)], 2 on Spleen Meridian [Sanyinjiao (SP 6), Xuehai (SP 10)], and the rest were extra points (Huatuo Jiaji) and Ashi points, so a conclusion could be drawn that the most common used acupoints were Bladder Meridian acupoints and supplemented by Gallbladder Meridian, Governor Vessel, Stomach Meridian, Spleen Meridian, extra points and Ashi points. The selected acupoints were most located on the lumbosacral region, leg and fewer located on the face, back and local part. PMID:24032212

Li, Ju-Bao; Xiong, Qi-Liang; Qu, Shang-Ke; Qi, Feng; Zhang, Lei; Wang, Qi; Bao, Ke; Li, Fan-Bing

2013-07-01

109

Survivorship analysis of 150 consecutive patients with DIAM(TM) implantation for surgery of lumbar spinal stenosis and disc herniation  

PubMed Central

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, 46.5 years; median value of follow-up, 23 months (range 1–48 months); 96 spinal stenosis and 54 disc herniations; and 146 one-level (115, L4–5; 31, L5–6) and 4 two-level (L4–5 and L5–6). 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 L5–6. 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 Kaplan–Meier 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 13.4 months (range 2–29 months). Kaplan–Meier analysis predicted an 8% cumulative reoperation rate 4 years post-operatively. Survival time was predicted to be 45.6 ± 0.9 months (mean ± standard deviation). Based on the log-rank test, the reoperation rate was higher at L5–6 (p = 0.002) and two-level (p = 0.01) DIAM™ implantation compared with L4–5 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, L5–6 [hazard ratio (HR), 10.3; 95% CI, 1.7–63.0; p = 0.01] and two-level (HR, 10.4; 95% CI, 1.2–90.2; p = 0.04) DIAM™ implantation were also significant variables associated with a higher reoperation rate. Survival time was significantly lower in L5–6 (47 vs. 22 months, p = 0.002) and two-level DIAM™ implantation (46 vs. 18 months, p = 0.01) compared with L4–5 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 4 years after surgery. Based on the limited data set, DIAM™ implantation at L5–6 and two-level in patients with LSTV are significant risk factors for reoperation.

Sur, Yoo-Joon; Kong, Chae-Gwan

2010-01-01

110

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

PubMed

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, 46.5 years; median value of follow-up, 23 months (range 1-48 months); 96 spinal stenosis and 54 disc herniations; and 146 one-level (115, L4-5; 31, L5-6) and 4 two-level (L4-5 and L5-6). 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 L5-6. 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 Kaplan-Meier 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 13.4 months (range 2-29 months). Kaplan-Meier analysis predicted an 8% cumulative reoperation rate 4 years post-operatively. Survival time was predicted to be 45.6 ± 0.9 months (mean ± standard deviation). Based on the log-rank test, the reoperation rate was higher at L5-6 (p = 0.002) and two-level (p = 0.01) DIAM™ implantation compared with L4-5 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, L5-6 [hazard ratio (HR), 10.3; 95% CI, 1.7-63.0; p = 0.01] and two-level (HR, 10.4; 95% CI, 1.2-90.2; p = 0.04) DIAM™ implantation were also significant variables associated with a higher reoperation rate. Survival time was significantly lower in L5-6 (47 vs. 22 months, p = 0.002) and two-level DIAM™ implantation (46 vs. 18 months, p = 0.01) compared with L4-5 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 4 years after surgery. Based on the limited data set, DIAM™ implantation at L5-6 and two-level in patients with LSTV are significant risk factors for reoperation. PMID:20953966

Sur, Yoo-Joon; Kong, Chae-Gwan; Park, Jong-Beom

2011-02-01

111

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

SciTech Connect

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.

Liu Wengui [Southeast University, Department of Radiology, Zhong-Da Hospital (China); Wu Xiaotao [Southeast University, Department of Orthopedics, Zhong-Da Hospital (China); Guo Jinhe [Southeast University, Department of Radiology, Zhong-Da Hospital (China); Zhuang Suyang [Southeast University, Department of Orthopedics, Zhong-Da Hospital (China); Teng Gaojun, E-mail: gjteng@vip.sina.co [Southeast University, Department of Radiology, Zhong-Da Hospital (China)

2010-08-15

112

The Combined Use of a Posterior Dynamic Transpedicular Stabilization System and a Prosthetic Disc Nucleus Device in Treating Lumbar Degenerative Disc Disease With Disc Herniations  

Microsoft Academic Search

BackgroundProsthetic replacement of spinal discs is emerging as a treatment option for degenerative disc disease. Posterior dynamic transpedicular stabilization (PDTS) and prosthetic disc nucleus (PDN) devices have been used sporadically in spinal surgery.

Mehdi Sasani; Ahmet Levent Aydin; Tunc Oktenoglu; Murat Cosar; Yaprak Ataker; Tuncay Kaner; Ali Fahir Ozer

2008-01-01

113

A finite element analysis of the influence of surgical herniation on the viscoelastic properties of the intervertebral disc.  

PubMed

The purpose of this paper was to study the influence of surgical herniation on the viscoelastic properties of the intervertebral disc. The work was broken down into two phases: experimentation and analysis. In the first step of experimentation, five specimens were excised from the L1-L2 level of young adult rhesus monkeys. The prepared specimen consisted of the intervertebral joint and the two adjacent vertebral centrums without either the posterior elements or associated soft tissue. The specimens were subjected to a constant compressive load for eight hours followed by a sixteen hour relaxation time. During all the load cycles, displacement of the specimens was measured with an LVDT. After the first compressive test, the specimens were herniated and then the compressive test repeated. In the second phase of the work, a viscoelastic axisymmetric finite element model was used to quantify the experimental data. A three parameter Kelvin solid was employed in the finite element model. The results of this paper will be used to construct a dynamic model for the vertebral column. PMID:6643516

Furlong, D R; Palazotto, A N

1983-01-01

114

Matrix metalloprotease-9 activity in the cerebrospinal fluid and spinal injury severity in dogs with intervertebral disc herniation.  

PubMed

We investigated whether matrix metalloproteinase (MMP)-9 expression in the cerebrospinal fluid (CSF) of dogs with intervertebral disc herniation (IVDH) is associated with the severity of neurological signs and prognosis. CSF from the cisterna magna (C-CSF) and the lumbar spine (L-CSF) of 34 dogs with IVDH was analyzed using zymography. Activity of MMP-9 in L-CSF was detected in 6 of 34 dogs with IVDH, often for more than 7 days after injury. MMP-9 activity was not detected from any of the C-CSF samples. Of the six cases that were MMP-9 positive, all four cases with grade V that had loss of deep pain were non-ambulatory 6 months after treatment. The remaining two cases with grade III and IV could recover mobility. In dogs with grade V thoracolumbar IVDH, MMP-9 expression in the CSF may indicate severe spinal cord injury with poor prognosis. PMID:20965533

Nagano, S; Kim, S H; Tokunaga, S; Arai, K; Fujiki, M; Misumi, K

2011-12-01

115

Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review of the Literature  

PubMed Central

The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.

Son, Eun-Seok; Park, So-Young; Kim, Ki-Tack; Kang, Chul-Hyung; Cho, Seong-Woo

2012-01-01

116

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

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.

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

2013-01-01

117

A functional polymorphism in THBS2 that affects alternative splicing and MMP binding is associated with lumbar-disc herniation.  

PubMed

Lumbar-disc herniation (LDH), one of the most common musculoskeletal diseases, has strong genetic determinants. Recently, several genes that encode extracellular matrix (ECM) proteins in the intervertebral disc have been reported to associate with LDH. Thrombospondins (THBSs) 1 and 2 are good candidates for the LDH susceptibility gene: They are intervertebral disc ECM proteins that regulate the effective levels of matrix metalloproteinases (MMPs) 2 and 9, which are key effectors of ECM remodeling. Here, we report that THBS2 is associated with LDH in Japanese populations. An intronic SNP in THBS2 (IVS10-8C --> T; rs9406328) showed significant association (p = 0.0000028) with LDH in two independent Japanese populations. This SNP, located in a polypyrimidine tract upstream of the 3' splice site of intron 10, exerts allelic differences on exon 11 skipping rates in vivo, with the susceptibility allele showing increased skipping. Skipping of exon 11 results in decreased THBS2 interaction with MMP2 and MMP9. Further, a missense SNP in MMP9 (Q279R; rs17576) is also strongly associated with LDH in the Japanese population (p = 0.00049) and shows a combinatorial effect with THBS2 (odds ratio 3.03, 95% confidence interval 1.58-5.77). Thus, a splicing-affecting SNP in THBS2 and a missense SNP in MMP9 are associated with susceptibility to LDH. Our data indicate that regulation of intervertebral disc ECM metabolism by the THBS2-MMP system plays an essential role in the etiology and pathogenesis of LDH. PMID:18455130

Hirose, Yuichiro; Chiba, Kazuhiro; Karasugi, Tatsuki; Nakajima, Masahiro; Kawaguchi, Yoshiharu; Mikami, Yasuo; Furuichi, Tatsuya; Mio, Futoshi; Miyake, Atsushi; Miyamoto, Takeshi; Ozaki, Kouichi; Takahashi, Atsushi; Mizuta, Hiroshi; Kubo, Toshikazu; Kimura, Tomoatsu; Tanaka, Toshihiro; Toyama, Yoshiaki; Ikegawa, Shiro

2008-05-01

118

Fragmentectomy versus Conventional Microdiscectomy in Single-Level Lumbar Disc Herniations : Comparison of Clinical Results and Recurrence Rates  

PubMed Central

Objective This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). Methods Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. Results Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. Conclusion If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.

Kim, Yeon-Seong; Lee, Min-Cheol; Song, Jae-Wook; Kim, Sang-Kyu; Kim, In-Hwan

2012-01-01

119

A 6.5-year follow-up of 14 patients who underwent ProDisc total disc arthroplasty for combined long-standing degenerative lumbar disc disease and recent disc herniation.  

PubMed

A highly selected cohort of nine women and five men (mean age±standard error of the mean, 39.6±10.2 years) with discogenic low-back pain (duration: 75.4±97.5 months) and radiculopathy due to disc herniation (duration: 9.4±11.8 months) underwent anterior microdiscectomy and ProDisc-L II arthroplasty (Synthes, Oberdorf, Switzerland) (L5/S1 in 13 patients, L4/5 in one). As reported earlier, initial results were excellent in 11 and good in three patients at 17.8±4.7 months. At an average of 6.5 years after surgery, all were reassessed using the SWISSDISC-questionnaire, which involves the EuroQol-5D and North American Spine Society evaluations (general health, low-back and lower limb status), and a telephone call. Patients reporting an unsatisfactory outcome were re-examined clinically and radiologically. Results were excellent for 10, good for two, satisfactory for one, and poor for one patient. Visual analog scores for back and leg pain at 6.5 years had improved significantly relative to preoperative values (p<0.01), and were only slightly higher than at 1.48 years (p=0.3). This study confirms the initial favorable results. PMID:22099076

Markwalder, Thomas-Marc; Wenger, Markus; Marbacher, Serge

2011-12-01

120

Changes in the total Oswestry Index and its ten items in females and males pre- and post-surgery for lumbar disc herniation: a 1-year follow-up  

Microsoft Academic Search

To study the characteristics and changes in the total Oswestry Disability Index (ODI) and in its ten component items in female\\u000a and male patients pre- and post-surgery for lumbar disc herniation. Ninety-eight patients [mean (SD) age 43 (13), 61% males]\\u000a undergoing lumbar disc herniation surgery were selected for this clinical 12-month follow-up. Subjective disability and back\\u000a and leg pain were

Arja Häkkinen; Hannu Kautiainen; Salme Järvenpää; Marja Arkela-Kautiainen; Jari Ylinen

2007-01-01

121

The influence of torsion on disc herniation when combined with flexion  

PubMed Central

The role of torsion in the mechanical derangement of intervertebral discs remains largely undefined. The current study sought to investigate if torsion, when applied in combination with flexion, affects the internal failure mechanics of the disc wall when exposed to high nuclear pressure. Thirty ovine lumbar motion segments were each positioned in 2° axial rotation plus 7° flexion. Whilst maintained in this posture, the nucleus of each segment was gradually injected with a viscous radio-opaque gel, via an injection screw placed longitudinally within the inferior vertebra, until failure occurred. Segments were then inspected using micro-CT and optical microscopy in tandem. Five motion segments failed to pressurize correctly. Of the remaining 25 successfully tested motion segments, 17 suffered vertebral endplate rupture and 8 suffered disc failure. Disc failure occurred in mature motion segments significantly more often than immature segments. The most common mode of disc failure was a central posterior radial tear involving a systematic annulus–endplate–annulus failure pattern. The endplate portion of these radial tears often propagated contralateral to the direction of applied axial rotation, and, at the lateral margin, only those fibres inclined in the direction of the applied torque were affected. Apart from the 2° of applied axial rotation, the methods employed in this study replicated those used in a previously published study. Consequently, the different outcome obtained in this study can be directly attributed to the applied axial rotation. These inter-study differences show that when combined with flexion, torsion markedly reduces the nuclear pressure required to form clinically relevant radial tears that involve cartilaginous endplate failure. Conversely, torsion appears to increase the disc wall’s resistance to radial tears that do not involve cartilaginous endplate failure, effectively halving the disc wall’s overall risk of rupture.

Robertson, Peter A.; Broom, Neil D.

2010-01-01

122

Correlation of serum trace elements and melatonin levels to radiological, biochemical, and histological assessment of degeneration in patients with intervertebral disc herniation  

Microsoft Academic Search

The aim of our study was to assess the blood concentrations of some trace elements and melatonin (MLT) in patients with intervertebral\\u000a disc herniation (IDH) and to investigate the interaction of histological and biochemical degeneration findings with aging.\\u000a The present study was carried out on 13 subjects (8 women and 5 men) diagnosed with IDH. They were divided into three

Mehmet Turgut; Çi?dem Yenisey; Orhan Akyüz; Yelda Öszunar; Muhan Erku?; Tuncay Biçakçi

2006-01-01

123

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

PubMed Central

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.

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

2012-01-01

124

A minimally invasive treatment for lumbar disc herniation: DiscoGel® chemonucleolysis in patients unresponsive to chemonucleolysis with oxygen-ozone.  

PubMed

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. O?-O? chemonucleolysis (O?-O? 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 alcohol 8,9. The present study aimed to assess the therapeutic outcome of DiscoGel® chemonucleolysis in patients with lumbar disc herniation unresponsive to O?-O? 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 O?-O? 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

Stagni, S; de Santis, F; Cirillo, L; Dall'olio, M; Princiotta, C; Simonetti, L; Stafa, A; Leonardi, M

2012-03-01

125

Radiculopathy due to microfibrillar collagen hemostat mimicking recurrence of disc herniation  

Microsoft Academic Search

Microfibrillar collagen hemostat (Avitene) is an absorbable topical hemostatic agent prepared from purified bovine corium collagen. A 65-year-old woman presented with left buttock and lower extremity radicular pain. The patient underwent a disc excision in which Avitene was used to control venous bleeding from the epidural space. Leg pain decreased postoperatively, but she developed radicular pain when she started walking

M. Doita; K. Nishida; M. Kurosaka

2006-01-01

126

Posterior lumbar interbody fusion with stand-alone Trabecular Metal cages for repeatedly recurrent lumbar disc herniation and back pain.  

PubMed

Object Patients with recurrent sciatica due to repeated reherniation of the intervertebral disc carry a poor prognosis for recovery and create a large burden on society. There is no consensus about the best treatment for this patient group. The goal of this study was to evaluate the 12-month results of the placement of stand-alone Trabecular Metal cages in these patients. Methods The authors performed a retrospective analysis of 26 patients with recurrent disc herniations treated with stand-alone posterior lumbar interbody fusion (PLIF) with Trabecular Metal cages. At 1 year patients were evaluated using the Roland Morris Disability Questionnaire (RMDQ) and a visual analog scale (VAS) for back and leg pain. Furthermore, Likert scores of perceived recovery and satisfaction with the treatment were recorded. Lumbar spine radiographs after 1 year were compared with postoperative radiographs to measure subsidence. Stability of the operated segment was assessed using dynamic radiography. Results The patient group consisted of 26 patients (62% male) with a mean age of 45.7 ± 11.4 years (± SD). Patients had a history of 1 (31%), 2 (42%), or more (27%) discectomies at the same level. The mean follow-up period was 15.3 ± 7.3 months. At follow-up the mean VAS score for pain in the affected leg was 36.7 ± 27.9. The mean VAS score for back pain was 42.5 ± 30.2. The mean RMDQ score at follow-up was 9.8 ± 6.2. Twelve (46%) of the 26 patients had a global perceived good recovery. With respect to treatment satisfaction, 18 patients (69%) were content or very content with the operation and would recommend it. Disc height was increased immediately postoperatively, and at the 1-year follow-up it was still significantly higher compared with the preoperative height (mean 41% ± 38.7%, range -25.7 to 126.8, paired t-test, both p < 0.001), although a mean of 7.52% ± 11.6% subsidence occurred (median 2.0% [interquartile range 0.0%-10.9%], p < 0.003). No significant correlation between subsidence and postoperative back pain was found (Spearman's rho -0.2, p = 0.459). Flexion-extension radiographs showed instability in 1 patient. Conclusions Although only 46% of patients reported a good recovery with significant reductions in back and leg pain, 85% of patients reported at least some benefit from the operation, and a marked improvement in working status at follow-up was noted. In view of previously published poor results of instrumented lumbar fusion for patients with failed back surgery syndrome, the present data indicate that Trabecular Metal interbody fusion cages can be used in a stand-alone fashion and should not always need supplemental posterior fixation in patients with recurrent disc herniation without spinal instability, although a long-term follow-up study is warranted. PMID:24678638

Lequin, Michiel B; Verbaan, Dagmar; Bouma, Gerrit J

2014-06-01

127

Motor evoked potential study suggesting L5 radiculopathy caused by l1-2 disc herniation: case report.  

PubMed

A 38-year-old male was referred because of pain in the left 5th lumbar (L5) root territory. Physical examination found moderate motor weakness in the left extensor hallucis longus (EHL) and the left tibialis anterior muscles. Magnetic resonance imaging found no stenotic lesion between L4-L5, but disc herniation was observed on the left between L1-L2. An L5 nerve root block provided temporary relief of the pain but the left foot weakness was exacerbated. Therefore, surgery was performed. Partial laminectomy and left herniotomy were performed at L1-L2, L2-L3, and L3-L4 with motor evoked potential (MEP) monitoring. The MEP amplitude of the left EHL muscle increased immediately after L1-L2 herniotomy. The MEP amplitude of the right EHL muscle also increased after both laminectomy and herniotomy. The postoperative course was uneventful. The left leg pain and motor weakness disappeared. The patient has been doing fine without recurrence for 12 months. Since the MEP of both left and right EHL muscles improved after the L1-2 herniotomy, circulatory insufficiency might have caused the L5 symptoms. Monitoring of the MEP during the surgery was useful for confirming the responsible lesion and also for predicting the postoperative course. PMID:21441749

Yasuda, Muneyoshi; Nakura, Takahiro; Kamiya, Taeko; Takayasu, Masakazu

2011-01-01

128

Lumbar Periradicular Abscess Mimicking a Fragmented Lumbar Disc Herniation : An Unusual Case  

PubMed Central

We herein describe the case of a focal spontaneous spinal epidural abscess who was initially diagnosed to have a free fragment of a lumbar disc. A 71-year-old woman presented with history of low back and right leg pain. Magnetic resonance imaging suggested a peripherally enhancing free fragment extending down from S1 nerve root axilla. Preoperative laboratory investigation showed elevation of c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels. She was taken for surgery and a fluctuating mass at the axilla of S1 nerve was found. When the mass was probed with a dissector, a dark yellow, thick pus drained out. Pus cultures were negative. Patients who present with extreme low back plus leg pain and increased leucocyte count, ESR and CRP levels should raise the suspicion of an infection of a vertebral body or spinal epidural space.

Tekkok, Ismail Hakki

2008-01-01

129

Cerebrospinal fluid tau protein as a biomarker for severity of spinal cord injury in dogs with intervertebral disc herniation.  

PubMed

Intervertebral disc herniation (IVDH) is a common cause of spinal cord injury (SCI) in dogs. Microtubule-associated protein tau derives predominantly from neurons and axons, making it a potential marker of neuronal injury. A retrospective study, including 51 dogs with thoracolumbar or cervical IVDH and 12 clinically normal dogs, was designed to describe associations between cerebrospinal fluid (CSF) tau concentration, degree of neurological signs and motor functional recovery in dogs with IVDH. Signalment, degree of neurological dysfunction and outcome were recorded. Cisternal CSF tau values were determined by ELISA. Associations between CSF tau concentration and various clinical parameters were evaluated. Receiver-operating characteristics curve (ROC) analyses were performed to assess the validity of protein tau measurements. CSF tau concentrations were significantly higher in dogs showing plegia (median, 79.9 pg/mL; range, 0-778.7 pg/mL; P=0.016) compared to healthy dogs and dogs with paresis (median, 30.1 pg/mL; range, 0-193.1 pg/mL; P=0.025). Plegic dogs that improved by one neurological grade within 1 week had significantly lower tau protein levels compared to plegic dogs that needed more time for recovery or did not show an improvement (P=0.008). A CSF tau concentration >41.3 pg/mL had a sensitivity of 86% and specificity of 83% to predict an unsuccessful outcome in plegic dogs based on ROC analysis (area under the curve, 0.887; P=0.007, 95% confidence interval [CI] 0.717-1.057). CSF protein tau levels are positively associated with the severity of spinal cord damage and may serve as a prognostic indicator in dogs with IVDH. PMID:23499240

Roerig, A; Carlson, R; Tipold, A; Stein, V M

2013-08-01

130

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

PubMed Central

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: ?16.7–4.9] and physical function [5.0; 95% CI: ?4.9–15]). 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.

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

2010-01-01

131

A Functional Polymorphism in COL11A1, Which Encodes the ?1 Chain of Type XI Collagen, Is Associated with Susceptibility to Lumbar Disc Herniation  

PubMed Central

Lumbar disc herniation (LDH), degeneration and herniation of the nucleus pulposus of the intervertebral disc (IVD) of the lumbar spine, is one of the most common musculoskeletal diseases. Its etiology and pathogenesis, however, remain unclear. Type XI collagen is important for cartilage collagen formation and for organization of the extracellular matrix. We identified an association between one of the type XI collagen genes, COL11A1, and LDH in Japanese populations. COL11A1, which encodes the ?1 chain of type XI collagen, was highly expressed in IVD, but its expression was decreased in the IVD of patients with LDH. The expression level was inversely correlated with the severity of disc degeneration. A single-nucleotide polymorphism (c.4603C?T [rs1676486]) had the most significant association with LDH (P=3.3×10-6), and the transcript containing the disease-associated allele was decreased because of its decreased stability. These observations indicate that type XI collagen is critical for IVD metabolism and that its decrease is related to LDH.

Mio, Futoshi; Chiba, Kazuhiro; Hirose, Yuichiro; Kawaguchi, Yoshiharu; Mikami, Yasuo; Oya, Takeshi; Mori, Masaki; Kamata, Michihiro; Matsumoto, Morio; Ozaki, Kouichi; Tanaka, Toshihiro; Takahashi, Atsushi; Kubo, Toshikazu; Kimura, Tomoatsu; Toyama, Yoshiaki; Ikegawa, Shiro

2007-01-01

132

Morphology and TGF-beta1 Concentration Analysis of Ligamentum Flavum in Patients with Lumbar Canal Stenosis and Lumbar Disc Herniation.  

PubMed

The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain and paresis. The aetiology of degenerative changes occurring in lumbar stenosis remain unclear: some authors hypothesize hyperplasia and others hypertrophy of the LF. The change in LF is known to be related to degenerative changes secondary to the aging process or mechanical instability. This study aimed to analyse the ligamentum flavum (LF) of patients with lumbar canal stenosis and lumbar disc herniation to evaluate the morphology and concentration of the Transforming Growth Factor-beta 1 (TGF-beta 1). The study was undertaken in three phases: A) Measurement of the thickness of the ligamentum flavum in patients with lumbar stenosis and/or herniated lumbar disc through axial T1 weighted lumbo-sacral MR images; B) Removal of ligamentum flavum in patients undergoing intervention for lumbar stenosis and lumbar disc herniation (control group); C) Optical microscopy study of the morphology of degenerated ligamentum and immunohistochemical analysis to assess the concentration of TGF-beta 1 in the LF. Morphological analysis of the LF (i.e. the increase in the number of fibres or distension and relaxation of the same as a result of degenerative processes) and the presence or absence of a high concentration of TGF-beta1 (then more fibroblasts involved in the degenerative process) can be important to establish whether there is hypertrophy or hyperplasia of the LF in lumbar canal stenosis. The current study showed that decreased elasticity of the LF in the elderly is due to a loss of elastic fibres that are degenerated and a concomitant increase in collagenous fibres (hypertrophy). TGF-beta1 concentrations of the LF were higher in lumbar spinal stenosis than in disc herniations. This suggest that LF of lumbar canal stenosis is hypertrophic: LF hypertrophy could be due to thickening of the normal elastic layer and the abnormal collagenous layer and to higher expression of TGF-beta 1 by fibroblasts. PMID:24148597

Rispoli, R; Mastrostefano, R; Brunelli, F

2010-06-01

133

The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study  

PubMed Central

Background Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation. Methods/Design Patients (age 18-65 years) presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years. Discussion Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial. Trial Registration Netherlands Trial Register NTR1289

2010-01-01

134

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

PubMed Central

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.

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

2014-01-01

135

Omental Herniation: A Rare Complication of Vacuum-Assisted Closure of Infected Sternotomy Wound  

PubMed Central

Vacuum-assisted closure (VAC) has recently been adopted as an acceptable modality for management of sternotomy wound infections. Although generally efficacious, the use of negative pressure devices has been associated with complications such as bleeding, retention of sponge, and empyema. We report the first case of greater omental hernia as a rare complication of vacuum-assisted closure of sternal wound infection following coronary artery bypass grafting.

Gukop, Philemon; Kuppuswamy, Madhan Kumar; Kourliouros, Antonios; Chandrasekaran, Venkatachalam

2012-01-01

136

The DQB1 *03:02 HLA haplotype is associated with increased risk of chronic pain after inguinal hernia surgery and lumbar disc herniation.  

PubMed

Neuropathic pain conditions are common after nerve injuries and are suggested to be regulated in part by genetic factors. We have previously demonstrated a strong genetic influence of the rat major histocompatibility complex on development of neuropathic pain behavior after peripheral nerve injury. In order to study if the corresponding human leukocyte antigen complex (HLA) also influences susceptibility to pain, we performed an association study in patients that had undergone surgery for inguinal hernia (n=189). One group had developed a chronic pain state following the surgical procedure, while the control group had undergone the same type of operation, without any persistent pain. HLA DRB1genotyping revealed a significantly increased proportion of patients in the pain group carrying DRB1*04 compared to patients in the pain-free group. Additional typing of the DQB1 gene further strengthened the association; carriers of the DQB1*03:02 allele together with DRB1*04 displayed an increased risk of postsurgery pain with an odds risk of 3.16 (1.61-6.22) compared to noncarriers. This finding was subsequently replicated in the clinical material of patients with lumbar disc herniation (n=258), where carriers of the DQB1*03:02 allele displayed a slower recovery and increased pain. In conclusion, we here for the first time demonstrate that there is an HLA-dependent risk of developing pain after surgery or lumbar disc herniation; mediated by the DRB1*04 - DQB1*03:02 haplotype. Further experimental and clinical studies are needed to fine-map the HLA effect and to address underlying mechanisms. PMID:23318129

Dominguez, Cecilia A; Kalliomäki, Maija; Gunnarsson, Ulf; Moen, Aurora; Sandblom, Gabriel; Kockum, Ingrid; Lavant, Ewa; Olsson, Tomas; Nyberg, Fred; Rygh, Lars Jørgen; Røe, Cecilie; Gjerstad, Johannes; Gordh, Torsten; Piehl, Fredrik

2013-03-01

137

Conferenza di Consenso. Ossigeno-Ozono Terapia Nel Trattamento Delle Lombosciatalgie da Ernia Discale Con Tecnica Iniettiva Intramuscolare Paravertebrale Istituto Superiore di Sanita Roma 20 Novembre 2006 (Consensus Conference. Lumbar Paravertebral Intramuscular Injection of Oxygen-Ozone in Radicular Pain Caused by Herniated Lumbar Disc. Istituto Superioe di Sanita. Rome, November 20, 2006).  

National Technical Information Service (NTIS)

The present paper is the final document of a Consensus Conference (CC) about Lumbar paravertebral intramuscular injection of oxygen-ozone in radicular pain caused by herniated lumbar disc. In Italy, about 1200 practioners perform this kind of intervention...

A. Napoletano D. Barbina D. Coclite D. Guerrera R. Guerra

2008-01-01

138

Psychosocial stress factors among patients with lumbar disc herniation, scheduled for disc surgery in comparison with patients scheduled for arthroscopic knee surgery  

Microsoft Academic Search

Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified\\u000a morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery\\u000a are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of\\u000a work-related stress, life

Ann-Christin Johansson; Michael Cornefjord; Leif Bergkvist; John Öhrvik; Steven J. Linton

2007-01-01

139

Risk factors of recurrent lumbar disk herniation  

PubMed Central

Background: Recurrent lumbar disc herniation (LDH) is a common cause of poor outcomes after lumbar discectomy surgery. Studies focused on risk factors of true recurrent disk herniation at the same level and side, are few. The aim of current study is to evaluate risk factors of recurrent disc herniation in Iranian population. Materials and Methods: We retrospectively reviewed 40 patients with recurrent disc herniation and 120 patients without recurrence to evaluate possible risk factors for herniation recurrence. A clinically significant recurrent herniation was defined as a disc herniation causing leg pain with radiographic (MRI) evidence of disc material at the same side and level of the index surgery causing impingement, compression, or deviation of nerve tissue. A series of patients without recurrence was used for comparison to identify possible risk factors for recurrent LDH. Results: There was significant difference between groups with and without LDH in sex (P = 0.003), smoking habit (P = 0.004), height (P = 0.04), weight (P = 0.006) and occupational characteristic (P < 0.001). By putting these differences in logistic regression analysis, it showed that gender (male), taller height, heavy works and being smoker could predict lumbar disc herniation recurrence. Conclusion: Considering sex, smoking and heavy works as predictors of recurrent LDH, surgeons should advice their patients to limit hard work and put away smoking especially in tall and male ones to prevent LDH recurrence.

Shimia, Mohammad; Babaei-Ghazani, Arash; Sadat, Bina Eftekhar; Habibi, Behnaz; Habibzadeh, Afshin

2013-01-01

140

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

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.

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

2009-01-01

141

Modification of rat model of sciatica induced by lumber disc herniation and the anti-inflammatory effect of osthole given by epidural catheterization.  

PubMed

One of the most treatable causes of lower back pain and associated sciatica is lumbar disc herniation (LDH), which is characterized by rupture of the hard outer wall (annulus fibrosis) in a lumbar intervertebral disc. In the current study, we aimed to: (1) develop and characterize a rat model of sciatica induced by LDH, while introducing a novel method of epidural catheterization; (2) use this model to evaluate the effect of osthole on pain due to LDH, and (3) gain insight into the mechanisms through which osthole affects sciatica induced by LDH. The results indicate that our newly developed rat model maintained mechanical allodynia for 28 days without reduction. Moreover, cyclooxygenase-2 (COX-2) and nitric oxide synthase (NOS) were overexpressed in the associated inflammatory response, which is consistent with clinical manifestations of the disease. We then used this model to study the effect and mechanisms through which osthole affected pain due to LDH. Our study suggests that osthole is capable of reversing hyperalgesia due to LDH, potentially through modulation of activity of COX-2 and NOS, two important proteins for the exacerbation of pain due to LDH. Finally, a molecular modeling simulation showed that osthole has unique binding capabilities to both NOS and COX-2. As the model-induced mechanical hyperalgesia response was consistent, and the position of the catheter tip and the extension/spreading of the drug in the epidural space were reliable, this study developed an improved model to study remedies for sciatic pain. Moreover, our studies demonstrate that osthole may be a feasible treatment for the reduction of pain due to hyperalgesia. PMID:23018204

Wei, Ming; Mo, Sui-Lin; Nabar, Neel R; Chen, Yuling; Zhang, Jin-Jun; He, Qiu-Lan; Zou, Xue-Nong; Liu, Xian-Guo; Sun, Lai-Bao; Zhou, Shu-Feng

2012-01-01

142

Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series  

PubMed Central

Background The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery. Methods We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers’ compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery. Results We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers’ compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI. Conclusion Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH.

Manson, Neil A.; McKeon, Melissa D.; Abraham, Edward P.

2013-01-01

143

Akt\\/PKB isoforms expression in the human lumbar herniated disc: correlation with clinical and MRI findings  

Microsoft Academic Search

Intervertebral disc (IVD) degeneration suggests a complex process influenced by genetics, lifestyle and biomechanics, which\\u000a accounts for the development of low back pain (LBP) and lumbar radiculopathy, a major cause of musculoskeletal disability\\u000a in humans. The family of Akt\\/PKB kinases is a principal mediator in the signal transduction pathways, which contribute to\\u000a transcriptional regulation, cell growth, proliferation, apoptosis, and survival

Dritan Pasku; Giannoula Soufla; Pavlos Katonis; Alexandros Tsarouhas; Antonis Vakis; Demetrios A. Spandidos

144

Foraminoplastic transfacet epidural endoscopic approach for removal of intraforaminal disc herniation at the L5-S1 level  

PubMed Central

Transforaminal endoscopic disc removal in the L5-S1 motion segment of the lumbar spine creates a technical challenge due to anatomical reasons and individual variability. The majority of surgeons prefer a posterior classical or minimally invasive approach. There is only one foraminoplastic modification of the technique in the literature so far. In this paper we present a new technique with a foraminoplastic transfacet approach that may be suitable in older patients with advanced degenerative disease of the spine.

Kaczmarczyk, Jacek; Nowakowski, Andrzej; Sulewski, Adam

2014-01-01

145

Foraminoplastic transfacet epidural endoscopic approach for removal of intraforaminal disc herniation at the L5-S1 level.  

PubMed

Transforaminal endoscopic disc removal in the L5-S1 motion segment of the lumbar spine creates a technical challenge due to anatomical reasons and individual variability. The majority of surgeons prefer a posterior classical or minimally invasive approach. There is only one foraminoplastic modification of the technique in the literature so far. In this paper we present a new technique with a foraminoplastic transfacet approach that may be suitable in older patients with advanced degenerative disease of the spine. PMID:24729817

Kubaszewski, Lukasz; Kaczmarczyk, Jacek; Nowakowski, Andrzej; Sulewski, Adam

2014-03-01

146

Physical fitness as a predictor of herniated lumbar disc disease - a 33-year follow-up in the Copenhagen male study  

PubMed Central

Background The role of physical fitness (VO2Max (mlO2*min-1*kg-1)) as a risk factor for herniated lumbar disc disease (HLDD) is unknown. The objective of this study was to examine the association between aerobic (physical) fitness and risk of hospitalisation due to HLDD in a long-term follow up. Methods The Copenhagen Male Study is a prospective cohort study established in 1970–71. At baseline, 5,249 men answered a questionnaire about their history of back disease, physical and psychosocial working conditions, lifestyle and social class. Height and weight was measured and aerobic capacity (physical fitness) was estimated based on a submaximal bicycle test. Information about hospitalization due to HLDD was obtained from the National Hospital Register covering the period 1977 – 2003. Hazard Ratios (HR) were calculated by Cox’s proportional hazard regression model. Results Among 3,833 men without history of low back disorders, 64 were hospitalized due to HLDD. The cumulative incidence of HLDD was 1.7% (n=34) among men with low physical fitness (15–32 ml O2*min-1*kg-1), and 1.7% (n=30) among men with high physical fitness (33–78 ml O2*min-1*kg-1). In a final model, adjusted for relevant confounders, the HR (95% CI) for HLDD for those with high physical fitness was 0.88 (0.51-1.50) compared to those with low physical fitness. In the same model, HR for men often exposed to strenuous work compared to those seldom or never exposed to strenuous work was 3.91(1.82-8.38). Also body height was a significant predictor. Conclusions Physical fitness is not associated with hospitalisation due to HLDD, and the only modifiable risk factor for hospitalisation due to HLDD seems to be strenuousness at work.

2013-01-01

147

Childhood intervertebral disc calcification  

Microsoft Academic Search

Two cases of intervertebral disc calcification in children are reported. A 13-year-old boy presented with right subscapular pain radiating into the axilla with radiographic demonstration of multiple calcified intervertebral discs and a herniated fragment of calcified nucleus pulposus at T2–3. His condition improved with conservative therapy, and follow-up radiographic evaluation revealed resolution of the herniated calcified disc material. A second

B. Theo Mellion; John P. Laurent; William C. Watters

1993-01-01

148

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

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 and 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

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

2014-01-01

149

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

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.

Misterska, Ewa; Jankowski, Roman; Glowacki, Maciej

2014-01-01

150

Toward a clinical lumbar CAD: herniation diagnosis  

Microsoft Academic Search

Purpose  A CAD system for lumbar disc degeneration and herniation based on clinical MR images can aid diagnostic decision-making provided\\u000a the method is robust, efficient, and accurate.\\u000a \\u000a \\u000a \\u000a \\u000a Material and methods  A Bayesian-based classifier with a Gibbs distribution was designed and implemented for diagnosing lumbar disc herniation.\\u000a Each disc is segmented with a gradient vector flow active contour model (GVF-snake) to extract shape

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

2011-01-01

151

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

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 1 year. 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.

2014-01-01

152

Spontaneous transdural spinal cord herniation.  

PubMed

A 42-year-old man with a history of benign incidental dorsal trauma 5 years earlier presented with progressive weakness of the right leg for 2 years. Clinical examination revealed decreased left-sided pain, temperature, and light touch sensation below the level of T2, right leg weakness, normal proprioception, and increased deep tendon reflexes in the right leg, in absence of bladder dysfunction. Spinal MRI showed herniation of the ventral spinal cord to the left at level T1 (figure). A diagnosis of transdural spinal cord herniation (TSCH) was made. TSCH is a rare cause of progressive myelopathy. TSCH is reported after spinal trauma or herniated disc surgery.(1) Spontaneous cases are also described.(2) Patients usually present with a Brown-Séquard-like syndrome or progressive paraparesis. PMID:24711533

Castelnovo, Giovanni; Hladky, Jean Pierre; Renard, Dimitri

2014-04-01

153

Changes in the total Oswestry Index and its ten items in females and males pre- and post-surgery for lumbar disc herniation: a 1-year follow-up.  

PubMed

To study the characteristics and changes in the total Oswestry Disability Index (ODI) and in its ten component items in female and male patients pre- and post-surgery for lumbar disc herniation. Ninety-eight patients [mean (SD) age 43 (13), 61% males] undergoing lumbar disc herniation surgery were selected for this clinical 12-month follow-up. Subjective disability and back and leg pain were assessed by ODI version 1.0 and the visual analog scale. Pre-operatively females had a significantly higher mean (SD) total ODI [59(3)] than males [51(2)] (P = 0.030). Females were more disabled in the walking, sex life, social life and travelling items of the ODI compared to males. The total Oswestry decreased by 38 (95% CI - 44 to - 31) in females and by 34 (- 39 to - 30) in males at the 1-year follow-up. Most of the improvement (88% in females and 80% in males) occurred during the first 6 weeks; thereafter the changes were minor. In males the changes were greatest in pain, social life and travelling and in females in walking, social life and travelling. Internal consistency value of ODI was 0.88 (95% CI 0.82-0.91). Item analysis of the ODI showed that all the items except pain had high corrected item correlation. As recovery following lumbar disc surgery occurred to a great extent during the first 6 weeks, the early post-operative outcome appears to be quite a reliable indicator of the overall post-operative outcome over the 1-year follow-up. The ODI proved to capture a wide range of disability in these lumbar disc surgery patients, thereby supporting the future use of the index. The "pain intensity" component, which collects data on the use of painkillers in version 1.0 of the ODI did not support the item structure of the index in this study. The use of ODI version 2.0 might remove this problem. PMID:16912888

Häkkinen, Arja; Kautiainen, Hannu; Järvenpää, Salme; Arkela-Kautiainen, Marja; Ylinen, Jari

2007-03-01

154

Cervical arthroplasty using ProDisc-C Case Report  

PubMed Central

Cervical disc replacement is an emerging motion-preserving technology in the surgical treatment of the cervical degenerative disc disorders used as an alternative to the classic interbody fusion. We present a case report of a patient diagnosed with C6-7 right disc herniation who underwent anterior discectomy and received a total disc replacement using ProDisc C artificial disc prosthesis.

Nica, DA; Copaciu, R

2013-01-01

155

Lumbar disc syndrome in Finland  

Microsoft Academic Search

The prevalence of lumbar disc syndrome (herniated disc or typical sciatica) and its consequences in terms of disability, handicap, and need for medical care were studied as part of the Mini-Finland Health Survey. A sample of 8000 persons representative of the Finnish population aged 30 or over was asked to come for examination, and 7217 (90%) participated. A diagnosis of

M Heliövaara; O Impivaara; K Sievers; T Melkas; P Knekt; J Korpi; A Aromaa

1987-01-01

156

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

PubMed Central

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.

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

2013-01-01

157

Acute postoperative cardiac herniation.  

PubMed

Acute herniation of the heart is an uncommon complication in patients undergoing pneumonectomy with associated pericardial resection. We report the case of a postoperative cardiac herniation after a right extrapleural pneumonectomy following neoadjuvant chemotherapy for malignant pleural mesothelioma. After surgery the patient was completely asymptomatic, but a postoperative chest X-ray revealed unexpected massive dextrocardia. The patient was immediately brought back to the operating room: a cardiac herniation was found to be caused by a partial dehiscence of the pericardial prosthesis suture. The defect was repaired without consequences. PMID:20940166

Kawamukai, Kenji; Antonacci, Filippo; Di Saverio, Salomone; Boaron, Maurizio

2011-01-01

158

Cervical arthroplasty using ProDisc-C case report.  

PubMed

Cervical disc replacement is an emerging motion-preserving technology in the surgical treatment of the cervical degenerative disc disorders used as an alternative to the classic interbody fusion. We present a case report of a patient diagnosed with C6-7 right disc herniation who underwent anterior discectomy and received a total disc replacement using ProDisc C artificial disc prosthesis. PMID:23599830

Nica, D A; Copaciu, R

2013-03-15

159

Intervertebral disc degeneration in dogs  

Microsoft Academic Search

Back pain is common in both dogs and humans, and is often associated with intervertebral disc (IVD) degeneration. The IVDs are essential structures of the spine and degeneration can ultimately result in diseases such as IVD herniation or spinal instability. In order to design new treatments halting or even preventing IVD degeneration, more basic knowledge of the disease process is

N. Bergknut

2011-01-01

160

Spontaneous Regression of a Large Lumbar Disc Extrusion  

PubMed Central

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.

Ryu, Sung-Joo

2010-01-01

161

Lumbar disc nucleoplasty using coblation technology: clinical outcome  

Microsoft Academic Search

Background and purposeAlthough the standard treatment for lumbar disc herniation is lumbar microdiscectomy, nucleoplasty offers a new technique with encouraging results in well selected cases. Nucleoplasty is a minimally invasive technique that manages intradiscal herniation through energy based removal of part of the nucleus pulposus. The purpose of this study was to assess the safety and clinical outcome of the

Alaa Azzazi; Sherif AlMekawi; Mostafa Zein

2010-01-01

162

Magnetic Resonance Imaging Interpretation in Patients with Sciatica Who Are Potential Candidates for Lumbar Disc Surgery  

PubMed Central

Background Magnetic Resonance Imaging (MRI) is considered the mainstay imaging investigation in patients suspected of lumbar disc herniations. Both imaging and clinical findings determine the final decision of surgery. The objective of this study was to assess MRI observer variation in patients with sciatica who are potential candidates for lumbar disc surgery. Methods Patients for this study were potential candidates (n?=?395) for lumbar disc surgery who underwent MRI to assess eligibility for a randomized trial. Two neuroradiologists and one neurosurgeon independently evaluated all MRIs. A four point scale was used for both probability of disc herniation and root compression, ranging from definitely present to definitely absent. Multiple characteristics of the degenerated disc herniation were scored. For inter-agreement analysis absolute agreements and kappa coefficients were used. Kappa coefficients were categorized as poor (<0.00), slight (0.00–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80) and excellent (0.81–1.00) agreement. Results Excellent agreement was found on the affected disc level (kappa range 0.81–0.86) and the nerve root that most likely caused the sciatic symptoms (kappa range 0.86–0.89). Interobserver agreement was moderate to substantial for the probability of disc herniation (kappa range 0.57–0.77) and the probability of nerve root compression (kappa range 0.42–0.69). Absolute pairwise agreement among the readers ranged from 90–94% regarding the question whether the probability of disc herniation on MRI was above or below 50%. Generally, moderate agreement was observed regarding the characteristics of the symptomatic disc level and of the herniated disc. Conclusion The observer variation of MRI interpretation in potential candidates for lumbar disc surgery is satisfactory regarding characteristics most important in decision for surgery. However, there is considerable variation between observers in specific characteristics of the symptomatic disc level and herniated disc.

el Barzouhi, Abdelilah; Vleggeert-Lankamp, Carmen L. A. M.; Lycklama a Nijeholt, Geert J.; Van der Kallen, Bas F.; van den Hout, Wilbert B.; Verwoerd, Annemieke J. H.; Koes, Bart W.; Peul, Wilco C.

2013-01-01

163

Occupational driving and lumbar disc degeneration: a case- control study  

Microsoft Academic Search

Summary Background Back problems are reported more by occupational drivers than by any other occupational group. One explanation is that whole-body vibration caused by the vehicle leads to accelerated disc degeneration, herniation, and associated symptoms. We aimed to investigate the effects of lifetime driving exposure on lumbar disc degeneration in monozygotic twins with very different histories of occupational driving during

Michele C Battié; Tapio Videman; Laura E Gibbons; Hannu Manninen; Kevin Gill; Malcolm Pope; Jaakko Kaprio

2002-01-01

164

Percutaneous treatment of lumbar intervertebral disc hernias with discogel.  

PubMed

A new percutaneous technique for the treatment of the backache and sciatica related to the lumbar disc herniation was applied in 34 patients at 40 levels. The technique is easy, safe, efficacious and without complications. In particular it is useful for the diagnosis and treatment of the underestimated "internal disc disruption" syndrome. PMID:24059722

Pardatscher, K; Volpentesta, G; Bombardieri, C; Giaquinta, A

2011-08-31

165

Traumatic lumbar visceral herniation in a young woman?  

PubMed Central

INTRODUCTION Lumbar herniation is uncommon, with traumatic etiology being rare. Traumatic lumbar hernias are usually caused by seatbelt injury in motor vehicle accidents. It is exceedingly uncommon to see lumbar hernias in an unrestrained passenger of a motor vehicle accident. PRESENTATION OF CASE We present a case of a traumatic inferior lumbar hernia in a young woman who was an unrestrained driver of a vehicle involved in a high-speed collision, with multiple rollover and ejection. CT scans of the abdomen and pelvis suggested soft tissue injury involving muscles in the left lower posterior flank with traumatic herniation of the colon and small bowel. Emergent midline abdominal laparotomy confirmed herniation in the left lower quadrant. After abdominal closure, in the prone position, an extensive laceration over the left flank also confirmed herniation. Due to its dirty nature, the wound was irrigated, lavaged and covered with wound vacuum-assisted closure placement. The decision was made in favor of delayed elective hernia repair. DISCUSSION Lumbar hernias are usually caused by sudden force to the abdomen, leading to increased intra-abdominal pressure. This pressure combined with areas of weakness in the superior and/or inferior triangle lead to herniation. Uncommonly, the contents of lumbar hernias can strangulate or incarcerate leading to bowel obstruction. This can often be prevented by detection with CT and laparotomy. CONCLUSION Lumbar herniation of traumatic etiology is rare. Early detection with CT and/or exploratory laparotomy is important to avoid increases in size of the defect and bowel strangulation and incarceration.

Woolbert, Ashley; Calasanz, Emily R.; Nazim, Muhammad

2013-01-01

166

Microendoscopic discectomy (MED) for lumbar disc prolapse  

Microsoft Academic Search

Microendoscopic discectomy (MED), which combines traditional lumbar microsurgical techniques with endoscopy, is being used as a minimally invasive procedure for lumbar disc herniation. We reviewed 30 patients who underwent MED at our institution and compared their outcome with that of patients subjected to the conventional method. Laboratory data suggested that MED was less invasive surgery. Moreover, MED allowed an early

Hiroyuki Nakagawa; Mikio Kamimura; Shigeharu Uchiyama; Kenji Takahara; Toshiro Itsubo; Tadaatsu Miyasaka

2003-01-01

167

Lumbar Discectomy Outcomes Vary by Herniation Level in the Spine Patient Outcomes Research Trial  

PubMed Central

Background: The Spine Patient Outcomes Research Trial showed an overall advantage for operative compared with nonoperative treatment of lumbar disc herniations. Because a recent randomized trial showed no benefit for operative treatment of a disc at the lumbosacral junction (L5-S1), we reviewed subgroups within the Spine Patient Outcomes Research Trial to assess the effect of herniation level on outcomes of operative and nonoperative care. Methods: The combined randomized and observation cohorts of the Spine Patient Outcomes Research Trial were analyzed by actual treatment received stratified by level of disc herniation. Overall, 646 L5-S1 herniations, 456 L4-L5 herniations, and eighty-eight upper lumbar (L2-L3 or L3-L4) herniations were evaluated. Primary outcome measures were the Short Form-36 bodily pain and physical functioning scales and the modified Oswestry Disability Index assessed at six weeks, three months, six months, one year, and two years. Treatment effects (the improvement in the operative group minus the improvement in the nonoperative group) were estimated with use of longitudinal regression models, adjusting for important covariates. Results: At two years, patients with upper lumbar herniations (L2-L3 or L3-L4) showed a significantly greater treatment effect from surgery than did patients with L5-S1 herniations for all outcome measures: 24.6 and 7.1, respectively, for bodily pain (p = 0.002); 23.4 and 9.9 for Short Form-36 physical functioning (p = 0.014); and ?19 and ?10.3 for Oswestry Disability Index (p = 0.033). There was a trend toward greater treatment effect for surgery at L4-L5 compared with L5-S1, but this was significant only for the Short Form-36 physical functioning subscale (p = 0.006). Differences in treatment effects between the upper lumbar levels and L4-L5 were significant for Short Form-36 bodily pain only (p = 0.018). Conclusions: The advantage of operative compared with nonoperative treatment varied by herniation level, with the smallest treatment effects at L5-S1, intermediate effects at L4-L5, and the largest effects at L2-L3 and L3-L4. This difference in effect was mainly a result of less improvement in patients with upper lumbar herniations after nonoperative treatment. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

Lurie, J.D.; Faucett, S.C.; Hanscom, B.; Tosteson, T.D.; Ball, P.A.; Abdu, W.A.; Frymoyer, J.W.; Weinstein, J.N.

2008-01-01

168

Heparanase isoform expression and extracellular matrix remodeling in intervertebral disc degenerative disease  

PubMed Central

OBJECTIVE: To determine the molecules involved in extracellular matrix remodeling and to identify and quantify heparanase isoforms present in herniated and degenerative discs. INTRODUCTION: Heparanase is an endo-beta-glucuronidase that specifically acts upon the heparan sulfate chains of proteoglycans. However, heparanase expression in degenerative intervertebral discs has not yet been evaluated. Notably, previous studies demonstrated a correlation between changes in the heparan sulfate proteoglycan pattern and the degenerative process associated with intervertebral discs. METHODS: Twenty-nine samples of intervertebral degenerative discs, 23 samples of herniated discs and 12 samples of non-degenerative discs were analyzed. The expression of both heparanase isoforms (heparanase-1 and heparanase-2) was evaluated using immunohistochemistry and real-time RT-PCR analysis. RESULTS: Heparanase-1 and heparanase-2 expression levels were significantly higher in the herniated and degenerative discs in comparison to the control tissues, suggesting a possible role of these proteins in the intervertebral degenerative process. CONCLUSION: The overexpression of heparanase isoforms in the degenerative intervertebral discs and the herniated discs suggests a potential role of both proteins in the mediation of inflammatory processes and in extracellular matrix remodeling. The heparanase-2 isoform may be involved in normal metabolic processes, as evidenced by its higher expression in the control intervertebral discs relative to the expression of heparanase-1.

Rodrigues, Luciano Miller Reis; Theodoro, Therese Rachell; Matos, Leandro Luongo; Mader, Ana Maria; Milani, Carlo; da Silva Pinhal, Maria Aparecida

2011-01-01

169

Chronic herniation of the hindbrain  

PubMed Central

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 Arnold—Chiari 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

Williams, Bernard

1981-01-01

170

46 CFR 64.61 - Rupture disc.  

Code of Federal Regulations, 2013 CFR

... 2013-10-01 2013-10-01 false Rupture disc. 64.61 Section 64.61 Shipping COAST...Vacuum Relief Devices for MPTs § 64.61 Rupture disc. If a rupture disc is the only pressure relief device on the tank,...

2013-10-01

171

[Traumatic recurrence of idiopathic spinal cord herniation].  

PubMed

Idiopathic spinal cord herniation is a rare cause of thoracic myelopathy and its recurrence is even more infrequent. Cord herniation is through an anterior dural defect in thoracic spine with unknown causes. Symptomatic cases must be surgically treated to reduce the hernia and seal the defect to prevent recurrences. We report a patient presenting a Brown-Séquard syndrome secondary to a D5 spinal cord herniation treated successfully and its posterior traumatic recurrence. PMID:23453309

Lorente-Muñoz, Asís; Cortés-Franco, Severiano; Moles-Herbera, Jesús; Casado-Pellejero, Juan; Rivero-Celada, David; Alberdi-Viñas, Juan

2013-01-01

172

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

NASA Technical Reports Server (NTRS)

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.

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

2014-01-01

173

Genome-wide association study in Dachshund: identification of a major locus affecting intervertebral disc calcification.  

PubMed

Intervertebral disc calcification and herniation commonly affects Dachshund where the predisposition is caused by an early onset degenerative process resulting in disc calcification. A continuous spectrum of disc degeneration is seen within and among dog breeds, suggesting a multifactorial etiology. The number of calcified discs at 2 years of age determined by a radiographic evaluation is a good indicator of the severity of disc degeneration and thus serves as a measure for the risk of developing intervertebral disc herniation. The aim of the study was to identify genetic variants associated with intervertebral disc calcification in Dachshund through a genome-wide association (GWA) study. Based on thorough radiographic examinations, 48 cases with ? 6 disc calcifications or surgically treated for disc herniation and 46 controls with 0-1 disc calcifications were identified. GWA using the Illumina CanineHD BeadChip identified a locus on chromosome 12 from 36.8 to 38.6 Mb with 36 markers reaching genome-wide significance (P(genome) = 0.00001-0.026). This study suggests that a major locus on chromosome 12 harbors genetic variations affecting the development of intervertebral disc calcification in Dachshund. PMID:21846751

Mogensen, Mette Sloth; Karlskov-Mortensen, Peter; Proschowsky, Helle Friis; Lingaas, Frode; Lappalainen, Anu; Lohi, Hannes; Jensen, Vibeke Frøkjær; Fredholm, Merete

2011-01-01

174

Evaluation of Percutaneous Disc Decompression Using Coblation in Chronic Back Pain With or Without Leg Pain  

Microsoft Academic Search

months post procedure. Eighty patients who presented with dis- cogenic low back pain with or without radicular pain associated with contained disc herniation underwent percutaneous disc decompression using Coblation™ technology (Nucleoplas- ty™) after failing at least 3 months of conserva- tive and injection therapies. Overall, 75% of patients indicated a decrease in their numeric pain scores at 12 months with

Vijay Singh; Chandur Piryani; Katherine Liao

2003-01-01

175

Effect of Nd?YAG laser on experimental disc degeneration part I. Biochemical and radiographical analysis  

Microsoft Academic Search

Summary Intervertebral disc herniation is an important health problem from both the social and economic aspect. It is often accompanied by a decrease in the content of water and proteoglycan (PG). The present study was undertaken to elucidate the effect of neodymium-yttrium-aluminum-garnet (Nd:YAG) laser on degenerated disc tissue.

M. Turgut; B. Açikgöz; K. Kilinç; O. Ekin Özcan; A. Erbengi

1996-01-01

176

Symptomatic intravertebral disc herniation (Schmorl's node) in the cervical spine.  

PubMed Central

A case of a Schmorl's node in the cervical vertebra causing neck pain is reported. An inflammatory focus was found on histological examination of Schmorl's node indicating a possible mechanism of pain production. Images

Lipson, S J; Fox, D A; Sosman, J L

1985-01-01

177

Symptomatic intravertebral disc herniation (Schmorl's node) in the cervical spine  

Microsoft Academic Search

A case of a Schmorl's node in the cervical vertebra causing neck pain is reported. An inflammatory focus was found on histological examination of Schmorl's node indicating a possible mechanism of pain production.

S J Lipson; D A Fox; J L Sosman

1985-01-01

178

Reoperation after lumbar disc surgery: Results in 130 cases  

Microsoft Academic Search

Summary Out of a series of 1850 cases operated upon for lumbar disc herniation 130 underwent re-operation because of persistent or recurrent symptoms. Re-operation was successful in 62%. The prognosis of re-operation was not related to special clinical symptoms and signs but only to the operative findings.

J. Fandifio; C. Botana; A. Viladrich; J. Gomez-Bueno

1993-01-01

179

Far lateral lumbar disc extrusion: MRI findings and surgical treatment.  

PubMed

This case report describes the magnetic resonance imaging (MRI) findings and the treatment of a far lateral extrusion of disc material at the sixth and seventh lumbar vertebrae (L6-L7) in a five-year-old male Alpine Dachsbracke dog referred to our hospital for investigation of the complaint of a one week progressive lameness in the left pelvic limb and poorly localized back pain. An extra-foraminal left lateral disc herniation impinging on the sixth lumbar nerve root was diagnosed by MRI examinations. Due to the far lateral position of the extruded disc material on MRI, surgical opening of the spinal canal was not necessary. Removal of the herniated soft disc material impinging on the L6 nerve root, and fenestration of the L6-L7 disc was performed laterally. To the author's knowledge 'far-lateral' disc herniation beyond the neuroforamen without any spinal canal contact has not been described in dogs until now. A complete recovery with no evidence of pain was achieved only after a couple of weeks after surgery. We acknowledge that it is possible that other pathological mechanisms may have contributed to clinical signs and to a delayed recovery. PMID:23857574

Fadda, A; Lang, J; Forterre, F

2013-01-01

180

Percutaneous diode laser disc nucleoplasty  

NASA Astrophysics Data System (ADS)

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%.

Menchetti, P. P.; Longo, Leonardo

2004-09-01

181

Transdiaphragmatic Intercostal Herniation following Blunt Trauma.  

PubMed

Intercostal herniation is very rarely and sporadically reported in the literature. Intercostal hernia can occur following blunt trauma and may be associated with rib fractures. We present a case of a patient who presented with rib fractures, diaphragmatic rupture, and intrathoracic herniation of abdominal contents with subsequent herniation of both lung and abdominal contents through an intercostal defect. The patient was successfully treated with primary surgical repair of the diaphragm and intercostal hernia. The presentation, pathophysiology, and management of this rare clinical entity are discussed. PMID:23198242

Sarkar, Debkumar; Warta, Melissa; Solomon, Jason

2012-01-01

182

Spontaneous regression of intervertebral disc calcifications in a child.  

PubMed

This article presents the case of a boy who complained of cervical and thoracic spine pain for the first time at the age of nine. Plain films of cervical and thoracic spine showed calcifications of intervertebral disc C4-C5, C5-C6, C6-C7 and D3-D4. The symptoms disappeared after conservative therapy. Plain films taken 16 months later showed spontaneous disappearance of all disc calcifications. This spontaneous regression of intervertebral disc calcifications in childhood has also been described in other cases reported in the medical literature. Except for the rare cases when disc calcifications are associated with disc herniation, the discovery of disc calcifications on a plain X-ray of a child corresponds to a benign abnormality. PMID:2065515

Ginalski, J M; Schnyder, P; Gerster, J C

1991-03-01

183

Histologic findings of disc, end plate and neural elements after coblation of nucleus pulposus: an experimental nucleoplasty study  

Microsoft Academic Search

Background contextPartial removal of the nucleus has been shown to decompress herniated discs, relieving pressure on nerve roots and, in some cases, offering relief from disc pain. The nucleoplasty technique builds on earlier surgical approaches that helped validate the strategy of intranuclear tissue removal. Nucleoplasty, a new minimally invasive procedure using patented coblation technology, combines coagulation and ablation for partial

Yung C Chen; Sang-Heon Lee; Yamil Saenz; Norman L Lehman

2003-01-01

184

Clarifying the nomenclature of intervertebral disc degeneration and displacement: from bench to bedside  

PubMed Central

As a significant determinant of low back pain, intervertebral disc degeneration (IDD) has attracted more and more attention of both investigators and physicians. Disc herniation, termed as intervertebral disc displacement, is amongst the most prevalent spinal diseases closely linked with IDD. Due to the same origins and similar pathophysiology, the ambiguity regarding the similarity and difference of IDD and intervertebral disc displacement thus remains. The aim of this study was to clarify the nomenclature of IDD and disc herniation in terms of molecular etiology, pathophysiology, nature history and clinical outcomes. Collectively, IDD is a type of multifaceted, progressive spinal disease with or without clinical symptoms as back pain, characterized by extracellular matrix and the integrity of NP and AF lost, fissures formation. Disc herniation (termed as intervertebral disc displacement) is a type of spinal disease based on IDD or not, with local pain and/or sciatica due to mechanical compression and autoimmune cascades upon the corresponding nerve roots. Clarifying the nomenclature of intervertebral disc degeneration and displacement has important implications both for investigators and for physicians.

Wang, Hai-Qiang; Samartzis, Dino

2014-01-01

185

Deuk Laser Disc Repair® is a safe and effective treatment for symptomatic cervical disc disease  

PubMed Central

Background: Deuk Laser Disc Repair® is a new full-endoscopic surgical procedure to repair symptomatic cervical disc disease. Methods: A prospective cohort of 66 consecutive patients underwent cervical Deuk Laser Disc Repair® for one (n = 21) or two adjacent (n = 45) symptomatic levels of cervical disc disease and were evaluated postoperatively for resolution of headache, neck pain, arm pain, and radicular symptoms. All patients were candidates for anterior cervical discectomy and fusion (ACDF) or arthroplasty. The Mann–Whitney Wilcoxon test was used to calculate P values. Results: All patients (n = 66) had significant improvement in preoperative symptoms with an average symptom resolution of 94.6%. Fifty percent (n = 33) had 100% resolution of all preoperative cervicogenic symptoms. Only 4.5% (n = 3) had less than 80% resolution of preoperative symptoms. Visual analog scale (VAS) significantly improved from 8.7 preoperatively to 0.5 postoperatively (P < 0.001) for the cohort. Average operative and recovery times were 57 and 52 minutes, respectively. There were no perioperative complications. Recurrent disc herniation occurred in one patient (1.5%). Average postoperative follow-up was 94 days and no significant intergroup difference in outcomes was observed (P = 0.111) in patients with <90 days (n = 52) or >90 days (n = 14, mean 319 days) follow-up. No significant difference in outcomes was observed (P = 0.774) for patients undergoing one or two level Deuk Laser Disc Repair®. Patients diagnosed with postoperative cervical facet syndrome did significantly worse (P < 0.001). Conclusion: Deuk Laser Disc Repair® is a safe and effective alternative to ACDF or arthroplasty for the treatment of one or two adjacent symptomatic cervical disc herniations with an overall success rate of 94.6%.

Deukmedjian, Ara J.; Jason Cutright, S. T.; Augusto Cianciabella, PA-C; Deukmedjian, Arias

2013-01-01

186

Tethered cord in the adult mimicking the lumbar disc syndrome: report of two cases.  

PubMed

Two adult patients with tethered cords whose symptoms mimicked those of lumbosacral intervertebral disc herniation are reported. Neither one of the patients had cutaneous stigmata, and one had normal plain x-ray examination of the spine. Magnetic resonance imaging in both patients demonstrated tethering of the cord. Untethering of the cord resulted in disappearance of the symptoms in both patients. These unusual cases suggest that tethering of the cord must be included in the differential diagnosis of the herniated lumbar intervertebral disc syndrome. PMID:8516740

Gokay, H; Barlas, O; Hepgul, K T; Hiçdonmez, T

1993-06-01

187

Disc Jockey.  

ERIC Educational Resources Information Center

"Disc Jockey" is described as a classroom activity for junior high students with moderate/severe disabilities. The disc jockey of the day chooses music and operates a classroom tape recorder. The activity encourages students to learn days of the week, communication skills, age-appropriate behavior, and motor skills, and to develop feelings of…

Sparber, Sandra R.

1996-01-01

188

Chronic lumbar extradural haematoma simulating disc syndrome  

PubMed Central

Two patients presenting with a clinical picture of nerve root compression suggestive of the herniated disc syndrome are reported. In both the diagnosis proved to be chronic encapsulated extradural haematoma. Recognition of this entity at the time of surgical exposure should render the surgical dissection easier. The postoperative results in both were excellent. One of these patients was on chronic anticoagulant therapy and the unusual location and good prognosis of extradural haematoma in the lumbar spinal canal in such patients is emphasized. In the other, the haematoma developed after a minor back injury, which introduces medico-legal implications. Images

Devadiga, K. V.; Gass, H. H.

1973-01-01

189

[Idiopathic spinal cord herniation: a rare condition].  

PubMed

Idiopathic spinal cord hernia, in which the reason that spinal cord protrudes through a defect in the dura mater is unknown, is a rare cause of progressive myelopathy. The most common clinical presentation is Brown-Séquard syndrome. Spinal cord herniation is a reversible cause of myelopathy: surgery to correct the defect in the dura mater has a high rate of functional recovery. Thus, early imaging detection is crucial. Magnetic resonance imaging is the technique of choice for the diagnosis. We present two cases of idiopathic spinal cord herniation and show the imaging findings that make it possible to recognize and diagnose this condition. PMID:20382404

Salvador Álvarez, E; Jiménez De La Peña, M; Herraiz Hidalgo, L; Pardo Moreno, J

2010-01-01

190

Sudden death following delayed traumatic diaphragmatic herniation.  

PubMed

Blunt force trauma to the chest can often result in diaphragmatic tears. These tears can go months without being discovered, until a secondary injury or circumstance causes an organ to herniate through the diaphragm. Special care should be taken at autopsy to determine the mechanism of injury of any tears in the diaphragm as this may influence the cause and manner of death. We present a case of a 28-year-old man who suffered multiple injuries in a motor vehicle collision. Six months later he presented with a left diaphragmatic tear and gastric fundal herniation, and died eventually. PMID:20683321

Yates, Adam M; Fulcher, James W; Ward, Michael E

2011-03-01

191

Does the choice of outcome scale influence prognostic factors for lumbar disc surgery?  

Microsoft Academic Search

From January to June 1994, we operated conventionally on 121 consecutive herniated lumbar disc patients as part of a prospective study. We analysed general data, case histories, neurological findings on admission and all data from imaging investigations and therapy. In addition, all patients received a questionnaire based on the Low Back Outcome Score. Most of the patients (93%) were followed-up

C. Woertgen; M. Holzschuh; R. D. Rothoerl; A. Brawanski

1997-01-01

192

Isolated trans-hiatal colonic herniation.  

PubMed

Isolated herniation of the colon through congenital or traumatic diaphragmatic defects are well documented. However, trans-hiatal herniation of the colon in the absence of an intrathoracic stomach has been reported only once. A 67-year-old man presented with intragastric abdominal pain and a chest x-ray film documenting a posterior mediastinal air-fluid level. Computed tomography showed gastrointestinal contents within the thorax. The findings on an upper gastrointestinal film with small bowel follow-through were normal. Finally, a barium enema identified transverse colon within the thoracic cavity. At laparoscopy, the entire transverse colon was reduced with the hernia sac. The crural defect was repaired, and a Toupet fundoplication was performed. A gastropexy was also added. The patient was discharged on postoperative day 2 able to tolerate a regular diet, and he has been asymptomatic for 5 months. This defect most likely represents a congenital deformity of the diaphragm with intact posterior gastric attachments, including the posterior phrenoesophageal ligament. An intact gastric mesentery enabled isolated colonic herniation with retention of the stomach its normal anatomic position. An antireflux procedure was performed in addition to the crural repair because of the circumferential dissection of the esophagus. This article is the second report of an isolated trans-hiatal herniation of the colon and the first report of laparoscopic repair of this entity. PMID:12737724

Felsher, Joshua; Brodsky, Jason; Brody, Fred

2003-04-01

193

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

PubMed Central

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.

2010-01-01

194

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

195

Lumbosacral intradural tumours simulating disc disease.  

PubMed

Twelve patients with symptoms and signs simulating lumbar disc disease were found to have intradural tumours in the lumbosacral area. Of the nine patients with a neurofibroma, two had previously had a laminectomy for an erroneous diagnosis of disc herniation and one had three separate tumours which were excised in two successive operations. One of the three patients with an ependymoma had a coccygectomy before the correct diagnosis was made. Only one patient who had an ependymoma showed radiographic abnormalities suggesting a neoplastic lesion, but eight of the ten cases in which the cerebrospinal fluid was analyzed had a protein content of 50 mg per 100 ml. Myelography provided the correct diagnosis in all cases. Excision of the tumour resulted in full clinical recovery except for one patient with an ependymoma. PMID:6804401

Postacchini, F; Urso, S; Tovaglia, V

1981-01-01

196

Upward transtentorial herniation: seven cases and a literature review.  

PubMed

Seven cases of upward transtentorial herniation occurred. In each patient, coma with reactive, miotic pupils, asymmetrical or absent caloric responses, and decerebrate posture indicated brain-stem compression. In this setting, the development of unequal, then midposition, fixed pupils signaled midbrain failure from upward herniation. Vertebral angiography showed upward displacement of the superior cerebellar arteries. Results of autopsy confirmed the existence of grooving of the vermis by the tentorial margins and, in one case, of anterior displacement and distortion of the midbrain. In five of 45 reported cases of upward herniation, the conditions were diagnosed antemortem. Instances of cerebellar hematoma and tumor predominated. In at least seven patients, performance of ventriculography may have precipitated herniation. Clinical details were provided in only nine patients and did not separate upward herniation from brain-stem compression. Cerebellar ischemic infarct found in one of our patients is a rarely reported cause of upward herniation. PMID:485890

Cuneo, R A; Caronna, J J; Pitts, L; Townsend, J; Winestock, D P

1979-10-01

197

Intercostal lung herniation - The role of imaging  

PubMed Central

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.

Detorakis, Efstathios E.; Androulidakis, Emmanuel

2014-01-01

198

Spinal cord dysfunction from lumbar disk herniation.  

PubMed

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

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

1989-12-01

199

Ambulatory surgery is safe and effective in radicular disc disease.  

PubMed

Advances in medicine, including diagnostic techniques and therapeutic procedures, have resulted in the ambulatory management of many diseases. A number of surgical procedures previously considered to require hospitalization now are offered on a routine basis as an outpatient or short-stay admission. Although the use of microdiscectomy for the treatment of virgin herniated disc in ambulatory patients has been reported in very limited numbers, it has not been applied to other problems, such as recurrent herniated disc, far lateral disc, or foramenal stenosis. In addition, it only has been used in optimal patients. The authors analyzed a diverse group of patients who underwent outpatient microdiscectomy and found, for most patients studied, hospitalization was not necessary. Seventy-four patients were prospectively studied to determine whether unilateral root decompression for disc or stenosis could be accomplished on an ambulatory basis. Ninety percent of the patients were able to be discharged on the day of surgery. There was no significant morbidity related to the ambulatory approach. The authors also found a significant cost savings for third party reimbursers. PMID:8184345

Bookwalter, J W; Busch, M D; Nicely, D

1994-03-01

200

Matrix metalloproteinase 28, a novel matrix metalloproteinase, is constitutively expressed in human intervertebral disc tissue and is present in matrix of more degenerated discs  

PubMed Central

Introduction The regulation and elevation in expression of the catabolic matrix metalloproteinases (MMPs) is of high importance in the human intervertebral disc since upregulation of these matrix-degrading enzymes results in matrix destruction associated with disc degeneration. MMP28 (epilysin) is a newly discovered MMP believed to play a role in matrix composition and turnover in skin. It is present in basal keratinocytes where its expression is upregulated with wound repair, and in cartilage and synovium where it is upregulated in osteoarthritis. Recent work has shown that mechanical compression can act to modulate expression of MMP28. The expression of MMP28 is unexplored in the intervertebral disc. Methods Following approval by our human subjects institutional review board, we employed microarray analyses to evaluate in vivo expression of MMP28 and the MMP28 precursor in human disc tissue, and utilized immunohistochemistry to determine cellular and extracellular matrix localization of MMP28 in 35 human disc tissue specimens. The percentage of cells positive for MMP28 immunocytochemical localization was also determined. Results The present work documents the expression and presence of MMP28 in cells and extracellular matrix (ECM) of the human intervertebral disc. Gene expression levels in human disc tissue were detectable for both MMP28 and the MMP28 precursor. MMP28 cytoplasmic localization was present in cells of the outer annulus; it was also present in some, but not all, cells of the inner annulus and nucleus. MMP28 was not found in the ECM of healthier Grade I to II discs, but was identified in the ECM of 61% of the more degenerated Grade III to V discs (P = 0.0018). There was a significant difference in cellular MMP28 distribution in the disc (P = 0.008): the outer annulus showed the largest percentage of cells positive for MMP28 immunolocalization, followed by the inner annulus and then the nucleus. Herniated discs showed a significantly greater proportion of MMP28-positive cells compared with nonherniated discs (P = 0.034). Conclusions Findings presented here show the first documentation of intervertebral disc expression and production of MMP28. MMP28 was found in both disc cell cytoplasm and in the ECM of more degenerated specimens, with greater cellular localization in the outer annulus and in herniated disc specimens. These findings are important because of the key role of MMPs in disc turnover and homeostasis, and previous indications of a role for this MMP in matrix repair and matrix turnover in other tissues. Our data, which show the presence of MMP28 in human disc tissue, suggest that MMP28 may have a potentially important role in ECM modulation in the healthy and degenerating disc.

2009-01-01

201

Immune cascades in human intervertebral disc: the pros and cons  

PubMed Central

The unique structural hallmark of the intervertebral disc has made its central composition, the nucleus pulposus (NP), excluded from the immunologic tolerance. Consequently, the intervertebral disc is identified as an immune-privileged organ. Traditionally, local detrimental immune activities caused by NP at the lesion sites of the disc are noted as a significant factor contributing to disc degeneration. However, given the beneficial activities of immune cells in other immune-privileged sites on basis of current evidence, the degenerate disc might need the assistance of a subpopulation of immune cells to restore its structure and lessen inflammation. In addition, the beneficial impact of immune cells can be seen in the absorption of the herniated NP, which is an important factor causes the mechanical compression of nerve roots. Consequently, a modulated immune network in degenerate disc is essential for the restoration of this immune-privileged organ. Until now, the understandings of immune response in disc degeneration still rest on the harmful aspect. Further studies are needed to explore its beneficial influence. Accordingly, there are no absolutely the pros and cons in terms of immune reactions caused by NP.

Sun, Zhen; Zhang, Ming; Zhao, Xu-Hong; Liu, Zhi-Heng; Gao, Yang; Samartzis, Dino; Wang, Hai-Qiang; Luo, Zhuo-Jing

2013-01-01

202

Correlation between clinical features and magnetic resonance imaging findings in lumbar disc prolapse  

PubMed Central

Background: Lumbar disc prolapse is one of the common causes of low back pain seen in the working population. There are contradictorty reports regarding the clinical significance of various magnetic resonance imaging (MRI) findings observed in these patients. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse. Materials and Methods: 119 clinically diagnosed patients with lumbar disc prolapse were included in the study. Clinical evaluation included pain distribution, neurological symptoms and signs. MR evaluation included grades of disc degeneration, type of herniation, neural foramen compromise, nerve root compression, and miscellaneous findings. These MRI findings were tested for inter- and intraobserver variability. The MRI findings were then correlated with clinical symptoms and the level of disc prolapse as well as neurological signs and symptoms. Statistical analysis included the Kappa coefficient, Odd’s ratio, and logistic regression analysis. Results: There were no significant inter- or intraobserver variations for most of MRI findings (Kappa value more than 0.5) except for type of disc herniation which showed a interobserver variation of 0.46 (Kappa value). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.8), but not all disc bulges produced symptoms. Central bulges and disc protrusions with thecal sac compression were mostly asymptomatic, while centrolateral protrusions and extrusions with neural foramen compromise correlated well with the dermatomal distribution of pain. Root compression observed in MRI did not produce neurological symptoms or deficits in all patients but when deficits were present, they correlated well with the presence of root compression in MRI. Multiple level disc herniations with foramen compromise were strongly associated with the presence of neurological signs. Conclusions: The presence of centrolateral protrusion or extrusion with gross foramen compromise correlates with clinical signs and symptoms very well, while central bulges and disc protrusions correlate poorly with clinical signs and symptoms. The presence of neural foramen compromise is more important in determining the clinical signs and symptoms while type of disc herniation (bulge, protrusion, or extrusion) correlates poorly with clinical signs and symptoms.

Janardhana, Aithala P; Rajagopal; Rao, Sharath; Kamath, Asha

2010-01-01

203

Transitional Cell Carcinoma within a Portion of Inguinally Herniated Bladder  

PubMed Central

Bladder herniation within the inguinal canal is a relatively uncommon finding. We report an even less-common occurrence of transitional cell carcinoma located within a portion of inguinally herniated bladder. Fewer than 20 reports exist in the literature describing this scenario.

Uhlman, Matthew A.; Bockholt, Nathan A.; Gupta, Amit

2013-01-01

204

Transdural Spinal Cord Herniation: Imaging and Clinical Spectra  

Microsoft Academic Search

PURPOSE: Transdural herniation of the spinal cord is a rarely reported clinical entity, and many of the existing reports were published before the advent of MR imaging. We describe five current cases and compare them with findings in 25 cases reported in the literature to delineate the clinical and imaging spectra of transdural spinal cord herniation. METHODS: MR imaging, CT

Michael R. Watters; John C. Stears; Anne G. Osborn; Gary E. Turner; Bradford S. Burton; Kevin Lillehei; William T. C. Yuh

1998-01-01

205

Brain code and coma recovery: aggressive management of cerebral herniation.  

PubMed

Cerebral herniation occurs due to lateral or vertical shifts in brain tissue as a complication of an intra- or extra-axial nervous system pathology. Midline shift of midline brain structures has been independently associated with poor outcome in a variety of neurologic injuries. Herniation may present as a subacute phenomenon constituting mild and progressive alteration of consciousness or as a hyperacute scenario wherein there is rapid decompensation of intracranial compliance. If left uncontrolled, cerebral herniation will lead to destruction of arousal mechanisms and result in a comatose state. A protocol-based approach for the management of herniation has the potential to minimize or reverse these shifts and in conjunction with clinical examination, radiologic data and neuromonitoring techniques offer the option of preventing a second catastrophe. In this article, the authors discuss the mechanisms that lead to coma in brain-herniating patients and the treatment choices that have been successfully used in this patient population. PMID:23888397

Kalanuria, Atul A; Geocadin, Romergryko G; Püttgen, Hans A

2013-04-01

206

Cerebellar Herniation in Syringomyelia: Relation between Tonsillar Herniation and the Dimensions of the Syrinx and the Remaining Spinal Cord  

Microsoft Academic Search

The dimensions of the syrinx, the remaining spinal cord and the degree of cerebellar herniation were analyzed by one- and two-dimensional MRI studies in 22 patients with syringomyelia. A deep and\\/or broad cyst tends to be a long one. The dimensions of the syrinx and the spinal cord have an inverse relationship. The degree of cerebellar herniation is not related

Harald Masur; Christoph Oberwittler; Georg Reuther; Petra Heyen

1995-01-01

207

D-Zero Cryostat Supplemental Rupture Disc  

SciTech Connect

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.

Mulholland, G.T.; /Fermilab

1987-08-03

208

Little-known Swiss contributions to the description, diagnosis, and surgery of lumbar disc disease before the Mixter and Barr era.  

PubMed

The understanding of lumbar spine pathologies made substantial progress at the turn of the twentieth century. The authors review the original publication of Otto Veraguth in 1929 reporting on the successful resection of a herniated lumbar disc, published exclusively in the German language. His early report is put into the historical context, and its impact on the understanding of pathologies of the intervertebral disc (IVD) is estimated. The Swiss surgeon and Nobel Prize laureate Emil Theodor Kocher was among the first physicians to describe the traumatic rupture of the IVD in 1896. As early as 1909 Oppenheim and Krause published 2 case reports on surgery for a herniated lumbar disc. Goldthwait was the first physician to delineate the etiopathogenes is between annulus rupture, symptoms of sciatica, and neurological signs in his publication of 1911. Further publications by Middleton and Teacher in 1911 and Schmorl in 1929 added to the understanding of lumbar spinal pathologies. In 1929, the Swiss neurologist Veraguth (surgery performed by Hans Brun) and the American neurosurgeon Walter Edward Dandy both published their early experiences with the surgical therapy of a herniated lumbar disc. Veraguth's contribution, however, has not been appreciated internationally to date. The causal relationship between lumbar disc pathology and sciatica remained uncertain for some years to come. The causal relationship was not confirmed until Mixter and Barr's landmark paper in 1934 describing the association of sciatica and lumbar disc herniation, after which the surgical treatment became increasingly popular. Veraguth was among the first physicians to report on the clinical course of a patient with successful resection of a herniated lumbar disc. His observations should be acknowledged in view of the limited experience and literature on this ailment at that time. PMID:24074509

Stienen, Martin Nikolaus; Surbeck, Werner; Tröhler, Ulrich; Hildebrandt, Gerhard

2013-12-01

209

Iliocaval arteriovenous fistula following lumbar disc surgery: endovascular treatment with a Stent-graft.  

PubMed

Arteriovenous (AV) fistulae, pseudoaneurysms, and lacerations may occur during disc surgery. AV fistula after lumbar disc surgery is rare. Early diagnosis and treatment of vascular complications associated with disc surgery is essential due to their high mortality and morbidity rates. We report a case report who was presented with fistulous shunt between right common iliac artery and inferior vena cava fifteen days after operation for herniated discs at L4-L5 and L5-S1 levels. Treatment was transcatheter covered stent placement at the fistulous site of right common iliac artery using a self expandable stent-graft. We suggest use of minimally invasive interventional techniques in the management of suitable vascular injuries following lumbar disc surgery. PMID:18814112

Düz, Bülent; Kaplan, Metin; Günay, Celalettin; Ustünsöz, Bahri; U?urel, Mehmet Sahin

2008-07-01

210

Biomechanics of the intrinsically optimal design of the intervertebral disc.  

PubMed

The spinal shock-absorbing disc needs to have the flexibility to enable the spine to bend and twist. At the same time under loading, its lateral and axial deformations have to be contained, so that it does not herniate and impinge on the spinal-chord. The disc is composed of a fluid-like nucleus pulposus (NP) contained within an annulus. Hence when the disc is loaded, the NP gets pressurized and stresses the surrounding annulus. Now, because its elastic modulus is stress-dependent (i.e. E-E 0 = ksigma, where k is a constitutive parameter ), the annulus stiffens under loading. In this way, the flexible disc is able to sustain its loading with minimal deformation and thereby contain its deformation. In this paper, we have carried out a stress and deformation analysis of the spinal disc, and demonstrated that its deformations are invariant with the load intensity and only dependent on its dimensions and its constitutive property parameter k. Thus, we demonstrate that the intrinsic design of the spinal disc makes it an optimal structure. PMID:17281213

Fan, S; Ghista, D; Sridhar, I; Ramakrishna, K

2005-01-01

211

Vacuum Mechatronics.  

National Technical Information Service (NTIS)

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 incr...

S. Hackwood S. E. Belinski G. Beni

1989-01-01

212

Automatic stepping in the pontomedullary stage of central herniation.  

PubMed

Both spontaneous and reflexive movements may occur during the final stages of herniation and following brain death. We describe spontaneous, rhythmic (0.2 to 0.5 Hz), alternating flexion of the hip, knee, and ankle in two patients during the pontomedullary phase of central herniation following a massive hemispheric infarct. Automatic stepping is likely a spinal automatism generated within the spinal locomotion center and regulated by both ascending and descending brainstem tracts. Clinicians and family members of neurologically devastated patients should be aware that this and other movements can occur during the late stages of central herniation preceding and following brain death. PMID:7746419

Hanna, J P; Frank, J I

1995-05-01

213

Disc-planet interactions in subkeplerian discs  

NASA Astrophysics Data System (ADS)

Context: One class of protoplanetary disc models, the X-wind model, predicts strongly subkeplerian orbital gas velocities, a configuration that can be sustained by magnetic tension. Aims: We investigate disc-planet interactions in these subkeplerian discs, focusing on orbital migration for low-mass planets and gap formation for high-mass planets. Methods: We use linear calculations and nonlinear hydrodynamical simulations to measure the torque and look at gap formation. In both cases, the subkeplerian nature of the disc is treated as a fixed external constraint. Results: We show that, depending on the degree to which the disc is subkeplerian, the torque on low-mass planets varies between the usual type I torque and the one-sided outer Lindblad torque, which is also negative but an order of magnitude stronger. In strongly subkeplerian discs, corotation effects can be ignored, making migration fast and inward. Gap formation near the planet's orbit is more difficult in such discs, since there are no resonances close to the planet accommodating angular momentum transport. The location of the gap is shifted inwards with respect to the planet, leaving the planet on the outside of a surface density depression. Conclusions: Depending on the degree to which a protoplanetary disc is subkeplerian, disc-planet interactions can be very different from the usual Keplerian picture, making these discs in general more hazardous for young planets.

Paardekooper, S.-J.

2009-11-01

214

Clinical correlation of magnetic resonance imaging with symptom complex in prolapsed intervertebral disc disease: A cross-sectional double blind analysis  

PubMed Central

Introduction: Low backache (LBA) is one of the most common problems and herniated lumbar disc is one of the most commonly diagnosed abnormalities associated with LBA. Disc herniation of the same size may be asymptomatic in one patient and can lead to severe nerve root compromise in another patient. Objective: To evaluate correlation between the clinical features of disc collapse and magnetic resonance imaging (MRI) finding to determine the clinical importance of anatomical abnormalities identified by MRI technique. Summary: From January 2010 to January 2012, 75 otherwise healthy patients (43 males 32 females) between the age of 19 and 55 years (average age was 44.5 years) with low back pain and predominant complaint of root pain who presented to our clinic were included in the study. Materials and Methods: Proper screening was done to rule out previous spine affection and subjected to MRI. Results: The results were analyzed under four headings viz. disc herniation, disc degeneration, thecal sac deformation and neural foramen effacement. All patients had a visual analog score (VAS) score more than 6. The interrater correlation coefficient kappa was calculated to be k=0.51. There were total 44 patients with herniation, 25 patients had mild, one patient had moderate degree of thecal sac deformation, 21 patients had one or more levels of foraminal effacement by the herniated tissue, 100% of the patients had disc degeneration ranging from grade 1 to 3 at different levels; and 48 patients (64%) had radiculopathy, six (8%) patients had bilateral and others had ipsilateral affection. Conclusion: In our study, the correlation was made between clinical findings and MRI findings. It can safely be concluded that treating physician should put more emphasis on history, clinical examination, and make the inference by these and then should correlate the clinical findings with that of MRI to reach a final diagnosis.

Bajpai, Jeetendra; Saini, Sumit; Singh, Rakhi

2013-01-01

215

Non-reclosing pressure relief device for vacuum systems  

DOEpatents

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.

Swansiger, William A. (Livermore, CA) [Livermore, CA

1994-01-01

216

Non-reclosing pressure relief device for vacuum systems  

SciTech Connect

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.

Swansiger, W.A.

1994-02-08

217

Dynamics of Astrophysical Discs  

NASA Astrophysics Data System (ADS)

Preface; Names and addresses of participants; Conference photograph; 1. Spiral waves in Saturn's rings; 2. Structure of the Uranian rings; 3. Planetary rings: theory; 4. Simulations of light scattering in planetary rings; 5. Accretion discs around young stellar objects and the proto-Sun; 6. The ß Pictoris disc: a planetary rather than a protoplanetary one; 7. Optical polarimetry and thermal imaging of the disc axound ß Pictoris; 8. Observations of discs around protostars and young stars; 9. VLA observations of ammonia towaxd moleculax outflow sources; 10. Derivation of the physical properties of molecular discs by an MEM method; 11. Masers associated with discs around young stars; 12. The nature of polarisation discs axound young stars; 13. The correlation between the main parameters of the interstellar gas (including Salpeter's spectrum of masses) as a result of the development of turbulent Rossby waves; 14. Discs in cataclysmic variables and X-ray binaries; 15. A disc instability model for soft X-ray transients containing black holes; 16. X-ray variability from the accretion disc of NGC 5548; 17. Viscously heated coronae and winds around accretion discs; 18. Optical emission line profiles of symbiotic stars; 19. The effect of formation of Fell in winds confined to discs for luminous stars; 20. Observational evidence for accretion discs in active galactic nuclei; 21. The fuelling of active galactic nuclei by non-axisynlinetric instabilities; 22. The circum-nuclear disc in the Galactic centre; 23. Non-axisymmetric instabilities in thin self-gravitating differentially rotating gaseous discs; 24. Non-linear evolution of non-axisymmetric perturbations in thin self-gravitating gaseous discs; 25. Eccentric gravitational instabilities in nearly Keplerian discs; 26. Gravity mode instabilities in accretion tori; 27. The stability of viscous supersonic shear flows - critical Reynolds numbers and their implications for accretion discs; 28. Asymptotic analysis of overstable convective modes of uniformly rotating stars; 29. Polytropic models in very rapid rotation; 30. Distribution and kinematics of gas in galaxy discs; 31. Are the smallest galaxies optically invisible?; 32. Can we understand the constancy of rotation curves?; 33. How well do we know the surface density of the Galactic disc?; 34. On the heating of the Galactic disc; 35. The bulge-disc interaction in galactic centres; 36. Dynamics of the large-scale disc in NGC 1068; 37. The flow of gas in barred galaxies; 38. The warped dust lane in A1029-459; 39. Structure and evolution of dissipative non-planar galactic discs; 40. Non-axisymmetric magnetic fields in turbulent gas discs; 41. Non-axisymmetric disturbances in galactic discs; 42. Spiral instabilities in N-body simulations; 43. Long-lived spiral waves in N-body simulations; 44. Overstable modes in stellar disc systems; 45. Galactic seismological approach to the spiral galaxy NGC 3198; 46. Characteristics of bars from 3-1) simulations; 47. Spirals and bars in linear theory; 48. Stellar hydrodynamical solutions for Eddington discs; 49. Theory of gradient instabilities of the gaseous Galactic disc and rotating shallow water; 50. Stability criteria for gravitating discs; 51. Stability of two-component galactic discs; 52. The smoothed particle hydrodynamics of galactic discs; 53. Tidal triggering of active disc galaxies by rich clusters; 54. The formation of spiral arms in early stages of galaxy interaction; 55. Formation of leading spiral arms in retrograde galaxy encounters; 56. The influence of galaxy interactions on stellar bars; 57. Disc galaxies - work in progress in Gothenburg; 58. Motion of a satellite in a disc potential; 59. Observer's summary; 60. Common processes and problems in disc dynamics; Citation index; Index of authors; Subject index.

Sellwood, J. A.

2004-01-01

218

Percutaneous diskectomy for lumbar disk herniation. A preliminary report.  

PubMed

Percutaneous diskectomy is a new method for reducing lumbar disk herniation. This procedure is simple, safe, and only semiinvasive since it causes no direct damage to the dura or nerve roots. This technique employs a nucleotome (blunt-tipped, suction-cutting probe) with a rotating electric shaver (3 mm in diameter) that was specially developed for this procedure. It was applied to 117 patients with lumbar disk herniation whose sciatica had not been relieved by conservative treatments. The results of the technique were considered effective in 94 patients (80.3%). The improvements were even more marked in patients with protrusion or prolapse type herniation. Reviewed with postoperative examinations using magnetic resonance imaging (MRI), excision of the herniated disk, resulting in decompression of the nerve root, may be correlated with the relief of symptoms. PMID:8425341

Sakou, T; Masuda, A

1993-01-01

219

Transforaminal Approach in Thoracal Disc Pathologies: Transforaminal Microdiscectomy Technique  

PubMed Central

Objective. Many surgical approaches have been defined and implemented in the last few decades for thoracic disc herniations. The endoscopic foraminal approach in foraminal, lateral, and far lateral disc hernias is a contemporary minimal invasive approach. This study was performed to show that the approach is possible using the microscope without an endoscope, and even the intervention on the discs within the spinal canal is possible by having access through the foramen. Methods. Forty-two cases with disc hernias in the medial of the pedicle were included in this study; surgeries were performed with transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin triangle, foramen was enlarged, and spinal canal was entered. Results. The procedure took 65 minutes in the average, and the mean bleeding amount was about 100cc. They were mobilized within the same day postoperatively. No complications were seen. Follow-up periods range between 5 and 84 months, and the mean follow-up period is 30.2 months. Conclusion. Transforaminal microdiscectomy is a method that can be performed in any clinic with standard spinal surgery equipment. It does not require additional equipment or high costs.

Dalbayrak, Sedat; Ozturk, Kadir; Y?lmaz, Mesut; Gokdag, Mahmut; Ayten, Murat

2014-01-01

220

[Coblation of nucleus pulposus in treatment of military men's lumbar disc protrusions].  

PubMed

Mini-invasive surgery is used more often for the treatment of spinal disc herniations today. Coblation is one of such contemporary methods. The aim of our investigation was to evaluate results of percutaneous disc nucleoplasty using coblation. 35 patients with disc protrusions diagnosed by MRI underwent operations using this method. We used Visual Analogue Pain Scale, took into account time of painless sitting, standing and walking position, and also patients' satisfaction to assess the immediate results of treatment and short-time outcomes. It was noted the better immediate results in group of operated patients in comparison with the non-operated group. It was obvious either on the table or the day after operation. There were 84 and 93% of good results in 3 months and in 1 year after operation, respectively. Coblation is definitely modern and effective way to treat disc protrusions with different types, sizes, and may be used in lumbar spine wherever. PMID:22888698

Manukovski?, V A; Badalov, V I; Tiulikov, K V; Korostelev, K E

2012-06-01

221

Automotive disc brake squeal  

NASA Astrophysics Data System (ADS)

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.

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

2003-10-01

222

Turbine disc sealing assembly  

DOEpatents

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.

Diakunchak, Ihor S.

2013-03-05

223

Video Discs in Education.  

ERIC Educational Resources Information Center

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)

Barker, Philip

1986-01-01

224

Bryan cervical disc prostheses: preservation of function over time.  

PubMed

Preserving the function of cervical disc prostheses, even over the short term, is a matter of concern among surgeons. Our case series highlights our results and protocol for increasing the probability of continued device function. Twenty-five consecutive patients with a mean (+/-SEM) age of 44.3+/-8.3 years underwent 29 cervical total disc arthroplasties for disc herniations. Three patients underwent primary bilevel arthroplasty, and one patient underwent a second arthroplasty for another herniation 2 years after the first. Prosthesis ranges of motion were measured using dynamic plain X-ray studies and compared to the ranges of motion of adjacent segments. At follow-up, all prostheses were in the correct location and without subsidence. All displayed firm secondary stability. One segment had fused. Twenty-eight of 29 devices were mobile an average of 9.5 degrees +/-4.7 degrees (range 3 degrees to 20 degrees ) (for all 29 devices the average movement angle was 9.2 degrees +/-5 degrees ; range 0 degrees to 20 degrees ), 25 upper adjacent segments were mobile an average of 10.9 degrees +/-4.5 degrees (range 2 degrees to 20 degrees ) (excluding the fused prosthesis: 11 degrees +/-4.6 degrees ) and 15 lower adjacent segments were mobile an average of 9.8 degrees +/-6 degrees (range 1 degrees to 21 degrees ). With our protocol, 28 of 29 cervical disc prostheses in 25 consecutive patients were mobile after an average of 22.3+/-9.4 months. Prosthesis motion was physiological and very similar to that of the healthy adjacent segments. Long-term studies including larger numbers of patients are required to validate our initial observations. PMID:19103491

Wenger, Markus; Hoonacker, Petrus van; Zachee, Benoit; Lange, Robert; Markwalder, Thomas-Marc

2009-02-01

225

Imbalanced Protein Expression Patterns of Anabolic, Catabolic, Anti-Catabolic and Inflammatory Cytokines in Degenerative Cervical Disc Cells: New Indications for Gene Therapeutic Treatments of Cervical Disc Diseases  

PubMed Central

Degenerative disc disease (DDD) of the cervical spine is common after middle age and can cause loss of disc height with painful nerve impingement, bone and joint inflammation. Despite the clinical importance of these problems, in current publications the pathology of cervical disc degeneration has been studied merely from a morphologic view point using magnetic resonance imaging (MRI), without addressing the issue of biological treatment approaches. So far a wide range of endogenously expressed bioactive factors in degenerative cervical disc cells has not yet been investigated, despite its importance for gene therapeutic approaches. Although degenerative lumbar disc cells have been targeted by different biological treatment approaches, the quantities of disc cells and the concentrations of gene therapeutic factors used in animal models differ extremely. These indicate lack of experimentally acquired data regarding disc cell proliferation and levels of target proteins. Therefore, we analysed proliferation and endogenous expression levels of anabolic, catabolic, ant-catabolic, inflammatory cytokines and matrix proteins of degenerative cervical disc cells in three-dimensional cultures. Preoperative MRI grading of cervical discs was used, then grade III and IV nucleus pulposus (NP) tissues were isolated from 15 patients, operated due to cervical disc herniation. NP cells were cultured for four weeks with low-glucose in collagen I scaffold. Their proliferation rates were analysed using 3-(4, 5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide. Their protein expression levels of 28 therapeutic targets were analysed using enzyme-linked immunosorbent assay. During progressive grades of degeneration NP cell proliferation rates were similar. Significantly decreased aggrecan and collagen II expressions (P<0.0001) were accompanied by accumulations of selective catabolic and inflammatory cytokines (disintegrin and metalloproteinase with thrombospondin motifs 4 and 5, matrix metalloproteinase 3, interleukin-1?, interleukin-1 receptor) combined with low expression of anti-catabolic factor (metalloproteinase inhibitor 3) (P<0.0001). This study might contribute to inhibit inflammatory catabolism of cervical discs.

Mern, Demissew S.; Beierfu?, Anja; Fontana, Johann; Thome, Claudius; Hegewald, Aldemar A.

2014-01-01

226

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

PubMed

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

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

2011-08-01

227

Herniation of the cervical disk in plastic surgeons.  

PubMed

Herniations of the cervical disk in plastic surgeons are far more common in practice than the paucity of reported cases would indicate. A likely explanation may be the peculiar, nonergonomic positions that plastic surgeons must hold during surgery while wearing a headlight and loupes. From January 2003 to December 2006, at Tri-Service General Hospital, Taiwan, 4 plastic surgeons experienced herniations of the cervical disk. Magnetic resonance imaging study indicated there was disk herniation or bulging with spinal cord impingement. Two plastic surgeons received cervical diskectomy, corpectomy with strut reconstruction using titanium cages. These 2 surgeons were symptom-free 2 years after their operations. The other 2 plastic surgeons were under conservative physical therapy with persistent symptoms. The clinical evidence indicated that cervical disk herniation is an occupational hazard in plastic surgeons. To prevent prolonged hyperflexion and twisting of the neck, we proposed wearing a cervical brace during surgery for the plastic surgeons at Tri-Service-General Hospital since January 2008. No more plastic surgeons have experienced herniation of the cervical disk since then. The results indicated that wearing a cervical brace may be an effective measure to protect plastic surgeons from cervical disk disease. PMID:23154341

Tzeng, Yuan-Sheng; Chen, Shyi-Gen; Chen, Tim-Mo

2012-12-01

228

5-Millimeter Trocar-Site Bowel Herniation Following Laparoscopic Surgery  

PubMed Central

Background and Objectives: This is a case report of a 5-mm trocar-site large bowel herniation following laparoscopic tubal sterilization. During laparoscopic sterilization, the 5-mm port site was closed initially. Large bowel herniation was recognized at the end of the case and managed immediately by laparoscopically reducing the hernia and closing the port site without any short- or long-term complications. Trocar-site bowel hernia is a rare complication after laparoscopic surgery. It is usually associated with trocar size >10mm. We describe a case of bowel herniation through a 5-mm trocar site, which was managed after laparoscopic surgery. Case Report: A 36-year-old multigravid patient underwent a laparoscopic tubal fulguration. Two 5-mm ports were used for the procedure. At the end of the procedure, the lateral trocar site was found to have fat protrusion that looked like appendices epiploicae. A laparoscopic camera was reintroduced into the abdominal cavity that showed a large bowel herniation through the 5-mm lateral port site. The hernia was reduced laparoscopically, and the fascial defect was repaired. Conclusion: Bowel herniation can occur through a 5-mm port. All port sites should be closed to avoid such complications.

Chung, Maurice; Horrigan, Terrence; Manahan, Kelly; Geisler, John P.

2012-01-01

229

Effectiveness and cost-effectiveness of rehabilitation after lumbar disc surgery (REALISE): design of a randomised controlled trial  

PubMed Central

Background Patients who undergo lumbar disc surgery for herniated discs, are advocated two different postoperative management strategies: a watchful waiting policy, or referral for rehabilitation immediately after discharge from the hospital. A direct comparison of the effectiveness and cost-effectiveness of these two strategies is lacking. Methods/Design A randomised controlled trial will be conducted with an economic evaluation alongside to assess the (cost-) effectiveness of rehabilitation after lumbar disc surgery. Two hundred patients aged 18–70 years with a clear indication for lumbar disc surgery of a single level herniated disc will be recruited and randomly assigned to either a watchful waiting policy for first six weeks or exercise therapy starting immediately after discharge from the hospital. Exercise therapy will focus on resumption of activities of daily living and return to work. Therapists will tailor the intervention to the individual patient’s needs. All patients will be followed up by the neurosurgeon six weeks postoperatively. Main outcome measures are: functional status, pain intensity and global perceived recovery. Questionnaires will be completed preoperatively and at 3, 6, 9, 12 and 26 weeks after surgery. Data will be analysed according to the intention-to-treat principle, using a linear mixed model for continuous outcomes and a generalised mixed model for dichotomous outcomes. The economic evaluation will be performed from a societal perspective. Discussion The results of this trial may lead to a more consistent postoperative strategy for patients who will undergo lumbar disc surgery. Trial registration Netherlands Trial Register: NTR3156

2013-01-01

230

Cervical lung lobe herniation in dogs identified by fluoroscopy  

PubMed Central

This study aimed to determine the frequency of cervical lung lobe herniation (CLLH) in dogs evaluated fluoroscopically and to identify associated characteristics. Reports of diagnostic procedures and patient summaries from 2008 to 2010 were reviewed retrospectively. Signalment, body weight, duration of cough, presence of heart murmur and airway collapse, and radiographic findings were compared between dogs with and without CLLH. Of the 121 dogs that were examined, CLLH occurred in 85 (70%). The extra-thoracic trachea kinked during herniation in 33 (39%) dogs with CLLH. Collapse of the intra-thoracic trachea (assessed fluoroscopically or bronchoscopically) and collapse of major bronchi (assessed fluoroscopically) were strongly associated with CLLH. Although redundant dorsal tracheal membrane on radiographs was associated with CLLH, extra-thoracic tracheal collapse, assessed fluoroscopically or bronchoscopically, was not. No other associations were found. Cervical lung lobe herniation was present in most dogs evaluated during cough and was associated with intra-thoracic large airway collapse, but not duration of cough.

Nafe, Laura A.; Robertson, Ian D.; Hawkins, Eleanor C.

2013-01-01

231

Nontraumatic Acute Paraplegia Associated With Cervical Disk Herniation  

PubMed Central

Background: Acute paraplegia is a true emergency. It is often the result of trauma but is rarely reported in association with cervical disk herniation in patients without antecedent injury. Methods: Case report. Findings: This 75-year-old man presented with acute paraplegia due to severe compression of the spinal cord by herniation of the C4-C5 cervical disk. He underwent emergency diskectomy and anterior fusion. Postoperatively, his neurologic functions improved gradually. Conclusions: Cervical disk herniation should be considered in the differential diagnosis of nontraumatic acute paraplegia. Pre-existing narrowed canal is an important predisposing factor and excessive neck movements are believed to be triggering factors. Immediate early decompressive surgery is recommended to avoid irreversible progression of neurologic deficit.

Liu, Chao; Huang, Yue; Cai, Hong-Xin; Fan, Shun-Wu

2010-01-01

232

Potential regenerative treatment strategies for intervertebral disc degeneration in dogs.  

PubMed

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

Bach, Frances C; Willems, Nicole; Penning, Louis C; Ito, Keita; Meij, Björn P; Tryfonidou, Marianna A

2014-01-01

233

Syndrome of transtentorial herniation: is vertical displacement necessary?  

PubMed Central

MRI from a comatose patient with a massive acute subdural haematoma showed most of the features of transtentorial herniation described in the classic pathology literature. In addition to encroachment on the perimesencephalic cisterns, infarction in the anterior and posterior cerebral artery territories, ischaemic change in the lower diencephalon, and ventricular enlargement were visualised. Despite the clinical syndrome and these secondary changes due to compression, there was only approximately 2 mm of downward displacement of the upper brainstem compared with 13 mm horizontal displacement. Although tissue shifts adjacent to the tentorial aperture cause brainstem and vascular compression, these changes may occur with minimal downward herniation. Images

Ropper, A H

1993-01-01

234

Surgical intradiscal decompression without annulotomy in lumbar disc herniation using a coblation device: preliminary results  

Microsoft Academic Search

Annulotomy is a mandatory step to perform intradiscal decompression to resolve a disco radicular conflict. However, this manoeuvre can lead to post surgical complications such as vertebral instability and back pain.

A. P. Fabrizi; M. Zucchelli

235

Twin Disc Gear Tooth Simulator.  

National Technical Information Service (NTIS)

This report describes the results of an effort to develop a disc on disc test rig for evaluating lubricant load capacity. The goal of the program has been to develop a reliable disc on disc (or Twin Disc) test rig capable of providing more reliable and lo...

M. W. Eusepi J. F. Dill

1994-01-01

236

Chronic Tonsillar Herniation and Crouzon’s Syndrome  

Microsoft Academic Search

Patients born with craniofacial syndromes such as Crouzon’s syndrome will often develop hydrocephalus after their initial craniofacial reconstructive procedures. We have treated 10 patients with Crouzon’s syndrome; 5 patients required a shunting procedure after cranial remodeling. Each of these 5 shunted patients later demonstrated chronic tonsillar herniation on magnetic resonance imaging studies. One of these patients exhibited signs of pseudotumor

Paul M. Francis; Stephen Beals; Harold L. Rekate; Hal W. Pittman; Kim Manwaring; Jacque Reiff

1992-01-01

237

Risk factors for developing brain herniation during diabetic ketoacidosis  

Microsoft Academic Search

The charts were reviewed of children admitted in diabetic ketoacidosis (DKA) to one hospital within 12 years. The frequency of brain herniation after admission was nine of 153 children admitted for one or more episodes of DKA. The severity of acidosis and hypercapnea were the most reliable risk factors. None of the children who maintained a blood pH greater than

C. Patrick Mahoney; Brien W Vlcek; Michael DelAguila

1999-01-01

238

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

NASA Astrophysics Data System (ADS)

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.

Ghosh, Subarna; Chaudhary, Vipin; Dhillon, Gurmeet

2013-03-01

239

Neonatal posterior fossa haemorrhage associated with vacuum extractor.  

PubMed

We report one case of posterior fossa intracranial haemorrhage in a full-term Malay baby boy following vacuum assisted delivery. The patient, a term baby boy was delivered by a vacuum extraction and later developed signs of increased intracranial pressure 72 hours after birth. Computed tomography (CT) of the brain showed a posterior fossa intracranial haemorrhage with acute obstructive hydrocephalus. He was initially treated with isolated ventricular shunting which later caused an upward cerebellar herniation. An immediate suboccipital craniectomy for evacuation of cerebellar haematoma was performed which resulted in a gradual recovery. PMID:16708744

Ghani, A R I; Prakash, R G; Abdullah, J

2006-03-01

240

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

PubMed Central

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.

Kim, Hyeong-Suk; Park, Jung-Soo

2012-01-01

241

Intradural migration of a sequestrated lumbar disc fragment masquerading as a spinal intradural tumor.  

PubMed

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

Kim, Hyeong-Suk; Eun, Jong-Pil; Park, Jung-Soo

2012-08-01

242

Lift the quilt in case of atrial fibrillation and disc prolapse  

PubMed Central

Background Peripheral embolism to the lower extremities may mimic disc prolapse with severe consequences. Case report A 71-year-old male with a history of chronic alcoholism developed low back pain radiating to both lower extremities in a nonradicular distribution and bilateral dysesthesias of the distal lower legs after lifting a heavy weight. Given that magnetic resonance imaging (MRI) of the lumbar spine showed disc herniation in L3/4 and L4/5, he was scheduled for laminectomy but was unable to undergo surgery due to thrombocytopenia. After transfer to another hospital, persistence of symptoms and signs, absent pulses on the distal lower legs, and rhabdomyolysis with temporary renal insufficiency, peripheral embolism with compartment syndrome was suspected. Magnetic resonance angiography revealed occlusion of the right superficial femoral artery and long high-grade stenosis of the left superficial and profound femoral arteries and distal arteries. He successfully underwent embolectomy and fasciotomy. Conclusions If lumbar pain is not radicular, peripheral pulses are minimally palpable, and distal limbs are cold and show livid decolorization, peripheral embolism is much more likely than disc herniation, particularly if the patient’s history is positive for atrial fibrillation. MRI of the lumbar spine must be interpreted in conjunction with clinical presentation.

Bastovansky, Adam; Ziegler, Kathrin; Stollberger, Claudia; Finsterer, Josef

2012-01-01

243

Tissue-engineered intervertebral discs produce new matrix, maintain disc height, and restore biomechanical function to the rodent spine  

PubMed Central

Lower back and neck pain are leading physical conditions for which patients see their doctors in the United States. The organ commonly implicated in this condition is the intervertebral disc (IVD), which frequently herniates, ruptures, or tears, often causing pain and limiting spinal mobility. To date, approaches for replacement of diseased IVD have been confined to purely mechanical devices designed to either eliminate or enable flexibility of the diseased motion segment. Here we present the evaluation of a living, tissue-engineered IVD composed of a gelatinous nucleus pulposus surrounded by an aligned collagenous annulus fibrosus in the caudal spine of athymic rats for up to 6 mo. When implanted into the rat caudal spine, tissue-engineered IVD maintained disc space height, produced de novo extracellular matrix, and integrated into the spine, yielding an intact motion segment with dynamic mechanical properties similar to that of native IVD. These studies demonstrate the feasibility of engineering a functional spinal motion segment and represent a critical step in developing biological therapies for degenerative disc disease.

Bowles, Robby D.; Gebhard, Harry H.; Hartl, Roger; Bonassar, Lawrence J.

2011-01-01

244

Vacuum Technology  

SciTech Connect

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.

Biltoft, P J

2004-10-15

245

Brain herniations into the dural venous sinuses or calvarium: MRI of a recently recognized entity.  

PubMed

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

Battal, Bilal; Castillo, Mauricio

2014-02-01

246

Chronic uncal herniation secondary to posterior fossa shunting: case report and literature review  

Microsoft Academic Search

Introduction  Chronic herniation syndromes other than tonsillar herniation are not well-recognized. Transtentorial uncal herniation in its\\u000a chronic form has been reported in only few case reports (Horowitz et al., J Neuroimaging 12:78–79, 2002; Naidich et al., Radiology 158:431–434, 1986; Ng and Valiante, J Clin Neurosci 16:944, 2009; Ng and Valiante, J Clin Neurosci 16:984, 2009). We hereby illustrate a case with

Suhas Udayakumaran; Liat Ben Sira; Shlomi Constantini

2010-01-01

247

Vacuum aperture isolator for retroreflection from laser-irradiated target  

DOEpatents

The disclosure is directed to a vacuum aperture isolator for retroreflection of a laser-irradiated target. Within a vacuum chamber are disposed a beam focusing element, a disc having an aperture and a recollimating element. The edge of the focused beam impinges on the edge of the aperture to produce a plasma which refracts any retroreflected light from the laser's target.

Benjamin, Robert F. (Los Alamos, NM); Mitchell, Kenneth B. (Los Alamos, NM)

1980-01-01

248

Skull malformation and cerebellar herniation in captive African lions.  

PubMed

Thickening of the cranial vault with a resulting cerebellar herniation is described in a series of litters of lion cubs, all with the same parents, one of whom was also very mildly affected. This animal, when mated to his daughter, also produced affected cubs. The aetiology of the condition is discussed and it is considered that vitamin A deficiency may have been less important than has been suggested by other authors. PMID:847879

Baker, J R; Lyon, D G

1977-02-01

249

Herniation through the foramen of Morgagni: early diagnosis and treatment  

Microsoft Academic Search

The majority of congenital diaphragmatic hernias (CDH) occur through the foramen of Bochdalek; herniation through the foramen\\u000a of Morgagni (MH) is rare. Fifteen children (12 males and 3 females) with congenital MH (7 right, 3 left, 5 bilateral) were\\u000a treated over a period of 15 years, comprising 11% of a total of 135 children with different types of CDH. The

Ahmed H. Al-Salem; Akhter Nawaz; Hilal Matta; Alic Jacobsz

2002-01-01

250

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

PubMed Central

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.

Wenger, Markus; Markwalder, Thomas-Marc

2010-01-01

251

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

PubMed

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

Wenger, Markus; Markwalder, Thomas-Marc

2010-01-01

252

Vacuum mechatronics  

NASA Technical Reports Server (NTRS)

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.

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

1989-01-01

253

Vacuum Virtues  

ERIC Educational Resources Information Center

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…

Rathey, Allen

2007-01-01

254

Vacuum regulator  

Microsoft Academic Search

This patent describes a vacuum regulator for automotive vehicles of the type having an engine exhaust system and a computer controlled exhaust gas recirculation system. The vacuum regulator consists of: a housing having separate interconnected upper and lower portions; a solenoid in the housing including a bobbin having a valve seat; a mechanism for defining an inlet for atmospheric air

M. Slavin; R. P. Fontecchio

1986-01-01

255

Acute renal failure caused by bilateral ureteral herniation through the sciatic foramen.  

PubMed

Ureteral herniation is rare. Only a few cases of bilateral ureterosciatic herniation have been reported. We report the case of a 74-year-old woman with flank pain and acute renal failure. The initial ultrasound scan showed bilateral hydronephrosis. Follow-up computed tomography imaging demonstrated sciatic herniation of both ureters, causing bilateral hydronephrosis and hydroureter. The patient underwent bilateral retrograde ureterography and ureteral stent placement, with improvement in renal function to normal limits. Observation after stent removal demonstrated recurrent sciatic herniation of both ureters. Definitive surgical correction was performed by way of laparoscopic bilateral ureterolysis and sciatic notch hernia repair using mesh. PMID:23602799

Whyburn, James J; Alizadeh, Ahmadreza

2013-06-01

256

Progressive cerebellar tonsillar herniation with recurrent divergence insufficiency esotropia.  

PubMed

The Chiari malformations are characterized by herniation of posterior fossa contents through the foramen magnum. Chiari I malformation is currently defined as ectopia of the cerebellar tonsils more than 5 mm below the foramen magnum. Extension of the cerebellar tonsils up to 3 mm may be found in the normal population. Although Chiari malformations are congenital, symptoms often do not manifest until the third and fourth decades of life, or even later. Patients usually present with headache, lower cranial nerve palsies, downbeat nystagmus, ataxia, or dissociated anesthesia of the trunk and extremities. Definitive diagnosis is made by magnetic resonance imaging (MRI), which shows the compressed tonsils extending through the foramen magnum into the cervical subarachnoid space. One of the rare presenting signs of Chiari I malformations is acquired esotropia with a divergence insufficiency pattern. We report such a case in which the initial neuroimaging showed tonsillar herniation, but of insufficient magnitude to meet diagnostic criteria for Chiari I malformation. When the strabismus recurred after initially successful eye muscle surgery, follow-up scan showed progressive tonsillar herniation. PMID:15226735

Pokharel, Dipesh; Siatkowski, R Michael

2004-06-01

257

Tethered thoracic cord resulting from spinal cord herniation.  

PubMed

Tethered cord syndrome (TCS) usually involves tethering of the lower cord at the conus medullaris from dural abnormalities, but may occur after spinal cord herniation. A tethered thoracic spinal cord is rare. We present an unusual case of a 30-year-old woman with a history of myelopathy presumed to be secondary to T6 cord compression resulting from T6-T8 arachnoid cyst. She continued to deteriorate after partial excision of the cyst. Repeat magnetic resonance imaging suggested recurrence of the presumed arachnoid cyst with cord compression and showed tethering at T6-T8. Surgical exploration revealed myelocele with cord herniation through the anterior thoracic dura. Pathologic diagnosis showed neural tissue with gliosis. After physical therapy treatments, the patient had increased lower extremity strength, ambulated with a cane, and regained some bladder control. Progressive myelopathy may represent tethering of the cord resulting from cord herniation. Early recognition of TCS, even in patients with minimal neurologic deficits, could prevent progressive disability. PMID:9161375

Henry, A; Tunkel, R; Arbit, E; Ku, A; Lachmann, E

1997-05-01

258

Multipoint determination of pressure-volume curves in human intervertebral discs.  

PubMed Central

To gain further insight into the biomechanics of the human intervertebral disc and to determine a potential mechanism for causation and relief of symptoms related to a herniated disc, the pressure-volume relation was determined within the nucleus pulposus. Pressure was measured continuously within the nucleus pulposus in 17 intact lumbar discs from human cadavers by means of a miniature strain gauge at the tip of a size 4 French (1.3 mm) catheter inserted into the nucleus pulposus. The volume of the nucleus pulposus was increased at the slow, continuous rate of 0.034 ml/min by the pump regulated infusion of saline coloured with methylene blue. In 12 unloaded discs, nucleus pulposus pressure rose in a linear fashion (linear r = 0.96) from an initial mean pressure of 174 (SD 81) kPa. The mean rate of pressure rise was 327 (SD 109) kPa/ml volume increase. The peak pressure measured was 550 kPa; this was slightly higher than the capability of the transducer. Similar linear relations were obtained during infusion of saline into five vertically loaded discs fixed at the deformation produced by a 9.1 kg weight. The data define the pressure-volume relation within the disc and show that the nucleus pulposus, surrounded by the relatively inelastic annulus and the solid vertebral end plates, has the properties of a tight hydraulic space in which a large pressure rise will regularly result from a small increase in volume. Presumably the opposite is also true. The data may provide a biomechanical basis for the physiological variation in symptoms related to the disc, and for any benefits obtained from interventions designed to remove disc tissue.

Ranu, H S

1993-01-01

259

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

PubMed Central

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.

Fernando, Magage; Schultz, Meleesa J.

2014-01-01

260

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

PubMed

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

Fernando, Magage; Schultz, Meleesa J

2014-01-01

261

Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks  

Microsoft Academic Search

Objective: To describe the use of intermittent cervical traction in managing 4 patients with cervical radiculopathy and large-volume herniated disks. Clinical Features: Four patients had neck pain radiating to the arm. The clinical examination was typical in all cases for radiculopathy of cervical origin. Magnetic resonance imaging (MRI) of the cervical spine revealed large-volume herniated disks in all patients. Intervention

Constantine Constantoyannis; Demetres Konstantinou; Harry Kourtopoulos; Nicolas Papadakis

2002-01-01

262

Focal bone tracer uptake associated with a herniation pit of the femoral neck  

Microsoft Academic Search

The herniation pit of the femoral neck is a common radiographic lesion whose pathogenesis has been described by Pitt et al and reported as negative on bone scanning. This case report demonstrates increased uptake of Tc-99m MDP in a herniation pit of the femoral neck.

CHARLES B. THOMASON; EUGENE D. SILVERMAN; RICHARD D. WALTER; ROBERT OLSHAKER

1983-01-01

263

Handmade compact disc spectroscope  

NASA Astrophysics Data System (ADS)

Astronomy data center held some programs for the open house day of 2005, and a program of handmade compact disc spectroscope in craft corner received a favorable review. We report a summary of the program and the product in this article.

Kawanomoto, Satoshi

2006-10-01

264

The Teddy Bears' Disc.  

ERIC Educational Resources Information Center

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)

Laurillard, Diana

1985-01-01

265

Head Disc Interface Design.  

National Technical Information Service (NTIS)

A recording medium for heat assisted magnetic recording includes a magnetic disc having a data zone portion and a non-data zone portion. A liquid lubricant is disposed on the non-data zone portion, and a solid lubricant disposed on the data zone portion. ...

C. L. Platt L. Li Y. T. Hsia

2004-01-01

266

Vortices in Astrophysical Discs  

Microsoft Academic Search

Dynamical theory of astrophysical discs predicts two different kinds of vortices: ``linear'' and ``nonlinear.'' If galactic spiral arms are density waves, linear vortices in the velocity field are predicted at infinitesimal amplitude, and both spirals and vortices grow together at equal rate. The centres of linear vortices lie in the neighborhood of the corotation circle and between spiral arms for

A. M. Fridman; O. V. Khoruzhii

1999-01-01

267

The Chemistry of Optical Discs.  

ERIC Educational Resources Information Center

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)

Birkett, David

2002-01-01

268

Revival of the Jumping Disc  

ERIC Educational Resources Information Center

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…

Ucke, C.; Schlichting, H-J.

2009-01-01

269

Diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy.  

PubMed

Minimally invasive techniques are increasingly being used for oesophagectomy. Diaphragmatic hernia is a rare complication of gastroplasty in open surgery. One of the advantages of the laparoscopic technique, the lack of peritoneal adhesions, may lead to an increased rate of this complication. We report two cases of diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy out of a series of 44 laparoscopic gastroplasties performed over 33 months. We discuss some technical aspects related to its occurrence. Prevention should include a limited crural division and fixation of the gastric tube to the diaphragmatic crura at primary surgery. PMID:16364043

Fumagalli, U; Rosati, R; Caputo, M; Bona, S; Zago, M; Lutmann, F; Peracchia, A

2006-01-01

270

Head Injury and Early Signs of Tentorial Herniation  

PubMed Central

In 100 patients intracranial exploration was done soon after severe head injury when signs of transtentorial herniation were present. A third of patients had extracerebral hematomas shown on initial burr hole examination. An additional 18 percent had parenchymal clots of clinical significance disclosed only by angiography after burr hole exploration or at autopsy. Half the patients in whom exploration was done did not have intracranial hematomas of sufficient size to warrant an operative approach. Detailed neurological examinations soon after injury and the availability of more rapid diagnostic tools may improve the accuracy of early diagnosis and allow more specific prognostication in patients with severe head injury.

Hoff, Julian T.; Spetzler, Robert; Winestock, David

1978-01-01

271

Delayed presentation of a traumatic diaphragmatic rupture with intrapericardial herniation.  

PubMed

Thoracic and abdominal blunt traumas are the major causes of diaphragmatic rupture. These ruptures may be recognized at the time of the initial trauma, but are diagnosed months or even years later during the workup for related symptoms. We present herein a patient who suffered from abdominal pain and dyspnea years after a motor vehicle accident. A chest computed tomography (CT) demonstrated diaphragmatic rupture with intrapericardial herniation of intraabdominal organs. Exploratory laparotomy confirmed the diagnosis. In this report, we describe our management of this unusual diaphragmatic rupture. PMID:21258833

Cipe, G; Genç, V; Uzun, C; Atasoy, C; Erkek, B

2012-08-01

272

Scalelength of disc galaxies  

NASA Astrophysics Data System (ADS)

We have derived disc scalelengths for 30374 non-interacting disc galaxies in all five Sloan Digital Sky Survey (SDSS) bands. Virtual Observatory methods and tools were used to define, retrieve and analyse the images for this unprecedentedly large sample classified as disc/spiral galaxies in the LEDA catalogue. Cross-correlation of the SDSS sample with the LEDA catalogue allowed us to investigate the variation of the scalelengths for different types of disc/spiral galaxies. We further investigate asymmetry, concentration and central velocity dispersion as indicators of morphological type, and are able to assess how the scalelength varies with respect to galaxy type. We note, however, that the concentration and asymmetry parameters have to be used with caution when investigating type dependence of structural parameters in galaxies. Here, we present the scalelength derivation method and numerous tests that we have carried out to investigate the reliability of our results. The average r-band disc scalelength is 3.79kpc, with an rms dispersion of 2.05kpc, and this is a typical value irrespective of passband and galaxy morphology, concentration and asymmetry. The derived scalelengths presented here are representative for a typical galaxy mass of 1010.8+/-0.54Msolar, and the rms dispersion is larger for more massive galaxies. Separating the derived scalelengths for different galaxy masses, the r-band scalelength is 1.52 +/- 0.65kpc for galaxies with total stellar mass 109-1010Msolar and 5.73 +/- 1.94kpc for galaxies with total stellar mass between 1011 and 1012Msolar. Distributions and typical trends of scalelengths have also been derived in all the other SDSS bands with linear relations that indicate the relation that connect scalelengths in one passband to another. Such transformations could be used to test the results of forthcoming cosmological simulations of galaxy formation and evolution of the Hubble sequence.

Fathi, Kambiz; Allen, Mark; Boch, Thomas; Hatziminaoglou, Evanthia; Peletier, Reynier F.

2010-08-01

273

Efficacy of percutaneous laser disc decompression on lumbar spinal stenosis.  

PubMed

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

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

2014-05-01

274

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

PubMed Central

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 7.58±0.86, after three weeks 2.75 ±1.42 and after two years 2.64±2.14). 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.

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

2009-01-01

275

Vacuum Gauges  

NSDL National Science Digital Library

This is a description for a learning module from Maricopa Advanced Technology Education Center. This PDF describes the module; access may be purchased by visiting the MATEC website. Semiconductor manufacturing equipment requires the use of many different types of vacuum gauges. Selection is based on range of process operations and production requirements. This MATEC module explores the theory and functionality of vacuum gauges and provides many examples of different types of gauges. The focus is on understanding the operating ranges and application constraints of each type of gauge. Mathematical equations are used to explain calibration, sensitivity, and overall operations of each type of gauge.

2012-11-28

276

Disc degeneration in Scheuermann disease.  

PubMed

Comparison of the radiographic signs of Scheuermann disease and the corresponding disc degeneration on thoracolumbar magnetic resonance (MR) images was made in 21 young patients. Marginal sclerosis, Schmorl nodes and narrowed disc spaces, but not irregular or wedge-shaped end-plates, were significantly associated with disc degeneration. Fifty-five percent of the discs in the patients with Scheuermann disease were abnormal on MRI, compared with 10% in asymptomatic controls. Our study confirms that thoracolumbar disc degeneration is enhanced in 20-year-old patients with low back pain who have radiological evidence of Scheuermann disease. PMID:2588031

Paajanen, H; Alanen, A; Erkintalo, M; Salminen, J J; Katevuo, K

1989-01-01

277

Cumulative occupational lumbar load and lumbar disc disease - results of a German multi-center case-control study (EPILIFT)  

PubMed Central

Background The to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study. Methods In four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg), patients seeking medical care for pain associated with clinically and radiologically verified lumbar disc herniation (286 males, 278 females) or symptomatic lumbar disc narrowing (145 males, 206 females) were prospectively recruited. Population control subjects (453 males and 448 females) were drawn from the regional population registers. Cases and control subjects were between 25 and 70 years of age. In a structured personal interview, a complete occupational history was elicited to identify subjects with certain minimum workloads. On the basis of job task-specific supplementary surveys performed by technical experts, the situational lumbar load represented by the compressive force at the lumbosacral disc was determined via biomechanical model calculations for any working situation with object handling and load-intensive postures during the total working life. For this analysis, all manual handling of objects of about 5 kilograms or more and postures with trunk inclination of 20 degrees or more are included in the calculation of cumulative lumbar load. Confounder selection was based on biologic plausibility and on the change-in-estimate criterion. Odds ratios (OR) and 95% confidence intervals (CI) were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males) or psychosocial strain at work (in females), respectively. To further elucidate the contribution of past physical workload to the development of lumbar disc diseases, we performed lag-time analyses. Results We found a positive dose-response relationship between cumulative occupational lumbar load and lumbar disc herniation as well as lumbar disc narrowing among men and women. Even past lumbar load seems to contribute to the risk of lumbar disc disease. Conclusion According to our study, cumulative physical workload is related to lumbar disc diseases among men and women.

Seidler, Andreas; Bergmann, Annekatrin; Jager, Matthias; Ellegast, Rolf; Ditchen, Dirk; Elsner, Gine; Grifka, Joachim; Haerting, Johannes; Hofmann, Friedrich; Linhardt, Oliver; Luttmann, Alwin; Michaelis, Martina; Petereit-Haack, Gabriela; Schumann, Barbara; Bolm-Audorff, Ulrich

2009-01-01

278

Biomechanics of Disc Degeneration  

PubMed Central

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.

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

2012-01-01

279

Intervertebral Disc Degeneration  

PubMed Central

Degeneration of the intervertebral disk (IVD) is a major pathological process implicated in low back pain and is a prerequisite to disk herniation. Although mechanical stress is an important modulator of the degeneration, the underlying molecular mechanism remains unclear. The association of human IVD degeneration, assessed by magnetic resonance imaging, with annulus fibrosus cell apoptosis and anti-cytochrome c staining revealed that the activation of the mitochondria-dependent apoptosome was a major event in the degeneration process. Mouse models of IVD degeneration were used to investigate the role of the mechanical stress in this process. The application of mechanical overload (1.3 MPa) for 24 hours induced annulus fibrosus cell apoptosis and led to severe degeneration of the mouse disks. Immunostaining revealed cytochrome c release but not Fas-L generation. The role of the caspase-9-dependent mitochondrial pathway in annulus fibrosus cell apoptosis induced by overload was investigated further with the use of cultured rabbit IVD cells in a stretch device. Mechanical overload (15% area change) induced apoptosis with increased caspase-9 activity and decreased mitochondrial membrane potential. Furthermore, Z-LEHD-FMK, a caspase-9 inhibitor, but not Z-IETD-FMK, a caspase-8 inhibitor, attenuated the overload-induced apoptosis. Our results from human samples, mouse models, and annulus fibrosus culture experiments demonstrate that the mechanical overload-induced IVD degeneration is mediated through the mitochondrial apoptotic pathway in IVD cells.

Rannou, Francois; Lee, Tzong-Shyuan; Zhou, Rui-Hai; Chin, Jennie; Lotz, Jeffrey C.; Mayoux-Benhamou, Marie-Anne; Barbet, Jacques Patrick; Chevrot, Alain; Shyy, John Y.-J.

2004-01-01

280

Optic disc vasculitis  

Microsoft Academic Search

Background: Our studies had indicated that optic disc vasculitis (ODV) is a distinct clinical entity. We investigated the presentation\\u000a and clinical characteristics of ODV and determined the efficacy of systemic corticosteroids in its management. Methods: From 1973 to 1997, we investigated 32 patients (34 eyes) with ODV. The information was obtained by complete medical and ophthalmic\\u000a history taking and a

K. T. Oh; D. M. Oh; S. S. Hayreh

2000-01-01

281

Total disc replacement.  

PubMed

Total disc replacement (TDR) (partial disc replacement will not be described) has been used in the lumbar spine since the 1980s, and more recently in the cervical spine. Although the biomechanical concepts are the same and both are inserted through an anterior approach, lumbar TDR is conventionally indicated for chronic low back pain, whereas cervical TDR is used for soft discal hernia resulting in cervicobrachial neuralgia. The insertion technique must be rigorous, with precise centering in the disc space, taking account of vascular anatomy, which is more complex in the lumbar region, particularly proximally to L5-S1. All of the numerous studies, including prospective randomized comparative trials, have demonstrated non-inferiority to fusion, or even short-term superiority regarding speed of improvement. The main implant-related complication is bridging heterotopic ossification with resulting loss of range of motion and increased rates of adjacent segment degeneration, although with an incidence lower than after arthrodesis. A sufficiently long follow-up, which has not yet been reached, will be necessary to establish definitively an advantage for TDR, particularly in the cervical spine. PMID:24412045

Vital, J-M; Boissière, L

2014-02-01

282

Advances in endoscopic disc and spine surgery: foraminal approach.  

PubMed

Endoscopic spine surgery is evolving rapidly due to improvements in surgical technique, endoscope design, and instrumentation. The current technique expands on the basic features and principles of Kambin's access to the spine through the triangular zone. A standardized method for foraminal surgery, the Yeung Endoscopic Spine System (YESS) (Richard Wolf Surgical Instrument Company, Vernon Hills, Illinois, USA) technique is proposed: (1) A protocol for optimal instrument placement by identifying the skin window, annular window, anatomic disc center, and disc inclination plane through topographical coordinates calculated by lines drawn on the skin from the C-Arm image. Adjustments in the trajectory are made to accommodate individual anatomic considerations and the pathologic disorders to be accessed. (2) Evocative Chromo-Discography (Richard Wolf Surgical Instrument Company, Vernon Hills, Illinois, USA). (3) Selective Endoscopic Discectomy (Richard Wolf Surgical Instrument Company, Vernon Hills, Illinois, USA). (4) Thermal discoplasty and annuloplasty. (5) Endoscopic foraminoplasty. (6) Accessing the epidural space in the axilla between the traversing and exiting nerve root. (7) Partially resecting the posterior annulus to get beneath the herniated fragment, if needed. This technique allows access to the epidural space from the lumbar disc as far cephalad as the middle of the vertebral body or approximately 2-3 mm caudally. The foraminal approach is routinely accessible from T-10 to L4-5. L5-S1 can be accessed with special techniques that include foraminoplasty of the lateral facet. Surgical results continue to improve, consistent with refinement of indications and techniques for specific conditions treatable by this endoscopic method. PMID:12931309

Yeung, Anthony T; Yeung, Christopher A

2003-01-01

283

A painful sneeze: spontaneous thoracic lung herniation induced by vigorous sneeze.  

PubMed

Lung herniation, defined as the protrusion of lung tissue outside the normal boundaries of thoracic cage, is an unusual event. This most commonly occurs as a consequence of thoracic trauma. Spontaneous subtypes of lung herniation are rare with only a few cases reported in medical literature. We present a 63-year-old male who presented with spontaneously herniated lung after an episode of vigorous sneezing. The possible underlying mechanisms, important physical examination and diagnostic imaging findings, and aspects of management considerations are briefly discussed. PMID:24419190

Bhardwaj, Himanshu; Bhardwaj, Bhaskar; Youness, Houssein A

2014-01-01

284

Vacuum Technology: Vacuum Technology III  

NSDL National Science Digital Library

This is a link to a PDF version of lecture slides that discuss gas sources in a vacuum. The presentation explains concepts such as vapor pressure curves, thermal desorption and first and second order desorption. Keywords: Vaporization, desorption, diffusion, permeation, backstreaming

Rack, Philip D.

2012-12-12

285

Disc-mass distribution in star-disc encounters  

NASA Astrophysics Data System (ADS)

Aims: Investigations of stellar encounters in cluster environments have demonstrated their potential influence on the mass and angular momentum of protoplanetary discs around young stars. We investigated how far the initial surface density in the disc surrounding a young star influences the outcome of an encounter. Methods: The numerical method applied here allows us to determine the mass and angular momentum losses in an encounter for any initial disc-mass distribution. On the basis of a power-law ansatz for the surface density, ?(r) ? r - p, we perform a parameter study of star-disc encounters with different initial disc-mass distributions using N-body simulations. Results: We demonstrate that the shape of the disc-mass distribution has a significant impact on the quantity of the disc-mass and angular momentum losses in star-disc encounters. In particular, the results are most sensitive to how the outer parts of the disc are perturbed by high-mass stars. In contrast, disc-penetrating encounters lead more or less independently of the disc-mass distribution always to large losses. However, maximum losses are generally obtained for initially flat distributed disc material. Based on a parameter study, a fit formula is derived, describing how the relative mass and angular momentum loss depend on the initial disc-mass distribution index p. Encounters generally lead to a steepening of the density profile of the disc. The resulting profiles can have a r-2-dependence or an even steeper one that is independent of the initial distribution of the disc material. Conclusions: From observations, the initial density distribution in discs remains unconstrained, hence the strong dependence on the initial density distribution that we find here might require a revision of the effect of encounters in young stellar clusters. The steep surface density distributions induced by some encounters might be a prerequisite to the formation of planetary systems similar to our own Solar System. Appendices A and B are available in electronic form at http://www.aanda.org

Steinhausen, M.; Olczak, C.; Pfalzner, S.

2012-02-01

286

Surgical vs Nonoperative Treatment for Lumbar Disk Herniation  

PubMed Central

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

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

287

Pathophysiology of Degenerative Disc Disease  

PubMed Central

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.

2009-01-01

288

Enclosed rotary disc air pulser  

DOEpatents

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.

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

1989-01-01

289

Dynamics of warped accretion discs  

NASA Astrophysics Data System (ADS)

Accretion discs are present around both stellar-mass black holes in X-ray binaries and supermassive black holes in active galactic nuclei. A wide variety of circumstantial evidence implies that many of these discs are warped. The standard Bardeen-Petterson model attributes the shape of the warp to the competition between Lense-Thirring torque from the central black hole and viscous angular-momentum transport within the disc. We show that this description is incomplete in many accretion discs, and that torques from the companion star (for X-ray binaries) or the self-gravity of the disc (for active galactic nuclei) can play a major role in determining the properties of the warped disc. Including these effects leads to a rich set of new phenomena. For example, (i) when a companion star is present and the warp arises from a misalignment between the companion's orbital axis and the black hole's spin axis, there is no steady-state solution of the Pringle-Ogilvie equations for a warped disc when the viscosity falls below a critical value, which typically requires a disc aspect ratio ?10-3 in X-ray binaries; (ii) in AGN accretion discs, the warp can excite short-wavelength bending waves governed by the self-gravity of the disc, which propagate inwards with growing amplitude until they are damped by the disc viscosity. We show that both phenomena can occur for plausible values of the black hole and disc parameters, and briefly discuss their observational implications.

Tremaine, Scott; Davis, Shane W.

2014-06-01

290

Twin disc gear tooth simulator  

NASA Astrophysics Data System (ADS)

This report describes the results of an effort to develop a disc on disc test rig for evaluating lubricant load capacity. The goal of the program has been to develop a reliable disc on disc (or Twin Disc) test rig capable of providing more reliable and lower cost evaluation of lubricant load capacity than the Ryder gear test which is currently used. Disc rigs have been evaluated for this application in the past, but have failed to provide scuffing results which are comparable to those found in gear tests. The unique feature of the rig designed and evaluated under this program is a drive system design which varies the disc to disc sliding and rolling speeds in a fixed manner to simulate the combined rolling and sliding motion found in a gear tooth contact. Other features include a drive system design which insures that the same points on each disc always contact each other as they rotate, and material selection and heating system design for operation with experimental lubricants at temperatures up to 700 deg F.

Eusepi, Martin W.; Dill, James F.

1994-05-01

291

Numbered nasal discs for waterfowl  

USGS Publications Warehouse

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.

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

1964-01-01

292

Minimally invasive removal of a recurrent lumbar herniated nucleus pulposus by the small incised microendoscopic discectomy interlaminar approach.  

PubMed

In this report, we introduce two cases of recurrent herniated nucleus pulposus (HNP) at L5-S1 that were successfully removed using the small incised microendoscopic discectomy (sMED) technique, proposed by Dezawa and Sairyo in 2011. sMED was performed via the interlaminar approach with a percutaneous endoscope. The patients had previously underdone microendoscopic discectomy for HNP. For the recurrent HNP, the sMED interlaminar approach was selected because the HNP occurred at the level of L5-S1; the percutaneous endoscopic transforaminal approach was not possible for anatomical reasons. To perform sMED via the interlaminar approach, we employed new, specially made devices to enable us to use this technique. In conclusion, sMED is the most minimally invasive approach available for HNP, and its limitations have been gradually eliminated with the introduction specially made devices. In the near future, percutaneous endoscopic surgery could be the gold standard for minimally invasive disc surgery. PMID:22776341

Koga, S; Sairyo, K; Shibuya, I; Kanamori, Y; Kosugi, T; Matsumoto, H; Kitagawa, Y; Sumita, T; Dezawa, A

2012-02-01

293

Minimally invasive and simultaneous removal of herniated intracanal and extracanal lumbar nucleus pulposus with a percutaneous spinal endoscope.  

PubMed

Herniated nucleus pulposus (HNP) in the lumbar spine is usually found in the neural canal (in the intracanal space) and occasionally in the extracanal space, where it is known as a lateral HNP. HNP is rarely found simultaneously in both spaces. However, we experienced such a case in a 48-year-old man who presented with right leg pain and lower back pain that had lasted for more than a year. MRI revealed HNP in both the right intracanal and extracanal spaces at L2-L3. A transforaminal approach was used to complete a percutaneous endoscopic discectomy. An 8-mm incision was made with the patient under local anesthesia, and the percutaneous endoscope was inserted at the affected disc space. First, the HNP fragments in the intracanal space were removed, and then the cannula and endoscope were extracted to the extracanal space where the extracanal fragments were removed. Two hours after the surgery, the patient stood and walked. Right leg pain and lower back pain had disappeared. Unlike other techniques such as Love's procedure and the microendoscopic discectomy technique, the use of a transforaminal approach with the percutaneous endoscopic technique enables the HNP fragments in the intracanal and extracanal spaces to be removed at the same time with a single approach. PMID:23095297

Kitagawa, Yasuhiro; Sairyo, Koichi; Shibuya, Isao; Kitahama, Yoshihiro; Kanamori, Yasuo; Koga, Soichi; Matsumoto, Hironori; Sumita, Takayuki; Yamada, Atsuhisa; Dezawa, Akira

2012-11-01

294

Post-traumatic diaphragmatic herniation of the liver, examined by positron emission tomography: case report  

PubMed Central

We present a case of post-traumatic diaphragmatic herniation of the liver, which mimicked an intrathoracic tumor. After an automobile accident, the patient underwent thoracotomies for hemothorax and lung cancer in the right chest. Seven months later, computed tomography (CT) demonstrated a round tumor in the thorax adjacent to the right diaphragm with a higher density than the liver parenchyma. An intrathoracic tumor including a primary or metastatic lung cancer was suspected. However, positron emission tomography (PET) showed that the uptake of fluorine-18-fluorodeoxyglucose (FDG) was identical to that in the liver, and the tumor appeared to be contiguous with the liver. Thus, we suspected liver herniation. Core needle biopsy revealed liver cells without neoplastic tissue. Upon surgical exploration, herniation of the liver was found and repaired. PET was helpful in providing morphological and functional information leading to accurate diagnosis of liver herniation in this unusual case.

2011-01-01

295

Surgical vs Nonoperative Treatment for Lumbar Disk Herniation  

PubMed Central

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

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

296

Sizes of protoplanetary discs after star-disc encounters  

NASA Astrophysics Data System (ADS)

Most stars do not form in isolation, but as part of a star cluster or association. These young stars are initially surrounded by protoplanetary discs. In these cluster environments tidal interactions with other cluster members can alter the disc properties. Besides the disc frequency, its mass, angular momentum, and energy, the disc's size is particularly prone to being changed by a passing star. So far the change in disc size has only been investigated for a small number of very specific encounters. Several studies investigated the effect of the cluster environment on the sizes of planetary systems like our own solar system, based on a generalisation of information from this limited sample. We performed numerical simulations covering the wide parameter space typical of young star clusters, to test the validity of this approach. Here the sizes of discs after encounters are presented, based on a size definition that is comparable to the one used in observational studies. We find that, except for encounters between equal-mass stars, the usually applied estimates are insufficient. They tend to severely overestimate the remaining disc size. We show that the disc size after an encounter can be described by a relatively simple dependence on the periastron distance and the mass ratio of the encounter partners. This knowledge allows us, for example, to pin down the types of encounter possibly responsible for the structure of today's solar system. Appendix A is available in electronic form at http://www.aanda.org

Breslau, Andreas; Steinhausen, Manuel; Vincke, Kirsten; Pfalzner, Susanne

2014-05-01

297

Dead discs, unstable discs and the stars they surround  

NASA Astrophysics Data System (ADS)

Strong stellar magnetic fields significantly alter the behaviour of surrounding accretion discs. Recent work has demonstrated that at low accretion rates a large amount of mass can remain confined in the disc, contrary to the standard assumption that the magnetic field will expel the disc in an outflow (the "propeller regime"). These "dead discs" often become unstable, causing cycles of accretion onto the central star. Here I present the main predictions of this model, and argue that it provides a good explanation for the peculiar behaviour seen in several accreting sources with strong magnetic fields. I will focus in particular on three accreting millisecond X-ray pulsars: SAX J1808.4-3658, NGC 6440 X-2 and IGR J00291+5934. These sources all show low-frequency quasi-periodic oscillations consistent with a variable accretion rate, as well as unusual outburst patterns that suggest gas is confined in the inner disc regions during quiescence.

D'Angelo, Caroline

2014-01-01

298

Transcript Levels of Major Interleukins in Relation to the Clinicopathological Profile of Patients with Tuberculous Intervertebral Discs and Healthy Controls  

PubMed Central

Objectives The purpose of the present study was to simultaneously examine the transcript levels of a large number of interleukins (ILs; IL-9, IL-10, IL-12, IL-13, IL-16, IL-17, IL-18, IL-26, and IL-27) and investigate their correlation with the clinicopathological profiles of patients with tuberculous intervertebral discs. Methods Clinical data were collected from 150 patients participating in the study from January 2013 to December 2013. mRNA expression levels in 70 tuberculous, 70 herniated, and 10 control intervertebral disc specimens were determined by real-time polymerase chain reaction. Results IL-10, IL-16, IL-17, IL-18, and IL-27 displayed stronger expression in tuberculous spinal disc tissue than in normal intervertebral disc tissue (P<0.05). Our results illustrated multiple correlations among IL-10, IL-16, IL-17, IL-18, and IL-27 mRNA expression in tuberculous samples. Smoking habits were found to have a positive correlation with IL-17 transcript levels and a negative correlation with IL-10 transcript levels (P<0.05). Pain intensity, symptom duration, C-reactive protein levels, and the erythrocyte sedimentation rate exhibited multiple correlations with the transcript levels of several ILs (P<0.05). Conclusions The experimental data imply a double-sided effect on the activity of ILs in tuberculous spinal intervertebral discs, suggesting that they may be involved in intervertebral discs destruction. Our findings also suggest that smoking may affect the intervertebral discs destruction process of spinal tuberculosis. However, further studies are necessary to elucidate the exact role of ILs in the intervertebral discs destruction process of spinal tuberculosis.

Liu, Chong; Zhan, Xinli; Xiao, Zengming; Fan, Qie; Deng, Li; Cui, Mingxing; Xiong, Chunxiang; Xue, Jingbo; Xie, Xiangtao

2014-01-01

299

Correlations between severity of clinical signs and histopathological changes in 60 dogs with spinal cord injury associated with acute thoracolumbar intervertebral disc disease.  

PubMed

The outcome of spinal surgery in dogs with absent voluntary motor function and nociception following intervertebral disc (IVD) herniation is highly variable, which likely attests to differences in the severity of spinal cord damage. This retrospective study evaluated the extent to which neurological signs correlated with histologically detected spinal cord damage in 60 dogs that were euthanased because of thoracolumbar IVD herniation. Clinical neurological grades correlated significantly with the extent of white matter damage (P<0.001). However, loss of nociception also occurred in 6/31 (19%) dogs with relatively mild histological changes. The duration of clinical signs, Schiff-Sherrington posture, loss of reflexes and pain on spinal palpation were not significantly associated with the severity of spinal cord damage. Although clinical-pathological correlation was generally good, some clinical signs frequently thought to indicate severe cord injury did not always correlate with the degree of cord damage, suggesting functional rather than structural impairment in some cases. PMID:23702280

Henke, D; Vandevelde, M; Doherr, M G; Stöckli, M; Forterre, F

2013-10-01

300

Fantastic Disc Activities for Fitness  

ERIC Educational Resources Information Center

Disc activities are an excellent elementary content area for both skill and fitness enhancement. They may occur through progressive skill and drill practice, small sided-game examples, modifications of traditional disc activities appropriate to large groups, and with adjustments designed to increase activity and fitness levels. For games in this…

Griffin, Michael R.; Johnson, Romona; Thomas, Jessica; Spell, Melissa; Popham, John; Croft, Brent; Umpleby, Albert; Verbel, Eric

2005-01-01

301

Intervertebral Disc Adaptation to Wedging  

Microsoft Academic Search

Although scoliosis includes wedge deformities of both vertebrae and discs, little is known about the causes of the discal changes, and whether they result from mechanical influences on growth and\\/or remodelling. Methods and Materials: An external apparatus attached to transvertebral pins applied compression and 15 degrees of angulation to each of two adjacent young rat caudal intervertebral discs for 5

Ian A. F. STOKES; David D. ARONSSON; Katherine C. CLARK; Maria L. ROEMHILDT

302

Cervical Total Disc Arthroplasty  

PubMed Central

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.

Basho, Rahul; Hood, Kenneth A.

2012-01-01

303

Use of vacuum-assisted closure in open incisional hernia repair: a novel approach to prevent seroma formation  

Microsoft Academic Search

Introduction  Frequent complications in incisional hernia surgery are re-herniation, wound infection and seroma formation. The use of subatmospheric\\u000a pressure dressings such as the vacuum-assisted closure (VAC) device has been shown to be an effective way to accelerate healing\\u000a of various wounds. Here, we describe the application of the VAC device as a postoperative dressing to prevent seroma formation\\u000a after open incisional

M. López-Cano; M. Armengol-Carrasco

304

Traumatic C4-C5 unilateral facet dislocation with posterior disc herniation above a prior anterior fusion.  

PubMed

We report the case of a unilateral cervical facet dislocation above the level of a prior non-instrumented cervical discectomy and fusion, resulting in incomplete neurologic injury. Pre-reduction imaging demonstrated a large posterior disk extrusion. This finding altered our management approach from closed reduction to urgent anterior cervical discectomy, open anterior reduction, and fusion. The patient had excellent neurologic recovery and outcome at 12 months postoperative follow-up. PMID:22837997

Raizman, Noah M; Yu, Warren D; Jenkins, Matthew V; Wallace, Matthew T; O'Brien, Joseph R

2012-06-01

305

Medical Information on Optical Disc*  

PubMed Central

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.

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

1987-01-01

306

Lumbar herniation following extended autologous latissimus dorsi breast reconstruction  

PubMed Central

Background Reconstructive breast surgery is now recognized to be an important part of the treatment for breast cancer. Surgical reconstruction options consist of implants, autologous tissue transfer or a combination of the two. The latissimus dorsi flap is a pedicled musculocutaneous flap and is an established method of autologous breast reconstruction. Lumbar hernias are an unusual type of hernia, the majority occurring after surgery or trauma in this area. The reported incidence of a lumbar hernia subsequent to a latissimus dorsi reconstruction is very low. Case presentation We present the unusual case of lumbar herniation after an extended autologous latissimus dorsi flap for breast reconstruction following a mastectomy. The lumbar hernia was confirmed on CT scanning and the patient underwent an open mesh repair of the hernia through the previous latissimus dorsi scar. Conclusion Lumbar hernias are a rare complication that can occur following latissimus dorsi breast reconstruction. It should be considered in all patients presenting with persistent pain or swelling in the lumbar region.

2013-01-01

307

Transmastoid approach to repair meningoencephalic herniation in the middle ear.  

PubMed

Meningoencephalic herniation (MEH) in the middle ear and mastoid is a rare pathological entity with possible life-threatening complications. We treated 24 patients with a trans-mastoid approach, and the bony defect was closed by heterologous materials positioned in a multilayer fashion. The cause of the bony defect were chronic otitis media with cholesteatoma, iatrogenic, spontaneous and post-traumatic. The major presenting symptoms were meningitis, headache, conductive hearing loss, cerebrospinal fluid (CSF leak), neurologic deficit and pneumoencephalus, and stenosis of a canal wall down cavity. During follow-up, no patient developed complications due to surgery or related to the pathology, and imaging showed a stable occlusion of the bony defect. Different surgical treatments have been proposed to repair MEH, and the choice is based on the localization and size of the bony defect, preoperative auditory function and the presence of a coexisting pathology. We propose the use of collagenous membranes and bone substitutes for reconstruction of the floor of the middle fossa. PMID:23853399

Sergi, B; Passali, G C; Picciotti, P M; De Corso, E; Paludetti, G

2013-04-01

308

QED vacuum loops and vacuum energy  

NASA Astrophysics Data System (ADS)

A QED-based "bootstrap" mechanism is suggested as a possible source of vacuum energy. In place of the conventional assumption that the vacuum expectation value of the current operator j ? vanishes in the absence of a classical, external field, one notes the possibility that, on very small scales, the vacuum fluctuations can generate an equation for an effective, C-number giving rise to a finite and computable vacuum energy.

Fried, H. M.; Gabellini, Y.

2013-12-01

309

Thoracic Disk Herniation, a not Infrequent Cause of Chronic Abdominal Pain  

PubMed Central

This study assesses the proportion of patients presenting with nonvisceral chronic abdominal pain who have thoracic disk herniation as a possible cause. We designed a descriptive transversal study of patients attending our offices between February 2009 and October 2010, with a complaint of chronic abdominal pain of suspected abdominal wall source (positive Carnett sign). Nuclear magnetic resonance (NMR) of the spinal column was performed on all patients. When the NMR showed thoracic disk herniation the patients were treated according to their etiology. We also evaluated the symptoms in patients with thoracic disk herniation and their response to the applied treatment. Twenty-seven patients with chronic abdominal pain were evaluated. The NMR results in 18 of these 27 patients (66.66%) showed evidence of disk herniation. We report on the results of these 18 patients, emphasizing that the symptoms are florid and varied. Many patients had been previously diagnosed with irritable bowel syndrome. Thoracic disk herniation may account for chronic abdominal pain in many patients who remain undiagnosed or are diagnosed with irritable bowel syndrome. Thus, this possibility needs to be taken into account to achieve a correct diagnosis and a suitable mode of treatment.

Lara, F.J. Perez; Berges, A. Ferrer; Quesada, J. Quintero; Ramiro, J.A. Moreno; Toledo, R. Bustamante; Munoz, H. Oliva

2012-01-01

310

Enlivening Physics, a Local Video Disc Project.  

ERIC Educational Resources Information Center

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)

McInerney, M.

1989-01-01

311

Disc pack cleaning table saves computer time  

NASA Technical Reports Server (NTRS)

Disc pack holding table is support frame upon which computer disc pack is loaded and protective cover released. This combination permits manual off-line cleaning of disc pack storage units at any time without shutting down the computer, and eliminates on-line disc drive unit to hold pack during cleaning.

Guy, J. T., Sr.

1970-01-01

312

Planet formation in evolving protoplanetary discs  

NASA Astrophysics Data System (ADS)

I attempt to summarize our knowledge of planet formation in evolving protoplanetary discs. I first review the physics of disc evolution and dispersal. For most of the disc lifetime evolution is driven by accretion and photoevaporation, and I discuss how the interplay between these processes shapes protoplanetary discs. I also discuss the observations that we use to test these models, and the major uncertainties that remain. I will then move on to consider planet formation and migration in evolving discs, and discuss how observations of both discs and planets can be used to inform our understanding of protoplanetary disc evolution.

Alexander, Richard

2014-01-01

313

Is the Transport of a Gadolinium-Based Contrast Agent Decreased in a Degenerated or Aged Disc? A Post Contrast MRI Study  

PubMed Central

A post contrast magnetic resonance imaging study has been performed in a wide population of low back pain patients to investigate which radiological and phenotypic characteristics influence the penetration of the contrast agent in lumbar discs in vivo. 37 patients affected by different pathologies (disc herniation, spondylolisthesis, foraminal stenosis, central canal stenosis) were enrolled in the study. The selected population included 26 male and 11 female subjects, with a mean age of 42.4±9.3 years (range 18–60). Magnetic resonance images of the lumbar spine were obtained with a 1.5 T scanner (Avanto, Siemens, Erlangen, Germany) with a phased-array back coil. A paramagnetic non–ionic contrast agent was injected with a dose of 0.4 ml/kg. T1-weighted magnetic resonance images were subsequently acquired at 5 time points, 5 and 10 minutes, 2, 4 and 6 hours after injection. Endplates presented clear enhancement already 5 minutes after injection, and showed an increase in the next 2 hours followed by a decrease. At 5 and 10 minutes, virtually no contrast medium was present inside the intervertebral disc; afterwards, enhancement significantly increased. Highly degenerated discs showed higher enhancement in comparison with low and medium degenerated discs. Discs classified as Pfirrmann 5 showed a statistically significant higher enhancement than Pfirrmann 1, 2 and 3 at all time points but the first one, possibly due to vascularization. Disc height collapse and Modic changes significantly increased enhancement. Presence of endplate defects did not show any significant influence on post contrast enhancement, but the lack of a clear classification of endplate defects as seen on magnetic resonance scans may be shadowing some effects. In conclusion, disc height, high level of degeneration and presence of Modic changes are factors which increase post contrast enhancement in the intervertebral disc. The effect of age could not be demonstrated.

Tibiletti, Marta; Galbusera, Fabio; Ciavarro, Cristina; Brayda-Bruno, Marco

2013-01-01

314

Region Specific Response of Intervertebral Disc Cells to Complex Dynamic Loading: An Organ Culture Study Using a Dynamic Torsion-Compression Bioreactor  

PubMed Central

The spine is routinely subjected to repetitive complex loading consisting of axial compression, torsion, flexion and extension. Mechanical loading is one of the important causes of spinal diseases, including disc herniation and disc degeneration. It is known that static and dynamic compression can lead to progressive disc degeneration, but little is known about the mechanobiology of the disc subjected to combined dynamic compression and torsion. Therefore, the purpose of this study was to compare the mechanobiology of the intervertebral disc when subjected to combined dynamic compression and axial torsion or pure dynamic compression or axial torsion using organ culture. We applied four different loading modalities [1. control: no loading (NL), 2. cyclic compression (CC), 3. cyclic torsion (CT), and 4. combined cyclic compression and torsion (CCT)] on bovine caudal disc explants using our custom made dynamic loading bioreactor for disc organ culture. Loads were applied for 8 h/day and continued for 14 days, all at a physiological magnitude and frequency. Our results provided strong evidence that complex loading induced a stronger degree of disc degeneration compared to one degree of freedom loading. In the CCT group, less than 10% nucleus pulposus (NP) cells survived the 14 days of loading, while cell viabilities were maintained above 70% in the NP of all the other three groups and in the annulus fibrosus (AF) of all the groups. Gene expression analysis revealed a strong up-regulation in matrix genes and matrix remodeling genes in the AF of the CCT group. Cell apoptotic activity and glycosaminoglycan content were also quantified but there were no statistically significant differences found. Cell morphology in the NP of the CCT was changed, as shown by histological evaluation. Our results stress the importance of complex loading on the initiation and progression of disc degeneration.

Chan, Samantha C. W.; Walser, Jochen; Kappeli, Patrick; Shamsollahi, Mohammad Javad; Ferguson, Stephen J.; Gantenbein-Ritter, Benjamin

2013-01-01

315

Molecular basis of intervertebral disc degeneration.  

PubMed

This review will acquaint the reader with normal development, structure, and function of the intervertebral disc. The disc is composed of the vertebral endplate, nucleus pulposus, and annulus fibrosus. These three functional components all serve important purposes for health and function of the disc. Nutrition and biomechanics are also discussed. The molecular basis of disc degeneration is reviewed so that biologic approaches to the reversal and or treatment of disc degeneration may be better understood. PMID:15541661

Walker, Matthew H; Anderson, D Greg

2004-01-01

316

Gangrenous small bowel obstruction secondary to congenital internal herniation: a case report.  

PubMed

Congenital internal herniation is a rare condition presenting as recurrent abdominal pain or acute intestinal obstruction. In cases in which bowel incarceration or strangulation develop, rapid progression to bowel ischemia, necrosis or perforation is inevitable. Mortality in such cases has been reported to be as high as 50%. Despite advances in imaging modalities, arriving at a pre-operative diagnosis of a congenital internal herniation remains a challenge. We report such a case where imaging was unsuccessful in determining the cause of intestinal obstruction in a 3 year old child. Congenital internal herniation may result in disastrous consequences if not addressed in a timely fashion due to its rarity. Hence a high index of clinical suspicion is needed to avoid missing this diagnosis in a child presenting with recurrent abdominal pain or acute intestinal obstruction. PMID:22582563

Tan, Y L; Alhagi, Muthu V

2012-02-01

317

Non traumatic liver herniation due to persistent cough mimicking a pulmonary mass  

PubMed Central

Background: Non traumatic liver herniation through a diaphragmatic defect is rare. Case Report: A 44 year old woman presented with lower lobe opacity at the right lung. Chest Computed tomography (CT) demonstrated a round tumor adjacent to the right diaphragm. Percutaneous needle biopsy revealed liver tissue. A small liver herniation through a diaphragmatic defect was detected in saggital and coronal CT views but no traumatic rupture of the diaphragm or endometriosis were documented. Conclusions: The patient suffered from gastroesophageal reflux disease and increased transdiaphragmatic pressure from paroxysmal cough due to aspirations may have provoked the diaphragmatic rupture.

Pataka, A; Paspala, A; Sourla, E; Bagalas, V; Argyropoulou, P

2013-01-01

318

Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia.  

PubMed

Acquired cerebellar tonsillar herniation and syringomyelia associated with posterior fossa mass lesions is an exception rather than the rule. In the present article, we describe the neuroimaging findings in a case of 28-year-old female patient presented with a history of paraesthesia involving right upper limb of 8-month duration. Magnetic resonance imaging showed a giant retrocerebellar arachnoid causing tonsillar herniation with cervical syringomyelia. The findings in the present case supports that the one of the primary mechanism for the development of syringomyelia may be the obstruction to the flow of cerebrospinal fluid causing alterations in the passage of extracellular fluid in the spinal cord and leading to syringomyelia. PMID:24381458

Joshi, Vijay P; Valsangkar, Ashwin; Nivargi, Satish; Vora, Nitant; Dekhne, Anish; Agrawal, Amit

2013-01-01

319

Thoracic disk herniation manifesting as sciatica-like pain--two case reports.  

PubMed

Two patients presented with sciatica-like pain caused by thoracic disk herniation. Sciatica-like pain was the initial and major symptom in both patients, but careful neurological examination showed vague signs of upper motor neuron disturbance, and thoracic magnetic resonance (MR) imaging revealed disk herniations at the mid-thoracic level. After video-assisted thoracoscopic discectomy, the pain was completely improved. Thorough neurological examination and MR imagery of the thoracic spine, and if needed, even the cervical spine, are required if lumbar image findings do not correlate with the symptoms or physical examination. PMID:21273750

Cho, Hyung-Lea; Lee, Sang-Ho; Kim, Jin-Sung

2011-01-01

320

The Inguinal Herniation of the Ovary in the Newborn: Ultrasound and Color Doppler Ultrasound Findings  

PubMed Central

Inguinal hernias in the newborn age group are seldom encountered. In the affected female patient, the ovaries, fallopian tubes, and the intestines may settle in the hernia sac. The early diagnosis of torsion in cases in which the ovary is herniated into the inguinal canal is of utmost importance in order to give surgery the chance of reduction and correction. In this paper, a case of an ovarian herniation into the inguinal canal without the presence of torsion is being presented, and the place of US and CDUS in the differential diagnosis of the situation is being discussed.

Kaya, Omer; Esen, Kaan; Gulek, Bozkurt; Yilmaz, Cengiz; Soker, Gokhan; Onem, Onder

2014-01-01

321

Delayed presentation of traumatic diaphragmatic rupture with herniation of the left kidney and bowel loops.  

PubMed

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

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

2013-01-01

322

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

PubMed Central

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.

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

2013-01-01

323

The Vacuum Bubble Nucleation  

SciTech Connect

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.

Lee, Bum-Hoon [Department of Physics and Center for Quantum Spacetime, Sogang University Seoul 121-742 (Korea, Republic of); Lee, Wonwoo [Center for Quantum Spacetime, Sogang University, Seoul 121-742 (Korea, Republic of)

2009-07-10

324

Natural vacuum electronics  

NASA Technical Reports Server (NTRS)

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.

Leggett, Nickolaus

1990-01-01

325

Germanium detector vacuum encapsulation  

NASA Technical Reports Server (NTRS)

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.

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

1991-01-01

326

Hydrogel discs for digital microfluidics  

PubMed Central

Hydrogels are networks of hydrophilic polymer chains that are swollen with water, and they are useful for a wide range of applications because they provide stable niches for immobilizing proteins and cells. We report here the marriage of hydrogels with digital microfluidic devices. Until recently, digital microfluidics, a fluid handling technique in which discrete droplets are manipulated electromechanically on the surface of an array of electrodes, has been used only for homogeneous systems involving liquid reagents. Here, we demonstrate for the first time that the cylindrical hydrogel discs can be incorporated into digital microfluidic systems and that these discs can be systematically addressed by droplets of reagents. Droplet movement is observed to be unimpeded by interaction with the gel discs, and gel discs remain stationary when droplets pass through them. Analyte transport into gel discs is observed to be identical to diffusion in cases in which droplets are incubated with gels passively, but transport is enhanced when droplets are continually actuated through the gels. The system is useful for generating integrated enzymatic microreactors and for three-dimensional cell culture. This paper demonstrates a new combination of techniques for lab-on-a-chip systems which we propose will be useful for a wide range of applications.

Fiddes, Lindsey K.; Luk, Vivienne N.; Au, Sam H.; Ng, Alphonsus H. C.; Luk, Victoria; Kumacheva, Eugenia; Wheeler, Aaron R.

2012-01-01

327

[Pseudopapilledema--optic disc drusen].  

PubMed

Optic disc drusen (ODD) are benign calcified deposits, which are located at the head of the optic disc. Most ODD patients are asymptomatic. Ocular complications, related to ODD, are considered rare. Optic disc drusen, especially if it is bilateral, may mimic the clinical presentation of papilledema. The clinical discrimination between ODD and papilledema may be a challenging task, and in many cases, especially in the pediatric population, an ocular ultrasound examination is needed. A fundus examination, in order to rule out papilledema, is a common daily task for the ophthalmologist and is considered perhaps the most common interface between pediatricians, neurologists, internal physicians and ophthalmologists. In this review, we focused on the pathogenesis, epidemiology, diagnosis and clinical implications of ODD. PMID:23713375

Kinori, Michael; Moroz, Iris; Zolf, Ricky; Fabian, Ido Didi

2013-03-01

328

Large residual strains are present in the intervertebral disc annulus fibrosus in the unloaded state.  

PubMed

The intervertebral disc annulus fibrosus (AF) is subjected to high circumferential tensile stresses resulting from nucleus pulposus pressurisation under axial compression. In other pressure containing tissues, such as blood vessel walls, residual compressive stresses along the inside surface of the tissues without pressurisation reduce peak tensile stresses under pressurisation. This study hypothesised that similar patterns of residual stress exist in the annulus fibrosus. Accurate characterisation of residual stresses is essential for both the incorporation of nonlinear material descriptions into models of the disc as well as the design of effective annulus repair strategies. By imaging nine bovine caudal discs before and after the release of residual stresses via incision, we measured a mean residual stretch of 0.86 ± 0.13 at the inner AF and 1.02 ± 0.08 at the outer AF. These stretch values were used to calculate a gradient of residual stress ranging from -230 ± 22 kPa of compression at the inner AF to 54 ± 0.2 kPa of tension at the outer AF. Material models of AF have assumed that the AF was in a stress free reference state when there are no external loads. However, this study documents that there are large residual stresses in the AF even without external loads. The release of residual tension in the outer AF by herniation, needle injection or incisions makes closure difficult and may accelerate degeneration of the surrounding tissue. Retention of these residual stresses may be essential to maintaining disc mechanical function and to producing viable AF repair techniques. PMID:22342138

Michalek, A J; Gardner-Morse, M G; Iatridis, J C

2012-04-30

329

Vacuum tribological behaviour of self lubricant quasicrystalline composite coatings  

NASA Astrophysics Data System (ADS)

High temperature resistant self-lubricant coatings are needed in space vehicles for components that operate at high temperatures and/or under vacuum. Thick composite lubricant coatings containing quasicrystalline alloys (QC) as the hard phase for wear resistance, have been deposited by thermal spray. The coatings also comprise lubricating materials (silver and BaF2-CaF2 eutectic) and NiCr as the tough component. This paper describes the vacuum tribological properties of TH103, a coating belonging to this family, with excellent microstructural quality. The coating was deposited by HVOF and tested under vacuum on a pin-on-disc tribometer. Different loads, linear speeds and pin materials were studied. The pin scars and disc wear tracks were characterized by EDS-SEM. A minimum mean steady friction coefficient of 0.32 was obtained employing a X-750 Ni superalloy pin in vacuum conditions under 10 N load and 15 cm/s linear speed, showing moderate wear of the disc and low wear of the pin.

Garcí de Blas, F. J.; Román, A.; de Miguel, C.; Longo, F.; Muelas, R.; Agüero, A.

2003-09-01

330

Debris disc formation induced by planetary growth  

NASA Astrophysics Data System (ADS)

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.

Kobayashi, H.; Löhne, T.

2014-08-01

331

Degeneration of the intervertebral disc  

PubMed Central

The intervertebral disc is a cartilaginous structure that resembles articular cartilage in its biochemistry, but morphologically it is clearly different. It shows degenerative and ageing changes earlier than does any other connective tissue in the body. It is believed to be important clinically because there is an association of disc degeneration with back pain. Current treatments are predominantly conservative or, less commonly, surgical; in many cases there is no clear diagnosis and therapy is considered inadequate. New developments, such as genetic and biological approaches, may allow better diagnosis and treatments in the future.

Urban, Jill PG; Roberts, Sally

2003-01-01

332

Partial left pericardial defect with herniation of the left atrial appendage  

Microsoft Academic Search

A case is reported of herniation of the left atrial appendage through a partial pericardial defect, probably congenital. The diagnosis was suggested by the history of chest pain and bulging of the middle segment of the left heart border on the plain chest film, without other signs. Angiography revealed a dilated left atrial appendage. An artificial left pneumothorax confirmed the

C. Pernot; J C. Hoeffel; M. Henry; R. Frisch; B. Brauer

1972-01-01

333

Single-level calcified cervical disk herniation in a 13-year-old girl.  

PubMed

This article describes a case of a 13-year-old girl with single-level calcified cervical disk herniation. The patient was treated conservatively for a symptomatic intervertebral calcification that caused neurological compression, and the data were reviewed retrospectively. Previous reports have shown that the natural history of the disease is self-limiting with a benign course and an excellent prognosis. However, on rare occasions when the calcified nucleus pulposus herniates into the spinal canal and compresses the spinal cord or its roots, neurological abnormalities can occur, such as radiculopathy and myelopathy. This also raises the question of whether operative therapy will eventually be necessary. In the current case, conservative treatment was applied. Plain radiographs are usually sufficient to determine the presence and extent of a calcified cervical disk, and computed tomography or magnetic resonance imaging can detect an associated disk herniation. Conservative treatment with antalgics, muscle relaxants, neurotrophic drugs, and a cervical collar were applied. The patient was completely free of symptoms 3 weeks after the initial treatment. Magnetic resonance imaging indicated complete vertebral canal clearance at final follow-up. Cervical intervertebral disk calcification and herniation is a rare disorder in children with an obscure etiology but a good prognosis. Conservative therapy produces satisfactory results, even if clinical symptoms due to nerve root or spinal cord compression are present. Surgical treatments are only suitable in rare cases with severe progressive radicular pain or neurological deficit. PMID:22868626

Li, Min; Rong, Weiping; Pan, Xianming; Yu, Lin

2012-08-01

334

Laparoscopic repair of a small bowel herniation through a broad ligament defect.  

PubMed

A 44-year-old female presented with a diagnosis of intestinal obstruction from unknown origin. Laparoscopy revealed herniation of small bowel trough a defect in the left broad ligament. After reduction, the defect was corrected laparoscopically. The post operative recovery was uneventful. PMID:25013338

Buero, Agustín; Silberman, Ezequiel A; Medina, Pablo; Morra, Matias E; Bogetti, Diego J; Porto, Eduardo A

2014-07-01

335

Artificial Discs for Lumbar and Cervical Degenerative Disc Disease -Update  

PubMed Central

Executive Summary Objective To assess the safety and efficacy of artificial disc replacement (ADR) technology for degenerative disc disease (DDD). Clinical Need Degenerative disc disease is the term used to describe the deterioration of 1 or more intervertebral discs of the spine. The prevalence of DDD is roughly described in proportion to age such that 40% of people aged 40 years have DDD, increasing to 80% among those aged 80 years or older. Low back pain is a common symptom of lumbar DDD; neck and arm pain are common symptoms of cervical DDD. Nonsurgical treatments can be used to relieve pain and minimize disability associated with DDD. However, it is estimated that about 10% to 20% of people with lumbar DDD and up to 30% with cervical DDD will be unresponsive to nonsurgical treatments. In these cases, surgical treatment is considered. Spinal fusion (arthrodesis) is the process of fusing or joining 2 bones and is considered the surgical gold standard for DDD. Artificial disc replacement is the replacement of the degenerated intervertebral disc with an artificial disc in people with DDD of the lumbar or cervical spine that has been unresponsive to nonsurgical treatments for at least 6 months. Unlike spinal fusion, ADR preserves movement of the spine, which is thought to reduce or prevent the development of adjacent segment degeneration. Additionally, a bone graft is not required for ADR, and this alleviates complications, including bone graft donor site pain and pseudoarthrosis. It is estimated that about 5% of patients who require surgery for DDD will be candidates for ADR. Review Strategy The Medical Advisory Secretariat conducted a computerized search of the literature published between 2003 and September 2005 to answer the following questions: What is the effectiveness of ADR in people with DDD of the lumbar or cervical regions of the spine compared with spinal fusion surgery? Does an artificial disc reduce the incidence of adjacent segment degeneration (ASD) compared with spinal fusion? What is the rate of major complications (device failure, reoperation) with artificial discs compared with surgical spinal fusion? One reviewer evaluated the internal validity of the primary studies using the criteria outlined in the Cochrane Musculoskeletal Injuries Group Quality Assessment Tool. The quality of concealment allocation was rated as: A, clearly yes; B, unclear; or C, clearly no. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the overall quality of the body of evidence (defined as 1 or more studies) supporting the research questions explored in this systematic review. A random effects model meta-analysis was conducted when data were available from 2 or more randomized controlled trials (RCTs) and when there was no statistical and or clinical heterogeneity among studies. Bayesian analyses were undertaken to do the following: Examine the influence of missing data on clinical success rates; Compute the probability that artificial discs were superior to spinal fusion (on the basis of clinical success rates); Examine whether the results were sensitive to the choice of noninferiority margin. Summary of Findings The literature search yielded 140 citations. Of these, 1 Cochrane systematic review, 1 RCT, and 10 case series were included in this review. Unpublished data from an RCT reported in the grey literature were obtained from the manufacturer of the device. The search also yielded 8 health technology assessments evaluating ADR that are also included in this review. Six of the 8 health technology assessments concluded that there is insufficient evidence to support the use of either lumbar or cervical ADR. The results of the remaining 2 assessments (one each for lumbar and cervical ADR) led to a National Institute for Clinical Excellence guidance document supporting the safety and effectiveness of lumbar and cervical ADR with the proviso that an ongoing audit of all clinical outcomes be undertaken owing to a lack of long-term outcome data from clinical trials. Regard

2006-01-01

336

Membrane tissue on the optic disc may cause macular schisis associated with a glaucomatous optic disc without optic disc pits  

PubMed Central

This article reports a case of possible involvement of membrane tissue on the optic disc with macular schisis formation associated with glaucomatous optic disc without optic disc pits. A 78-year-old man presented with loss of central visual acuity of the left eye. He had a medical history of primary open-angle glaucoma. Visual acuity was 0.6 in his left eye, and funduscopy revealed macular schisis and a glaucomatous optic disc without optic disc pits. Optical coherence tomography (OCT) revealed membrane tissue on the optic disc and a tunnel-like hyporeflective lesion connecting the schisis cavity and a site near the tissue, but no obvious optic disc pit. He underwent pars plana vitrectomy during which the membrane tissue on the disc and internal limiting membrane were removed. Posterior vitreous detachment was observed intraoperatively. Thereafter, the tunnel-like lesion observed on OCT was rapidly obscured and the macular schisis gradually reduced. Eighteen months after surgery, his visual acuity had improved to 0.9 with almost complete regression of the macular schisis. No optic disc pit was visualized after surgery. The changes in OCT findings described here suggest an etiology for macular schisis without optic disc pits in an eye with a glaucomatous optic disc with posterior vitreous detachment. A connection between the schisis cavity and the vitreous cavity may have appeared via the tunnel-like structure due to the membrane tissue exerting traction on the optic disc.

Takashina, Saori; Saito, Wataru; Noda, Kousuke; Katai, Maki; Ishida, Susumu

2013-01-01

337

Membrane tissue on the optic disc may cause macular schisis associated with a glaucomatous optic disc without optic disc pits.  

PubMed

This article reports a case of possible involvement of membrane tissue on the optic disc with macular schisis formation associated with glaucomatous optic disc without optic disc pits. A 78-year-old man presented with loss of central visual acuity of the left eye. He had a medical history of primary open-angle glaucoma. Visual acuity was 0.6 in his left eye, and funduscopy revealed macular schisis and a glaucomatous optic disc without optic disc pits. Optical coherence tomography (OCT) revealed membrane tissue on the optic disc and a tunnel-like hyporeflective lesion connecting the schisis cavity and a site near the tissue, but no obvious optic disc pit. He underwent pars plana vitrectomy during which the membrane tissue on the disc and internal limiting membrane were removed. Posterior vitreous detachment was observed intraoperatively. Thereafter, the tunnel-like lesion observed on OCT was rapidly obscured and the macular schisis gradually reduced. Eighteen months after surgery, his visual acuity had improved to 0.9 with almost complete regression of the macular schisis. No optic disc pit was visualized after surgery. The changes in OCT findings described here suggest an etiology for macular schisis without optic disc pits in an eye with a glaucomatous optic disc with posterior vitreous detachment. A connection between the schisis cavity and the vitreous cavity may have appeared via the tunnel-like structure due to the membrane tissue exerting traction on the optic disc. PMID:23690678

Takashina, Saori; Saito, Wataru; Noda, Kousuke; Katai, Maki; Ishida, Susumu

2013-01-01

338

Requirements and Specifications for Cartographic Video Discs.  

National Technical Information Service (NTIS)

Video discs can store large quantities of analog (paper film, and video tape) and digital cartographic products on a compact, nonvolatile medium. These discs can be interfaced with microcomputers to provide compact and portable systems for accessing this ...

D. J. Costanzo

1984-01-01

339

26 CFR 1.246-4 - Dividends from a DISC or former DISC.  

Code of Federal Regulations, 2010 CFR

...2009-04-01 2009-04-01 false Dividends from a DISC or former DISC. 1.246-4 Section 1.246-4 Internal Revenue...for Corporations § 1.246-4 Dividends from a DISC or former DISC. The deduction provided...

2009-04-01

340

26 CFR 1.246-4 - Dividends from a DISC or former DISC.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false Dividends from a DISC or former DISC. 1.246-4 Section 1.246-4 Internal Revenue...for Corporations § 1.246-4 Dividends from a DISC or former DISC. The deduction provided...

2013-04-01

341

Stellar discs in massive galaxies  

NASA Astrophysics Data System (ADS)

Excluding those unsettled systems undergoing mergers, bright galaxies come in two flavours: with and without discs. In this work we look for photometric evidence for presence of discs and compare it with kinematic results of the ATLAS3D survey (Cappellari et al. 2011). We fit a Sérsic (1968) function to azimuthally averaged light profiles of ATLAS3D galaxies to derive single component fits and, subsequently, we fit a combination of the Sérsic function (free index n) and an exponential function (n=1) with the purpose of decomposing the light profiles into ``bulge'' and ``disc'' components (B+D model) of all non-barred sample galaxies. We compare the residuals of the B+D models with those of the single Sérsic fits and select the B+D model as preferred only when the improvement is substantial and there are no correlations within residuals. We find that the high angular momentum objects (fast rotators) are disc dominated systems with bulges of typically low n (when their light profiles can be decomposed) or are best represented with a single Sérsic function with a low Sérsic index (n<3). Single component systems with large Sérsic indices are characteristic of low angular momentum objects (slow rotators).

Krajnovi?, D.; Alatalo, K.; Blitz, L.; Bois, M.; Bournaud, F.; Bureau, M.; Cappellari, M.; Davies, R. L.; Davis, T. A.; de Zeeuw, P. T.; Emsellem, E.; Khochfar, S.; Kuntschner, H.; McDermid, R. M.; Morganti, R.; Naab, T.; Sarzi, M.; Scott, N.; Serra, P.; Weijmans, A.; Young, L. M.

2013-07-01

342

Tank Car Frangible Disc Test.  

National Technical Information Service (NTIS)

Tests were performed at the Transportation Test Center to evaluate the performance of various frangible disc designs, with respect to AAR Specification A5.03. Tests were also performed to determine the range of burst pressures and effect of temperature, c...

D. A. DiBrito B. R. Rajkumar

1990-01-01

343

Electromagnetic Levitation of a Disc  

ERIC Educational Resources Information Center

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…

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

2012-01-01

344

Circumstellar discs around A stars  

NASA Astrophysics Data System (ADS)

Since the IRAS mission it is known that a couple of nearby young stars are surrounded by dust disks (Aumann 1995); two prominent examples are Vega and \\beta Pictoris. CO radio observations of these stars, carried out to trace the gas component of these disks, revealed a strong depletion of CO (Dent et al. 1995). This has been interpreted as a general gas depletion, and models for the formation of gas-giant planets have been called in question. Detailed disc models concentrating on the discs' gas component show that CO has been selectively depleted in the dusty and gaseous discs by photodissociation and freezing out of CO on the cold dust grain surfaces (Rentzsch-Holm, Holweger & Bertoldi (1998), Kamp & Bertoldi 1998). We will now compare our models with the observation to fix the remaining free parameters. The disc mass, the main free parameter, can be inferred from modeling the infrared excess using dust models with various grain sizes and chemical composition. References: Aumann, H.H. 1985. PASP 97, 885 Dent, W.R.F., et al. 1995. MNRAS 277, L25 Rentzsch-Holm, I., Holweger, H., Bertoldi, F. 1998. ASP Conference Series 132, 275 Kamp, I., Bertoldi, F. 1998. in preparation

Kamp, I.; Holweger, H.; Bertoldi, I.

345

Locating the Optic Disc in Retinal Images  

Microsoft Academic Search

We present a method to automatically outline the optic disc in a retinal image. Our method for finding the optic disc is based on the properties of the optic disc using simple image processing algorithms which include thresholding, detection of object roundness and circle detection by Hough transformation. Our method is able to recognize the retinal images with general properties

Mira Park; Jesse S. Jin; Suhuai Luo

2006-01-01

346

Location of Optical Disc in Retinal Image  

Microsoft Academic Search

This paper proposes a method to automatically locate the optic disc in a retinal image. Our method of finding the optic disc is based on the properties of the optic disc using simple image processing algorithms which include multilevel thresholding, Morphological process detection of object roundness and circle detection by circle fitting method. The proposed method is able to recognize

D. Santhi; D. Manimegalai

2007-01-01

347

Integrated modeling for the manufacture of Ni-based superalloy discs from solidification to final heat treatment  

Microsoft Academic Search

Process models of the various stages of gas-turbine disc manufacture have been integrated to simulate the physical and microstructural\\u000a transformations occurring within a nickel-based superalloy throughout the entire manufacturing route. Production of these\\u000a critical rotating structural components requires several distinct processing stages: vacuum-induction melting (VIM), vacuum-arc\\u000a remelting (VAR), homogenization heat treatment, cogging, forging, final heat treatment, and machining. During the

S. Tin; P. D. Lee; A. Kermanpur; M. McLean; M. Rist

2005-01-01

348

Educational Vacuum Trainers  

NSDL National Science Digital Library

Have you inherited a bell jar vacuum system and are scratching your head over how to set it up or are unsure of its operations or capabilities? Or do you want to do more with your bell jar vacuum? The forum on Bell Jar Vacuums - with the topic Vacuum Trainers can help you. The intent of this forum is for this to be a place where technical issues, classroom exercises, activities, etc. can be discussed. There's no endorsement by manufacturers and commercial issues are off limits. Steve Hansen (bell jar expert) gives some brief descriptions of the vacuum trainers that are or have been available over the past decade or so - Varian, MKS, Science Source, American Vacuum Society. Links are provided to various data sheets, articles and online exercises. Steve, the forum moderator has experience in all of these.Keywords: vacuum, "vacuum trainer","bell jar" and/or belljar, MKSVarian, VPAL, VTS, sputtering, plasma

Hansen, Steve

2012-07-31

349

Optimizing process vacuum condensers  

SciTech Connect

Vacuum condensers play a critical role in supporting vacuum processing operations. Although they may appear similar to atmospheric units, vacuum condensers have their own special designs, considerations and installation needs. By adding vacuum condensers, precondensers and intercondensers, system cost efficiency can be optimized. Vacuum-condensing systems permit reclamation of high-value product by use of a precondenser, or reduce operating costs with intercondensers. A precondenser placed between the vacuum vessel and ejector system will recover valuable process vapors and reduce vapor load to an ejector system--minimizing the system`s capital and operating costs. Similarly, an intercondenser positioned between ejector stages can condense motive steam and process vapors and reduce vapor load to downstream ejectors as well as lower capital and operating costs. The paper describes vacuum condenser systems, types of vacuum condensers, shellside condensing, tubeside condensing, noncondensable gases, precondenser pressure drop, system interdependency, equipment installation, and equipment layout.

Lines, J.R.; Tice, D.W. [Graham Mfg. Co., Batavia, NY (United States)

1997-09-01

350

Vacuum Probe Surface Sampler.  

National Technical Information Service (NTIS)

A vacuum probe surface sampler for rapidly sampling relatively large surface areas which possess relatively light loading densities of microorganisms, drug particles or the like is described. A vacuum head having a hollow handle connected to a suitable va...

B. A. Zahlava

1971-01-01

351

Papilledema and optic disc pit: The association of two pathologies in one patient  

PubMed Central

Histologically, optic disc pit (ODP) is described as a small congenital defect in the cribriform plate where a herniation of the dysplastic retina extends to the subarachnoid space in the optic nerve, which is surrounded by a layer of collagen-rich tissue. Approximately 25–75% of cases are complicated by optic disc pit maculopathy (ODPM). The pathogenesis of maculopathies associated with ODP has not been fully elucidated. We present an unusual case of a patient with a history of papilledema secondary to a fronto-temporal meningioma. The patient underwent a successful surgical intervention with resolution of the papilledema 15 years before the detection of an ODP that was associated with retinal detachment in the macular region. Several studies have reported on the importance of intracranial pressure in the development of maculopathies associated with ODP. During the period of intracranial hypertension and papilledema in our patient, the hernia sac that was associated with ODP may have been small, which would have decreased the chances of developing a maculopathy that was associated with OPD.

Galvez-Ruiz, Alberto; Ghazi, Nicola; Ruhaily, Yasir

2012-01-01

352

The Classical Vacuum.  

ERIC Educational Resources Information Center

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…

Boyer, Timothy H.

1985-01-01

353

Sealing arrangement with annular flexible disc  

DOEpatents

Fluid sealing arrangements including an annular shaped flexible disc having enlarged edges disposed within channel-shaped annular receptacles which are spaced from one another. The receptacles form an annular region for contacting and containing the enlarged edges of the disc, and the disc is preloaded to a conical configuration. The disc is flexibly and movably supported within the receptacles so that unevenly distributed relative motion between the components containing the receptacles is accommodated without loss of sealing contact between the edges of the disc and the walls of the receptacles.

Pennell, William E. (Greensburg, PA) [Greensburg, PA; Honigsberg, Charles A. (Monroeville, PA) [Monroeville, PA

1983-01-01

354

Shear Mechanics of the TMJ Disc  

PubMed Central

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 disc’s 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 region’s 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 disc’s 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.

Juran, C.M.; Dolwick, M.F.; McFetridge, P.S.

2013-01-01

355

Modelling spikes in quasar accretion disc temperature  

NASA Astrophysics Data System (ADS)

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.

Hall, P. B.; Noordeh, E. S.; Chajet, L. S.; Weiss, E.; Nixon, C. J.

2014-08-01

356

Percutaneous intradiscal high-pressure injection of saline and lidocaine in patients with lumbar intervertebral disc extrusion.  

PubMed

The intradiscal high-pressure injection of saline and lidocaine (IDHP) is a minimally invasive percutaneous procedure for a lumbar intervertebral disc extrusion. The purpose of this study was to investigate the clinical outcomes of IDHP in terms of pain relief, reduction of disability, and risk of complications. Thirty patients with primarily radicular pain due to an extrusion-type disc herniation who underwent IDHP were enrolled in the study. A visual analogue pain scale (VAS) and the Japanese Orthopedic Association (JOA) scoring system for the treatment of low back disorders were used at pre-treatment, 2 weeks post-treatment, and 3 months post-treatment. The mean VAS decreased significantly (p < 0.01) from 64.3 mm at pre-treatment to 26.3 mm at 2 weeks post-treatment and 15.5 at 3 months post-treatment. The mean JOA score improved significantly (p < 0.01) from 14.7 to 21.3 at 2 weeks post-treatment and 24.6 at 3 months post-treatment. IDHP appeared to produce significant effects in patients with radicular pain, leading to the improvement of VAS and JOA scores. IDHP appears to be a safe, minimally invasive treatment option for a lumbar intervertebral disc extrusion. PMID:22669640

Fukui, Sei; Nitta, Kazuhito; Iwashita, Narihito; Tomie, Hisashi; Nosaka, Shuichi

2012-10-01

357

Heating steels in vacuum  

SciTech Connect

It is recommended that high-strength and corrosion-resistant steels be heated in an electric vacuum furnace. Absence of oxidation and decarburization, decrease in the deformation of the part, increase in service life, plus safety, and nontoxicity in the shop, are cited as advantages. Annealing, carburizing, hardening, brazing, and sintering--all detailed-can be more efficiently accomplished in vacuum heating. As vacuum heating requires certain surface conditions, the compositions of residual mediums is studied. The microrelief and surface finish obtained after vacuum heating is determined. Annealing in a vacuum is compared to annealing in air, a depletion in manganese indicating a greater savings by use of vacuum. Ductility is also tested. The gas of special purity nitrogen is recommended for best results. In general, then, use of electric vacuum furnaces is recommended.

Marmer, E.N.

1983-03-01

358

Star-disc-binary interactions in protoplanetary disc systems and primordial spin-orbit misalignments  

NASA Astrophysics Data System (ADS)

We study the interactions between a protostar and circumstellar disc under the influence of a binary companion to determine the evolution of the mutual misalignment between the stellar spin and disc angular momentum axes. Significant misalignments can be generated as the star-disc system evolves in time such that the frequency of disc precession (driven by the binary companion) and that of stellar precession (driven by the disc) cross each other. This resonance behaviour can be understood in a geometric way from the precession dynamics of spin and disc angular momenta. We show that such resonance crossing can occur under reasonable protostar-disc-binary conditions. The star-disc inclination is also affected by mass accretion and by magnetic star-disc interaction torques, which can either promote or reduce star-disc misalignment. In general, a variety of star-disc misalignment angles are produced within the lifetimes of protoplanetary discs. We discuss the implications of our results for stellar spin orientations in binaries, for the alignments/misalignments of protostellar and debris discs, and for the stellar obliquities in exoplanetary systems. In particular, even for systems where the Kozai effect is absent or suppressed, misaligned planets and hot Jupiters may still be produced during the protoplanetary disc phase.

Lai, Dong

2014-06-01

359

Papilloedema and the optic disc.  

PubMed

The anatomy and blood supply of the optic nerve head are reviewed along with the variations in normal appearance and the aetiology of so-called pseudo-papilloedema. The clinical features and causes of papilloedema due to increased intra-cranial pressure are discussed along with optic disc oedema from other causes. The conditions of optic neuritis, neuropathy and the ischaemic optic neuropathies are also evaluated. PMID:2751237

Cullen, J F

1989-03-01

360

Determination and comparison of specifics of nucleus pulposus cells of human intervertebral disc in alginate and chitosan-gelatin scaffolds  

PubMed Central

Introduction: Low back pain is a major economical and social problem nowadays. Intervertebral disc herniation and central degeneration of disc are two major reasons of low back pain that occur because of structural impairment of disc. The intervertebral disc contains three parts as follows : Annulus fibrosus, transitional region, and nucleus pulposus, which forms the central nucleus of the disc. The reduction of cell count and extracellular matrix, especially in nucleus pulposus, causes disc degeneration. Different scaffolds (natural and synthetic) have been used for tissue repairing and regeneration of the intervertebral disc in tissue engineering. Most scaffolds have biodegradable and biocompatible characteristics and also prepare a fine condition for proliferation and migration of cells. In this study, proliferation of NP cells of human intervertebral disc compromised in Chitosan-gelatin scaffold with alginate scaffold was studied. Materials and Methods: NP cells derived from nucleus pulposus by collagenase enzymatic hydrolysis. They were derived from patients who undergoing open surgery for discectomy in the Isfahan Alzahra hospital. Chitosan was blended with gelatin and glutaraldehyde was used for cross linking the two polymers. Then, alginate scaffold was prepared. Cellular suspension with 1 × 105 transferred to each scaffold and cultured for 21 days. Cell viability and proliferation investigated by trypan blue and (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Scanning electron microscope (SEM) was used to assert the porosity and to survey structure of scaffold. Results: MTT assay dem1onstrated that cell viability of third day had significant difference in contrast by first day in both scaffolds. Accordingly, there was a significant decreased in cellular viability from day 3 to 21. Results of the cell count showed a punctual elevation cell numbers for alginate scaffold but there was no similar result for chitosan–gelatin scaffold. Conclusion: Alginate scaffold prepared a better condition for proliferation of NP cells in comparison with chitosan–gelatin scaffold. Results of this study suggest that alginate scaffold could be useful in in vivo studies and treatment.

Renani, Hamid Bahramian; Ghorbani, Masood; Beni, Batool Hashemibeni; Karimi, Z; Mirhosseini, MM; Zarkesh, H; Kabiri, A

2012-01-01

361

Naturally occurring disk herniation in dogs: an opportunity for pre-clinical spinal cord injury research.  

PubMed

Traumatic spinal cord injuries represent a significant source of morbidity in humans. Despite decades of research using experimental models of spinal cord injury to identify candidate therapeutics, there has been only limited progress toward translating beneficial findings to human spinal cord injury. Thoracolumbar intervertebral disk herniation is a naturally occurring disease that affects dogs and results in compressive/contusive spinal cord injury. Here we discuss aspects of this disease that are analogous to human spinal cord injury, including injury mechanisms, pathology, and metrics for determining outcomes. We address both the strengths and weaknesses of conducting pre-clinical research in these dogs, and include a review of studies that have utilized these animals to assess efficacy of candidate therapeutics. Finally, we consider a two-species approach to pre-clinical data acquisition, beginning with a reproducible model of spinal cord injury in the rodent as a tool for discovery with validation in pet dogs with intervertebral disk herniation. PMID:21438715

Levine, Jonathan M; Levine, Gwendolyn J; Porter, Brian F; Topp, Kimberly; Noble-Haeusslein, Linda J

2011-04-01

362

Naturally Occurring Disk Herniation in Dogs: An Opportunity for Pre-Clinical Spinal Cord Injury Research  

PubMed Central

Abstract Traumatic spinal cord injuries represent a significant source of morbidity in humans. Despite decades of research using experimental models of spinal cord injury to identify candidate therapeutics, there has been only limited progress toward translating beneficial findings to human spinal cord injury. Thoracolumbar intervertebral disk herniation is a naturally occurring disease that affects dogs and results in compressive/contusive spinal cord injury. Here we discuss aspects of this disease that are analogous to human spinal cord injury, including injury mechanisms, pathology, and metrics for determining outcomes. We address both the strengths and weaknesses of conducting pre-clinical research in these dogs, and include a review of studies that have utilized these animals to assess efficacy of candidate therapeutics. Finally, we consider a two-species approach to pre-clinical data acquisition, beginning with a reproducible model of spinal cord injury in the rodent as a tool for discovery with validation in pet dogs with intervertebral disk herniation.

Levine, Gwendolyn J.; Porter, Brian F.; Topp, Kimberly; Noble-Haeusslein, Linda J.

2011-01-01

363

Intradural disk herniation at L1-L2: report of two cases  

PubMed Central

Context Lumbar intradural disk herniation (IDH) is a rare but serious complication of spinal disk protrusions. Although the pathogenesis of lumbar IDH is still vague, it is believed to be associated with the adhesion of the posterior longitudinal ligament with the ventral wall of the dura. Diagnosis is still difficult despite current neuroradiologic imaging techniques. Findings Two women, ages 63 and 69 years, presented with recent exacerbation of back pain. In each case, imaging studies revealed a ventral herniated disk at L1–L2. Both patients underwent surgery and in both cases a hard mass was palpated through the dura. Both patients experienced immediate postoperative relief of back pain following surgery. One patient required fusion and postoperative rehabilitation; her neurologic deficit returned to baseline. Conclusion/clinical relevance Prompt surgical intervention is indicated for IDH; disk removal allows for symptomatic relief and minimization of neurologic deficit.

Arnold, Paul M.; Wakwaya, Yosafe T.

2011-01-01

364

Third ventricle herniation into the sphenoid sinus following endoscopic transnasal transsphenoidal fenestration of Rathkes cleft cyst.  

PubMed

Rathke cleft cyst (RCC) is an uncommon albeit benign sellar lesion with an incidence rate of between 2 to 33%. RCCs are usually asymptomatic except in the large cases whit suprasellar extension. We herein describe a unique case of RCC, which presented with severe visual loss owing to massive herniation of the optic chiasm and third ventricle down into the sphenoid sinus through a small 8 x 8 mm foramen after transnasal endoscopic surgical fenestration and marsupialization of the cyst. We describe a reconstruction method via endonasal transsphenoidal approach in this case and suggest prophylactic reconstruction of the sellar floor in sellar lesions with equal or more voluminous suprasellar extensions that are susceptible to such massive herniation and secondary empty sella syndrome. PMID:24535793

Jalessi, Maryam; Sharifi, Guive; Jahanbakhshi, Amin; Parsa, Khosro; Yazdanifard, Parin

2014-01-01

365

Incarcerated Thoracic Gastric Herniation after Nephrectomy: A Report of Two Cases  

PubMed Central

Iatrogenic diaphragmatic hernias can occur after abdominal or thoracic surgery. Acute presentation of a diaphragmatic hernia varies depending on the extent and nature of the organ which has herniated. The initial diagnosis can be challenging due to the nonspecific nature of the presenting symptoms. Delay in diagnosis poses a significant risk to the patient, and a rapid deterioration can occur in the context of strangulation. We outline two cases of acute gastric herniation through a defect in the diaphragm after an open and a laparoscopic nephrectomy. Both had characteristic findings on imaging, required emergency, surgery and had a successful outcome. Both cases highlight the potential for late presentation with non-specific symptoms and the necessity for urgent surgical management where gastric perfusion is compromised.

Fitzgerald, Conall; Mc Cormack, Orla; Awan, Faisal; Elliott, Jessie; Ravi, Narayanasamy; Reynolds, John V.

2013-01-01

366

The Aerodynamics of a Flying Sports Disc  

NASA Astrophysics Data System (ADS)

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.

Potts, Jonathan R.; Crowther, William J.

2001-11-01

367

Congenital partial pericardial defect and herniated right atrial appendage: a rare anomaly.  

PubMed

A congenital partial defect of the right-sided pericardium is a rare cardiac anomaly and it represents defective formation of the pleuropericardial membrane. Patients can be asymptomatic, but they may experience chest pain, myocardial ischemia, emboli, arrhythmia, and sudden death. In this report, we present an 8-month-old boy with pericardial defect and right atrial appendage herniation. It was diagnosed by echocardiography and cardiac magnetic resonance imaging. PMID:16999699

Karakurt, Cem?it; O?uz, Deniz; Karademir, Selmin; Sungur, Metin; Ocal, Burhan

2006-10-01

368

Idiopathic ventral spinal cord herniation: a rare presentation of tethered cord.  

PubMed

Idiopathic ventral spinal cord herniation is a rare condition that has been increasingly reported in the last decade. The natural history and optimal management have yet to be defined. Therefore, debate exists regarding the pathogenesis and surgical management of this condition. The purpose of this review article is to further educate neurosurgeons about the surgical techniques and outcomes associated with treating this rare and often misdiagnosed condition. PMID:20593998

Shin, John H; Krishnaney, Ajit A

2010-07-01

369

Laparoscopic repair of intrathoracic liver herniation after traumatic rupture of the diaphragm.  

PubMed

Right diaphragmatic hernia after abdominal trauma is a rare injury. Most patients can be asymptomatic, and the diagnosis may be delayed for several years. The treatment of choice involves surgical repair via laparotomy. The authors treated a young patient with transdiaphragmatic herniation of the right hepatic lobe and delayed diagnosis using a laparoscopic approach and accomplished a successful complete repair. The 6-month radiologic follow-up assessment confirmed good results. PMID:21556995

Fiscon, Valentino; Portale, Giuseppe; Migliorini, Giovanni; Frigo, Flavio

2011-10-01

370

Usefulness of gadolinium in MRI evaluation of non surgically treated herniated disk.  

PubMed

PURPOSE: The rationale for the use of Gadolinium (Gd) in the MRI evaluation of non surgically treated herniated disk is based on the known presence of inflammatory granulation tissue and neoangiogenesis which plays an important role in both pain and the spontaneous resorption of the hernia. The AIM: of this study was to determine the usefulness of Gd in MRI examination for detecting the inflammatory reaction around the discal hernia. MATERIALS AND METHODS: Thirty-eight patients (mean age 45 years; range 20-70 years) with non surgically treated herniated disk were evaluated with MRI between January 2000 and July 2004. T2w-FAST-SE sagittal and T1w-SE transaxial and sagittal images were acquired before and after the administration of Gd. RESULTS: Twenty out of 22 patients with acute sciatic pain (symptoms =/< 40 days) showed significant peri-hernial enhancement which facilitated the differential diagnosis with other extradural lesions, such as synovial cysts (2/22 cases), as well as the correct definition of the extension of discal hernia in the spinal canal. In the remaining 16 with chronic sciatic pain (symptoms > 6 months) the discal hernia did not show peri-hernial enhancement. CONCLUSIONS: In MRI evaluation of the herniated disk, peri-hernial enhancement is correlated with inflammatory reaction around the hernia which is associated with acute symptoms. The absence of peri-hernial enhancement in chronic herniated disk is due to the poorly vascular fibrotic tissue. Therefore, peri-hernial enhancement facilitates the differential diagnosis in uncertain cases and represents a reliable prognostic index of response to non-surgical therapy and of the possible spontaneous resorption of discal hernia. PMID:15973229

Motta, E; Boniotti, V; Miserocchi, L; Caudana, R

2005-01-01

371

Paraplegia caused by posture during MRI in a patient with cervical disk herniation.  

PubMed

A 48-year-old man presented with numbness in the lower left extremity of 4 months' duration. One month earlier, he presented to an orthopedic clinic and magnetic resonance imaging (MRI) revealed cervical disk herniation. Because the pain did not subside, he visited the clinic again and MRI was performed. His neck was slightly extended and fixed to the headrest of the MRI instrument. Because of the posture of his cervical spine, he suffered severe pain in the scapular region during the MRI. After 15 minutes the pain was unbearable and the MRI examination was aborted. As the patient tried to descend from the MRI table, he was unable to move his bilateral lower extremities. No muscle contraction was observed in his lower limbs. Following MRI with flexion posture of the cervical spine, he was diagnosed with paraplegia caused by cervical disk herniation. Emergency surgery consisting of anterior decompression and fusion was performed. The patient showed good neurological recovery. Three weeks postoperatively, the patient could walk without assistance and he was discharged. The extension posture of the cervical spine during MRI was considered to be the cause of acute paraplegia in this patient. Care should be taken with the posture of the cervical spine, when performing MRI in patients with cervical disk herniation. Extended posture of the cervical spine during MRI may lead to acute neurological deterioration. PMID:20806756

Kato, Yoshihiko; Nishida, Norihiro; Taguchi, Toshihiko

2010-06-01

372

Rapid progression of traumatic bifrontal contusions to transtentorial herniation: A case report  

PubMed Central

We report a case of mild to moderate traumatic brain injury in which ICP monitoring or quantitative cerebral perfusion data may have allowed earlier recognition of impending herniation, avoidance of a secondary insult, and ultimately resulted in a better outcome, even though the patient did not meet the standard guidelines of the Brain Trauma Foundation. A thirty-five year old male who presented with traumatic bifrontal contusions and GCS of fourteen and twelve hours later progressed rapidly to having dilated pupils and transtentorial/central herniation over the course of fifteen minutes. The patient was taken emergently for a bifrontal craniectomy. Post operatively he had an acute infarct in the posterolateral left temporal lobe with expected evolution of parenchymal contusions as well as infarcts in the splenium of the corpus callosum, left thalamus and medial right occipital lobe. This case signifies an exception from the guidelines submitted by the Brain Trauma Foundation for intracranial pressure monitoring in patients with severe brain injury. We also point out previous reports which state that in such a patient a more sensitive test for detection would perhaps be quantitative blood flow monitoring, and may have led to a better outcome. We recommend using intracranial pressure monitoring or blood flow measurements to trend patients with bifrontal intraparenchymal contusions and GCS greater than eight to prevent clinically undetected deterioration from transtentorial/central herniation.

Rehman, Tausif; Ali, Rushna; Tawil, Isaac; Yonas, Howard

2008-01-01

373

Rapid progression of traumatic bifrontal contusions to transtentorial herniation: A case report.  

PubMed

We report a case of mild to moderate traumatic brain injury in which ICP monitoring or quantitative cerebral perfusion data may have allowed earlier recognition of impending herniation, avoidance of a secondary insult, and ultimately resulted in a better outcome, even though the patient did not meet the standard guidelines of the Brain Trauma Foundation. A thirty-five year old male who presented with traumatic bifrontal contusions and GCS of fourteen and twelve hours later progressed rapidly to having dilated pupils and transtentorial/central herniation over the course of fifteen minutes. The patient was taken emergently for a bifrontal craniectomy. Post operatively he had an acute infarct in the posterolateral left temporal lobe with expected evolution of parenchymal contusions as well as infarcts in the splenium of the corpus callosum, left thalamus and medial right occipital lobe. This case signifies an exception from the guidelines submitted by the Brain Trauma Foundation for intracranial pressure monitoring in patients with severe brain injury.We also point out previous reports which state that in such a patient a more sensitive test for detection would perhaps be quantitative blood flow monitoring, and may have led to a better outcome. We recommend using intracranial pressure monitoring or blood flow measurements to trend patients with bifrontal intraparenchymal contusions and GCS greater than eight to prevent clinically undetected deterioration from transtentorial/central herniation. PMID:18831756

Rehman, Tausif; Ali, Rushna; Tawil, Isaac; Yonas, Howard

2008-01-01

374

Brain herniation in a patient with apparently normal intracranial pressure: a case report  

PubMed Central

Introduction Intracranial pressure monitoring is commonly implemented in patients with neurologic injury and at high risk of developing intracranial hypertension, to detect changes in intracranial pressure in a timely manner. This enables early and potentially life-saving treatment of intracranial hypertension. Case presentation An intraparenchymal pressure probe was placed in the hemisphere contralateral to a large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically ventilated and sedated because of depressed consciousness. Intracranial pressures were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped, our patient showed clinical signs of transtentorial brain herniation, despite apparently normal intracranial pressures (less than 10 mmHg). Computed tomography revealed that the size of the intracerebral hematoma had increased together with significant unilateral brain edema and transtentorial herniation. The contralateral hemisphere where the intraparenchymal pressure probe was placed appeared normal. Our patient underwent emergency decompressive craniotomy and was tracheotomized early, but did not completely recover. Conclusions Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral hematoma may dramatically underestimate intracranial pressure despite apparently normal values, even in the case of transtentorial brain herniation.

2010-01-01

375

Rossby wave instability in astrophysical discs  

NASA Astrophysics Data System (ADS)

A brief review is given of the Rossby wave instability in astrophysical discs. In non-self-gravitating discs, around for example a newly forming stars, the instability can be triggered by an axisymmetric bump at some radius r0 in the disc surface mass-density. It gives rise to exponentially growing non-axisymmetric perturbation (\\propto \\exp \\,({ { i}}m\\phi ) , m = 1,2,…) in the vicinity of r0 consisting of anticyclonic vortices. These vortices are regions of high pressure and consequently act to trap dust particles which in turn can facilitate planetesimal growth in proto-planetary discs. The Rossby vortices in the discs around stars and black holes may cause the observed quasi-periodic modulations of the disc's thermal emission.

Lovelace, R. V. E.; Romanova, M. M.

2014-08-01

376

Vacuum probe surface sampler  

NASA Technical Reports Server (NTRS)

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.

Zahlava, B. A. (inventor)

1973-01-01

377

Turbulent drag reduction through oscillating discs  

NASA Astrophysics Data System (ADS)

The changes of a turbulent channel flow subjected to oscillations of wall flush-mounted rigid discs are studied by means of direct numerical simulations. The Reynolds number is $R_\\tau$=$180$, based on the friction velocity of the stationary-wall case and the half channel height. The primary effect of the wall forcing is the sustained reduction of wall-shear stress, which reaches a maximum of 20%. A parametric study on the disc diameter, maximum tip velocity, and oscillation period is presented, with the aim to identify the optimal parameters which guarantee maximum drag reduction and maximum net energy saving, computed by taking into account the power spent to actuate the discs. This may be positive and reaches 6%. The Rosenblat viscous pump flow is used to predict the power spent for disc motion in the turbulent channel flow and to estimate localized and transient regions over the disc surface subjected to the turbulent regenerative braking effect, for which the wall turbulence exerts work on the discs. The FIK identity is employed to show that the wall-friction reduction is due to two distinguished effects. One effect is linked to the direct shearing action of the near-wall oscillating disc boundary layer on the wall turbulence, which causes the attenuation of the turbulent Reynolds stresses. The other effect is due the additional disc-flow Reynolds stresses produced by the inter-disc structures. The contribution to drag reduction due to turbulent Reynolds stress attenuation depends on the penetration thickness of the disc-flow boundary layer, while the contribution due to the elongated structures scales linearly with a simple function of the maximum tip velocity and oscillation period for the largest disc diameter tested, a result suggested by the Rosenblat flow solution. A brief discussion on the future applicability of the oscillating-disc technique is also presented.

Wise, Daniel J.; Ricco, Pierre

2014-05-01

378

DISC: the dynamic instruction set computer  

Microsoft Academic Search

A dynamic instruction set computer (DISC) has been developed to support demand-driven instruction set modification. Using partial reconfiguration, DISC pages instruction modules in and out of an FPGA as demanded by the executing program. Instructions occupy FPGA resources only when needed and FPGA resources can be reused to implement an arbitrary number of performance-enhancing application-specific instructions. DISC further enhances the

Michael J. Wirthlin; Brad L. Hutchings

1995-01-01

379

Accretion in giant planet circumplanetary discs  

NASA Astrophysics Data System (ADS)

During the final growth phase of giant planets, accretion is thought to be controlled by a surrounding circumplanetary disc. Current astrophysical accretion disc models rely on hydromagnetic turbulence or gravitoturbulence as the source of effective viscosity within the disc. However, the magnetically coupled accreting region in these models is so limited that the disc may not support inflow at all radii, or at the required rate. Here, we examine the conditions needed for self-consistent accretion, in which the disc is susceptible to accretion driven by magnetic fields or gravitational instability. We model the disc as a Shakura-Sunyaev ? disc and calculate the level of ionization, the strength of coupling between the field and disc using Ohmic, Hall and Ambipolar diffusevities for both a magnetorotational instability (MRI) field and vertical field, and the strength of gravitational instability. We find that the standard constant-? disc is only coupled to the field by thermal ionization within 30 RJ with strong magnetic diffusivity prohibiting accretion through the bulk of the mid-plane. In light of the failure of the constant-? disc to produce accretion consistent with its viscosity, we drop the assumption of constant-? and present an alternate model in which ? varies radially according to the level magnetic turbulence or gravitoturbulence. We find that a vertical field may drive accretion across the entire disc, whereas MRI can drive accretion out to ˜ 200 RJ, beyond which Toomre's Q = 1 and gravitoturbulence dominates. The discs are relatively hot (T ? 800 K), and consequently massive (Mdisc ˜ 0.5 MJ).

Keith, Sarah L.; Wardle, Mark

2014-05-01

380

Reevaluation of predictive factors for complete recovery in dogs with nonambulatory tetraparesis secondary to cervical disk herniation.  

PubMed

The vast majority of dogs with cervical disk herniation experience cervical pain and only mild motor deficits; therefore, not much is known about the factors that predict recovery in dogs with nonambulatory tetraparesis (NAT) secondary to cervical disk herniation. In this retrospective study, we tested the hypothesis that two previously reported prognostic factors, site of disk herniation and severity of neurological deficits, are useful predictors of complete recovery. Overall, 20 (62%) of 32 dogs with cervical disk herniation-associated NAT had complete recovery. Site of disk herniation was not a significant predictor of complete recovery; dogs with high cervical lesions (C2 to C3, C3 to C4) did not have a higher likelihood of complete recovery than other dogs. Likewise, severity of neurological deficits (i.e., intact voluntary motor function versus absent voluntary motor function) was not a significant predictor of complete recovery. Using stepwise logistic regression, two significant predictors of complete recovery were identified. Small dogs (delta15 kg body weight) were six times more likely to achieve complete recovery than larger dogs. Dogs that regained the ability to walk within 96 hours after surgery were seven times more likely to completely recover than dogs not walking 96 hours after surgery. We conclude that neither the site of disk herniation nor severity of neurological deficits assists the clinician in predicting postoperative outcome in dogs with cervical disk herniation-associated NAT. Reliable preoperative predictors of complete recovery are needed to advance current diagnostic and treatment protocols to improve overall prognosis. PMID:19570897

Hillman, Robert B; Kengeri, Seema S; Waters, David J

2009-01-01

381

Accretion Discs Show Their True Colours  

NASA Astrophysics Data System (ADS)

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.

2008-07-01

382

Linear eigenvalue analysis of the disc-brake squeal problem  

Microsoft Academic Search

SUMMARY This paper presents a numerical method to calculate the unstable frequencies of a car disc brake and suggests a suitable analysis procedure. The stationary components of the disc brake are modelled using finite elements and the disc as a thin plate. The separate treatments of the stationary components and the rotating disc facilitate the modelling of the disc brake

Q. Cao; H. Ouyang; M. I. Friswell; J. E. Mottershead

2004-01-01

383

Use of adipose stem cells and polylactide discs for tissue engineering of the temporomandibular joint disc  

PubMed Central

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.

Maenpaa, Katja; Ella, Ville; Mauno, Jari; Kellomaki, Minna; Suuronen, Riitta; Ylikomi, Timo; Miettinen, Susanna

2010-01-01

384

Intervertebral disc cells as competent phagocytes in vitro: implications for cell death in disc degeneration  

Microsoft Academic Search

INTRODUCTION: Apoptosis has been reported to occur in the intervertebral disc. Elsewhere in the body, apoptotic cells are cleared from the system via phagocytosis by committed phagocytes such as macrophages, reducing the chance of subsequent inflammation. These cells, however, are not normally present in the disc. We investigated whether disc cells themselves can be induced to become phagocytic and so

Philip Jones; Lucy Gardner; Janis Menage; Gwyn T Williams; Sally Roberts

2008-01-01

385

Intervertebral Disc Cell Therapy for Regeneration: Mesenchymal Stem Cell Implantation in Rat Intervertebral Discs  

Microsoft Academic Search

This study explores the use of mesenchymal stem cells (MSCs) for intervertebral disc regeneration. We used an in vivo model to investigate the feasibility of exogenous cell delivery, retention, and survival in the pressurized disc space. MSC injection into rat coccygeal discs was performed using 15% hyaluronan gel as a carrier. Injections of gel with or without MSCs were performed.

Gwen Crevensten; Andrew J. L. Walsh; Dheera Ananthakrishnan; Paul Page; George M. Wahba; Jeffrey C. Lotz; Sigurd Berven

2004-01-01

386

Protoplanetary disc evolution affected by star-disc interactions in young stellar clusters  

NASA Astrophysics Data System (ADS)

Most stars form in a clustered environment. Therefore, it is important to assess how this environment influences the evolution of protoplanetary discs around young stars. In turn, this affects their ability to produce planets and ultimately life. We present here for the first time 3D smoothed particle hydrodynamics/N-body simulations that include both the hydrodynamical evolution of the discs around their natal stars, as well as the dynamics of the stars themselves. The discs are viscously evolving, accreting mass on to the central star and spreading. We find penetrating encounters to be very destructive for the discs as in previous studies, although the frequency of such encounters is low. We also find, however, that encounter influence the disc radii more strongly than other disc properties such as the disc mass. The disc sizes are set by the competition between viscous spreading and the disruptive effect of encounters. As discs spread, encounters become more and more important. In the regime of rapid spreading, encounters simply truncate the discs, stripping the outer portions. In the opposite regime, we find that the effect of many distant encounters is able to limit the disc size. Finally, we predict from our simulations that disc sizes are limited by encounters at stellar densities exceeding ˜2-3 × 103 pc-2.

Rosotti, Giovanni P.; Dale, James E.; de Juan Ovelar, Maria; Hubber, David A.; Kruijssen, J. M. Diederik; Ercolano, Barbara; Walch, Stefanie

2014-07-01

387

A Study of Disc Wear on a Pin-on-Disc Tester by Thin Layer Activation.  

National Technical Information Service (NTIS)

The wear rate of an iron disc in lubricated contact with an iron pin on a pin-on-disc wear tester was measured using thin layer activation. The ratio of disc wear to pin wear was shown to be lower than that predicted on the basis of equal volumetric wear ...

J. Asher A. T. Peacock

1982-01-01

388

Dead zones in protostellar discs: the case of jet emitting discs  

Microsoft Academic Search

Context. Among the many aspects related to planet formation and migration, dead zones are of particular importance as they may influence both processes. The ionisation level in the disc is the key element in determining the existence and the location of the dead zone. This has been studied either within the standard accretion disc (SAD) framework or using parametrized discs.

Céline Combet; Jonathan Ferreira; Fabien Casse

2010-01-01

389

Compact vacuum insulation embodiments  

Microsoft Academic Search

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

D. K. Benson; T. F. Potter

1992-01-01

390

Compact vacuum insulation  

Microsoft Academic Search

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

David K. Benson; Thomas F. Potter

1993-01-01

391

Working in a Vacuum  

ERIC Educational Resources Information Center

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)…

Rathey, Allen

2005-01-01

392

Study of Vacuum Welding.  

National Technical Information Service (NTIS)

Vacuum cold welding and shear friction of several engineering materials was studied at extremely high vacuum levels above 10 to the -12th power torr in the temperature range 90 to 260 C with interface contact stresses up to 1000 psi. The effect of surface...

M. J. Hordon J. R. Roehrig

1967-01-01

393

Vacuuming radioactive sludge  

SciTech Connect

Vacuuming an estimated 55 cubic yards of radioactive sludge from the floor of Hanford's K East Basin was a complicated process. Workers stood on grates suspended above the 20-foot deep basin and manipulated vacuuming equipment at the end of long poles--using underwater cameras to guide their work.

2006-10-16

394

Vacuum Probe Surface Sampler.  

National Technical Information Service (NTIS)

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 vacu...

B. A. Zahlava

1973-01-01

395

Vacuum driven accelerated expansion  

Microsoft Academic Search

It has been shown that an improved estimation of quantum vacuum energy can yield not only acceptable but also experimentally sensible results. The very idea consists in a straightforward extraction of gravitationally interacting part of the full quantum vacuum energy by means of gauge transformations. The implementation of the idea has been performed in the formalism of effective action, in

B. Broda; P. Bronowski; Marcin Ostrowski; Micha? Szanecki

2008-01-01

396

Stellarator Helical Vacuum Vessel.  

National Technical Information Service (NTIS)

A design study of a stainless steel, heavy wall, helically shaped vacuum torus has been made for use in a proposed Stellarator configuration. The study concerns itself with the shape of the vacuum vessel and the division of the vessel into components that...

E. J. Yavornik

1983-01-01

397

A method for quantitative measurement of lumbar intervertebral disc structures: an intra- and inter-rater agreement and reliability study  

PubMed Central

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 Altman’s 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.

2013-01-01

398

Cryogenic vacuum tight adhesive  

NASA Astrophysics Data System (ADS)

A synthetic adhesive for vacuum tight joints at cryogenic temperatures has been developed. It consists of three components, the main component being epoxy silicone organic resin. The joints made with the adhesive remain vacuum tight at liquid helium temperature, including superfluid helium. It was found possible to connect different materials with the adhesive (copper and stainless steel with each other, aluminum, aluminum alloys, fiberglass, etc.). The joints withstood thermal shock tests of ten repeated sharps cooling to liquid nitrogen temperature and heating in hot water. Using the adhesive a lot of different vacuum tight low temperature joints have been made. More than fifteen years of wide application of this adhesive in vacuum tight cryogenic joints proved its high reliability. Some designs of vacuum tight cryogenic joints are presented and the technique of their manufacturing is described.

Anashkin, O. P.; Keilin, V. E.; Patrikeev, V. M.

1999-12-01

399

Stellar discs in Aquarius dark matter haloes  

NASA Astrophysics Data System (ADS)

We investigate the gravitational interactions between live stellar discs and their dark matter haloes, using ? cold dark matter haloes similar in mass to that of the Milky Way taken from the Aquarius Project. We introduce the stellar discs by first allowing the haloes to respond to the influence of a growing rigid disc potential from z = 1.3 to 1.0. The rigid potential is then replaced with star particles which evolve self-consistently with the dark matter particles until z = 0.0. Regardless of the initial orientation of the disc, the inner parts of the haloes contract and change from prolate to oblate as the disc grows to its full size. When the disc's normal is initially aligned with the major axis of the halo at z = 1.3, the length of the major axis contracts and becomes the minor axis by z = 1.0. Six out of the eight discs in our main set of simulations form bars, and five of the six bars experience a buckling instability that results in a sudden jump in the vertical stellar velocity dispersion and an accompanying drop in the m = 2 Fourier amplitude of the disc surface density. The bars are not destroyed by the buckling but continue to grow until the present day. Bars are largely absent when the disc mass is reduced by a factor of 2 or more; the relative disc-to-halo mass is therefore a primary factor in bar formation and evolution. A subset of the discs is warped at the outskirts and contains prominent non-coplanar material with a ring-like structure. Many discs reorient by large angles between z = 1 and 0, following a coherent reorientation of their inner haloes. Larger reorientations produce more strongly warped discs, suggesting a tight link between the two phenomena. The origins of bars and warps appear independent: some discs with strong bars show little disturbances at the outskirts, while the discs with the weakest bars show severe warps.

DeBuhr, Jackson; Ma, Chung-Pei; White, Simon D. M.

2012-10-01

400

Theory of Black Hole Accretion Discs  

NASA Astrophysics Data System (ADS)

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. Björnsson; 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.

Abramowicz, Marek A.; Björnsson, Gunnlaugur; Pringle, James E.

1999-03-01

401

Theory of Black Hole Accretion Discs  

NASA Astrophysics Data System (ADS)

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. Björnsson; 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.

Abramowicz, Marek A.; Björnsson, Gunnlaugur; Pringle, James E.

2010-08-01

402

Radiographic Markers of Femoroacetabular Impingement: Correlation of Herniation Pit and Femoral Bump with a Positive Cross-Over Ratio  

PubMed Central

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.

Scheyerer, Max J.; Copeland, Carol E.; Stromberg, Jeffrey; Ruckstuhl, Thomas; Werner, Clement M. L.

2014-01-01

403

A new digital optic disc stereo camera: intraobserver and interobserver repeatability of optic disc measurements  

PubMed Central

AIMS—To investigate the intraobserver and interobserver repeatability of optic disc measurement using a new digital optic disc stereo camera.?METHODS—112 consecutive new patients presenting to a glaucoma service had dilated optic disc photography performed using a new digital stereo camera (Discam, Marcher Enterprises Ltd, Hereford). The images were analysed by two masked observers using a stereo viewer and computer simulated stereopsis. Vertical and horizontal cup:disc ratios (CDR), cup area:disc area, and cup circumference:disc circumference were computed. Intraobserver and interobserver repeatability analyses were performed. Intraclass correlation coefficients (ICC) and 95% tolerance for change (TC) were computed.?RESULTS—220 optic discs were photographed, of which 196 were suitable for analysis (10 were of poor image quality and 14 had anomalous discs). Mean age of patients was 65 years, 60 were male and 48 female. For intraobserver measurements of: horizontal CDR, ICC = 0.94, TC = 0.11 (15% of range); vertical CDR, ICC = 0.92, TC = 0.14 (16% of range); cup area:disc area, ICC = 0.95, TC = 0.10 (13% of range), and cup circumference:disc circumference, ICC = 0.95, TC = 0.09 (14% of range). For interobserver measurements of: horizontal CDR, ICC = 0.89, TC = 0.14 (19% of range); vertical CDR, ICC = 0.90, TC = 0.14 (16% of range); cup area:disc area, ICC = 0.92, TC = 0.13 (16% of range), and cup circumference:disc circumference, ICC = 0.90, TC = 0.12 (17% of range). Systematic bias between observers was within acceptable limits.?CONCLUSIONS—Digital stereo disc photography and analysis provide repeatable measures of optic disc variables. The results compare favoura