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Sample records for vacuum disc herniation

  1. Percutaneous Intradiscal Aspiration of a Lumbar Vacuum Disc Herniation: A Case Report

    PubMed Central

    Pak, Kevin I.; Hoffman, David C.; Herzog, Richard J.

    2010-01-01

    We report a case of an 83-year-old gentleman presenting with acute low back pain and radicular left lower extremity pain after golfing. A magnetic resonance imaging (MRI) of the lumbar spine revealed a low-signal-density lesion compressing the L5 nerve. A computed tomography scan was then ordered, confirming an extra-foraminal disc protrusion at the L5–S1 level, containing a focus of gas that was compressing the left L5 nerve root and communicating with the vacuum disc at L5–S1. After a failed left L5 transforaminal epidural steroid injection, the patient was brought back for a percutaneous intradiscal aspiration of the vacuum disc gas. This resulted in immediate relief for the patient. A follow-up MRI performed 2 months after the procedure found an approximate 25% reduction in the size of the vacuum disc herniation. Six months after the procedure, the patient remains free of radicular pain. This case report suggests that a percutaneous aspiration of gas from a vacuum disc herniation may assist in the treatment of radicular pain. PMID:22294964

  2. LUMBAR DISC HERNIATION

    PubMed Central

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

    2015-01-01

    Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physiotherapy, sometimes associated with percutaneous nerve root block. Surgical treatment is indicated if pain control is unsuccessful, if there is a motor deficit greater than grade 3, if there is radicular pain associated with foraminal stenosis, or if cauda equina syndrome is present. The latter represents a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence over the long term. PMID:27019834

  3. Lumbar Epidural Varix Mimicking Disc Herniation

    PubMed Central

    Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur

    2016-01-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  4. Lumbar Disc Herniation Presented with Contralateral Symptoms

    PubMed Central

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

    2017-01-01

    Objective This study aimed to unravel the putative mechanism underlying the neurologic deficits contralateral to the side with lumbar disc herniation (LDH) and to elucidate the treatment for this condition. Methods From January 2009 to June 2015, 8 patients with LDH with predominantly contralateral neurologic deficits underwent surgical treatment on the side with LDH with or without decompressing the symptomatic side. A retrospective review of charts and radiological records of these 8 patients was performed. The putative mechanisms underlying the associated contralateral neurological deficits, magnetic resonance imaging (MRI), electromyography (EMG), and the adequate surgical approach are discussed here. Results MRI revealed a similar laterally skewed paramedian disc herniation, with the apex deviated from the symptomatic side rather than directly compressing the nerve root; this condition may generate a contralateral traction force. EMG revealed radiculopathies in both sides of 6 patients and in the herniated side of 2 patients. Based on EMG findings and the existence of suspicious lateral recess stenosis of the symptomatic side, 6 patients underwent bilateral decompression of nerve roots and 2 were subjected to a microscopic discectomy to treat the asymptomatic disc herniation. No specific conditions such as venous congestion, nerve root anomaly or epidural lipomatosis were observed, which may be considered the putative pathomechanism causing the contralateral neurological deficits. The symptoms resolved significantly after surgery. Conclusion The traction force generated on the contralateral side and lateral recess stenosis, rather than direct compression, may cause the contralateral neurologic deficits observed in LDH. PMID:28264243

  5. Lumbar herniated disc: spontaneous regression

    PubMed Central

    Yüksel, Kasım Zafer

    2017-01-01

    Background Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. Methods This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3−L4, L4−L5 or L5−S1 were enrolled. Results The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Laségue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3−L4, L4−L5, and L5−S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5−22). Conclusions It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery. PMID:28119770

  6. Risk Factors for Recurrent Lumbar Disc Herniation

    PubMed Central

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

    2016-01-01

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

  7. Thalamic Pain Misdiagnosed as Cervical Disc Herniation.

    PubMed

    Lim, Tae Ha; Choi, Soo Il; Yoo, Jee In; Choi, Young Soon; Lim, Young Su; Sang, Bo Hyun; Bang, Yun Sic; Kim, Young Uk

    2016-04-01

    Thalamic pain is a primary cause of central post-stroke pain (CPSP). Clinical symptoms vary depending on the location of the infarction and frequently accompany several pain symptoms. Therefore, correct diagnosis and proper examination are not easy. We report a case of CPSP due to a left acute thalamic infarction with central disc protrusion at C5-6. A 45-year-old-male patient experiencing a tingling sensation in his right arm was referred to our pain clinic under the diagnosis of cervical disc herniation. This patient also complained of right cramp-like abdominal pain. After further evaluations, he was diagnosed with an acute thalamic infarction. Therefore detailed history taking should be performed and examiners should always be aware of other symptoms that could suggest a more dangerous disease.

  8. Risk Factors for Recurrent Lumbar Disc Herniations

    PubMed Central

    2014-01-01

    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

  9. Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level

    PubMed Central

    Gürcan, Serkan

    2016-01-01

    Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain due to disc herniation caudally immigrating at L4-5 level three years ago. He refused the surgical intervention that was offered and was treated conservatively at that time. He had no neurological deficit and a history of spontaneous regression of the extruded lumbar disc; so, a conservative therapy, including bed rest, physical therapy, nonsteroidal anti-inflammatory drugs, and analgesics, was advised. In conclusion, herniated lumbar disc fragments may regress spontaneously. Reports are prone to advise conservative treatment for extruded or sequestrated lumbar disc herniations. However, these patients should be followed up closely; new herniation at adjacent/different level may occur. Furthermore, it is important to know which herniated disk should be removed and which should be treated conservatively, because disc herniation may cause serious complications as muscle weakness and cauda equine syndrome. PMID:27429818

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

    PubMed Central

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

    2015-01-01

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

  11. Sacral Perineural Cyst Accompanying Disc Herniation

    PubMed Central

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

    2009-01-01

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

  12. Concomitance of fibromyalgia syndrome and cervical disc herniation

    PubMed Central

    Güler, Mustafa; Aydın, Teoman; Akgöl, Erdal; Taşpınar, Özgür

    2015-01-01

    [Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2–3, 16.6% C5–6, 16.6% C6–7, 33.3% C4–5, C5–6 (two levels in two patients) and 16.6% C4–5, C5–6, C7–1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population. PMID:25931731

  13. Spontaneous Intracranial Hypotension Secondary to Lumbar Disc Herniation

    PubMed Central

    Kim, Kyoung-Tae

    2010-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2005-07-01

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

  15. [L1-2 lumbar disc herniation: a case report].

    PubMed

    Monobe, T; Fujita, T; Nakaue, Y; Nishi, N

    1996-03-01

    A 49-year-old female presented a two-year history of pain in the right thigh and lower back. Neurological examination on admission demonstrated weakness of the right iliopsoas and quadriceps, hypesthesia on the right L1-2 dermatome. Radiological examination including myelography, CT myelography and discography disclosed an L1-2 herniated disc. Sagittal MRI also revealed an L1-2, an L4-5 and L5-S1 protruded disc. A posterior microdiscectomy (Love's method) was performed for the L1-2 disc. A controlateral protruded disc which compressed the L-2 nerve root was identified and partially removed. The postoperative myelography showed residual disc. The patient was free from pain and regained normal sensorimotor function. Love's posterior microdiscectomy has a disadvantage in that the operative field is limited. Careful surgical procedure was needed to avoid injury to nerve roots and the cauda equina in a tight L1-2 lumbar canal.

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

    NASA Astrophysics Data System (ADS)

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

    2010-03-01

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

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

    PubMed

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

    2016-01-28

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

  18. Treatment of symptomatic thoracic disc herniations with lateral interbody fusion

    PubMed Central

    Parker, Rhiannon M.

    2015-01-01

    Background Symptomatic thoracic herniated discs have historically been treated using open exposures (i.e., thoracotomy), posing a clinical challenge given the approach related morbidity. Lateral interbody fusion (LIF) is one modern minimally disruptive alternative to thoracotomy. The direct lateral technique for lumbar pathologies has seen a sharp increase in procedural numbers; however application of this technique in thoracic pathologies has not been widely reported. Methods This study presents the results of three cases where LIF was used to treat symptomatic thoracic disc herniations. Indications for surgery included thoracic myelopathy, radiculopathy and discogenic pain. Patients were treated with LIF, without supplemental internal fixation, and followed for 24 months postoperatively. Results: Average length of hospital stay was 5 days. One patient experienced mild persistent neuropathic thoracic pain, which was managed medically. At 3 months postoperative all patients had returned to work and by 12 months all patients were fused. From preoperative to 24-month follow-up there were mean improvements of 83.3% in visual analogue scale (VAS), 75.3% in Oswestry Disability Index (ODI), and 79.2% and 17.4% in SF-36 physical (PCS) and mental component scores (MCS), respectively. Conclusions LIF is a viable minimally invasive alternative to conventional approaches in treating symptomatic thoracic pathology without an access surgeon, rib resection, or lung deflation. PMID:27683683

  19. [Functional status of patients after lumbar disc herniation surgery].

    PubMed

    Imamović, Maida Zonić; Hodzić, Mirsad; Duraković, Suada Kapidzić; Basić, Nedima Kapidzić; Cickusić, Amela; Imamović, Goran

    2010-01-01

    The aim of this study was to determine whether early rehabilitation from the first postoperative day after lumbar disc herniation surgery improved functional status of patients compared to the rehabilitation that started 3 weeks after surgery. Oswestry index was used for functional status assessment before surgery and after rehabilitation in 60 patients divided in 2 groups, i.e., early and control group of rehabilitation strated 3 weeks after surgery, 30 in each. Oswestry index values before surgery and after rehabilitation in the early rehabilitation group were 78.4 +/- 17 and 19.6 +/- 9.9, respectively (p < 0.0001) and in the control group the values were 79 +/- 13 and 37 +/- 14, respectively (p < 0.0001). The difference of Oswestry index before operation and after rehabilitation in the early rehabilitation group was 58.7 +/- 18.9, and in the control group 41.6 +/- 13.2 (p = 0.0001). Onset of rehabilitation from the first post operative day lead to better functional recovery compared to delayed rehabilitation 3 weeks after lumbar disc herniation surgery.

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

    PubMed Central

    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

    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. PMID:14573712

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

    PubMed Central

    Kazemi, Mohsen

    1999-01-01

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

  2. Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations

    PubMed Central

    Jung, Je-Tea; Lee, Sang-Jin; Kim, Young-Sang; Jang, Han-Jin; Yoo, Bang

    2016-01-01

    The major problems of revision surgery for recurrent lumbar disc herniation (LDH) include limited visualization due to adhesion of scar tissue, restricted handling of neural structures in insufficient visual field, and consequent higher risk of a dura tear and nerve root injury. Therefore, clear differentiation of neural structures from scar tissue and adhesiolysis performed while preserving stability of the remnant facet joint would lower the risk of complications and unnecessary fusion surgery. Biportal endoscopic spine surgery has several merits including sufficient magnification with panoramic view under very high illumination and free handling of instruments normally impossible in open spine surgery. It is supposed to be a highly recommendable alternative technique that is safer and less destructive than the other surgical options for recurrent LDH. PMID:27583117

  3. Transition of a herniated lumbar disc to lumbar discal cyst: A case report

    PubMed Central

    Bansil, Rohit; Hirano, Yoshitaka; Sakuma, Hideo; Watanabe, Kazuo

    2016-01-01

    Background: Another rare cause of lower back pain with radiculopathy is the discal cyst. It is believed to arise from degeneration of a herniated disc, although many other theories of its origin have been proposed. Here, we report a patient with lower back pain/radiculopathy attributed originally to a herniated lumbar disc, which transformed within 6 months into a discal cyst. Case Description: A 42-year-old male had a magnetic resonance (MR) documented herniated lumbar disc at the L4-5 level. It was managed conservatively for 6 months, after which symptoms recurred and progressed. The follow-up MR study revealed a discal cyst at the L4-5 without residual herniated disc. Of interest, the cyst communicated with the L4-5 intervertebral disc, which was herniated under the posterior longitudinal ligament and the disc space. During surgery, the cyst was completely removed, and his symptoms/signs resolved. Conclusion: A discal cyst develops as pathological sequelae of a degenerated herniated disc. Although rare, these lesions must be considered among the differential diagnoses in young patients with radicular back pain. MR study clearly documents these lesions, and surgical excision of the cyst is the treatment of choice. PMID:27843689

  4. Propriospinal Myoclonus Induced by a Herniated Lumbar Intervertebral Disc at a Young Age: A Case Report

    PubMed Central

    Song, Kwan Su; Kim, Chang Hyun; Lee, Ho Kook

    2011-01-01

    The cause of propriospinal myoclonus (PSM) is idiopathic. Cervical trauma, ischemic myelopathy secondary to a spinal dural arteriovenous fistula, syringomyelia, Lyme neuroborreliosis, human immunodeficiency virus central nervous system infection, and cervical disc herniation can be the cause of PSM, but lumbar herniated intervertebral disc (HIVD) induced PSM has not been reported. We describe a patient who presented with PSM induced by HIVD and was treated with an epidural steroid injection using a transforaminal approach. PMID:26064150

  5. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher

    PubMed Central

    Kato, Kinshi; Yabuki, Shoji; Otani, Koji; Nikaido, Takuya; Otoshi, Ken-ichi; Watanabe, Kazuyuki; Kikuchi, Shin-ichi; Konno, Shin-ichi

    2016-01-01

    Abstract Symptomatic thoracic disc herniation is clinically rare. There are few cases of disc herniation of the thoracic spine in top athletes described in the literature. We herein present a rare case of chest wall pain due to thoracic disc herniation in a professional baseball pitcher. A 30-year-old, left-handed pitcher complained of left-sided chest wall pain in the region of his lower ribs during a game. Neurological examination revealed hypoesthesia of the left side of the chest at the level of the lower thoracic spine. Magnetic resonance imaging (MRI) of the thoracic spine showed a left-sided paramedian disc herniation at the T9-T10 level. The player was initially prescribed rest, administration of pregabalin (150 mg twice a day), and subsequent physical rehabilitation. He was able to resume full training and pitching without medication 6 months after the onset. A follow-up MRI of the thoracic spine showed a reduction in the size of the herniated disc compared to the initial findings. Though relatively rare, thoracic disc herniation should be considered in cases of chest wall pain in athletes. PMID:26983590

  6. Treatment of Recurrent Disc Herniation: A Systematic Review

    PubMed Central

    Ugiliweneza, Beatrice; Al-Khouja, Lutfi; Yang, Dongyan; Johnson, Patrick; Kim, Terrence; Boakye, Maxwell

    2016-01-01

    Intervertebral disc herniation is one of the most common causes of back and extremity pain. The most commonly used surgical treatment is lumbar discectomy. About 0.5-25% go on to develop recurrent disc herniation (rDH) after a successful first discectomy. Currently, there aren’t any guidelines to assist surgeons in determining which approach is most appropriate to treat rDH. A recent survey showed significant heterogeneity among surgeons regarding treatment options for rDH. It remains unclear which methods lead to better outcomes, as there are no comparative studies with a sufficient level of evidence. In this study, we aimed to perform a systematic review to compare treatment options for rDH and determine if one intervention provides better outcomes than the other; more specifically, whether outcome differences exist between discectomy alone and discectomy with fusion. We applied the PICOS (participants, intervention, comparison, outcome, study design) format to develop this systematic review through PubMed. Twenty-seven papers from 1978-2014 met our inclusion criteria and were included in the analysis. Nine papers reported outcomes after discectomy and seven of them showed good or excellent outcomes (70.60%-89%). Ten papers reported on minimally invasive discectomy. The percent change in visual analog scale (VAS) ranged from -50.77% to -86.57%, indicating an overall pain reduction. Four studies out of the ten reported good or excellent outcomes (81% to 90.2%). Three studies looked at posterolateral fusion. Three studies analyzed posterior lumbar interbody fusion. For one study, we found the VAS percentage change to be -46.02%. All reported good to excellent outcomes. Six studies evaluated the transforaminal lumbar interbody fusion. All reported improvement in pain. Four used VAS, and we found the percent change to be -54% to -86.5%. The other two used the Japanese Orthopedic Association (JOA) score, and we found the percent change to be 68.3% to 93.3%. We

  7. Higher risk for cervical herniated intervertebral disc in physicians

    PubMed Central

    Liu, Cheng; Huang, Chien-Cheng; Hsu, Chien-Chin; Lin, Hung-Jung; Guo, How-Ran; Su, Shih-Bin; Wang, Jhi-Joung; Weng, Shih-Feng

    2016-01-01

    Abstract There is no study about cervical herniated intervertebral disc (cervical HIVD) in physicians in the literature; therefore, we conceived a retrospective nationwide, population-based cohort study to elucidate the topic. We identified 26,038 physicians, 33,057 non-physician healthcare providers (HCPs), and identical numbers of non-HCP references (i.e., general population). All cohorts matched a 1:1 ratio with age and gender, and each were chosen from the Taiwan National Health Insurance Research Database (NHIRD). We compared cervical HIVD risk among physicians, nonphysician HCPs, and non-HCP references and performed a follow-up between 2007 and 2011. We also made comparisons among physician specialists. Both physicians and nonphysician HCPs had higher cervical HIVD risk than non-HCP references (odds ratio [OR]: 1.356; 95% confidence interval (CI): 1.162–1.582; OR: 1.383; 95% CI: 1.191–1.605, respectively). There was no significant difference of cervical HIVD risk between physicians and nonphysician HCPs. In the comparison among physician specialists, orthopedists had a higher cervical HIVD risk than other specialists, but the difference was not statistically significant (adjusted OR: 1.547; 95% CI: 0.782–3.061). Physicians are at higher cervical HIVD risk than the general population. Because unknown confounders could exist, further prospective studies are needed to identify possible causation. PMID:27741118

  8. Experience in the treatment of thoracic herniated disc using image-guided thorascopy.

    PubMed

    Bordon, G; Burguet Girona, S

    Thoracoscopic micro-discectomy is a treatment option for thoracic disc disease that combines the advantages of the anterior approach and the benefits of a minimally invasive technique. Adding a navigation system provides many advantages to the usual technique, as it allows accurate marking of the lesion level, improvement in the surgical approach, and precise control of herniated disc resection and vertebral osteotomy. The navigation system also reduces the learning curve for thoracoscopic technique. We report our experience in the treatment of thoracic disc herniation with image-guided thoracoscopy.

  9. Brown-Sequard syndrome produced by calcified herniated cervical disc and posterior vertebral osteophyte: Case report

    PubMed Central

    Guan, Dawei; Wang, Guanjun; Clare, Morgan; Kuang, Zhengda

    2015-01-01

    Brown-Sequard syndrome (BSS) produced by cervical disc disorders has rarely been seen clinically and only 50 cases have been reported in English literatures. However, most of which have resulted from acute disc herniation. Here, we report a case of BSS produced by calcified herniated C4-C5 disc and posterior vertebral osteophyte, in which decompression through anterior approach was performed. This case revealed the potential of cervical spondylopathy leading to BSS in a chronic manner. Once the diagnosis is established, it is advisable to perform decompression as early as possible. PMID:27047233

  10. Outcomes After Lumbar Disc Herniation in the National Basketball Association

    PubMed Central

    Minhas, Shobhit V.; Kester, Benjamin S.; Hsu, Wellington K.

    2016-01-01

    Background: Professional basketball players are at risk for lumbar disc herniation (LDH), yet the evidence guiding treatment after operative or nonoperative management of this condition in the National Basketball Association (NBA) is limited. Hypothesis: NBA players with LDH will have different performance outcomes based on treatment type. Study Design: Case-control study. Level of Evidence: Level 4. Methods: Athletes in the NBA with an LDH were identified through team injury reports, transaction records, and public sports archives. A 1:2 case-control study was performed in which LDH players and players without LDH were matched for player variables. Statistical analysis was employed to compare pre- and postindex season performance (games played and player efficiency rating [PER]) and career longevity between test subjects and controls in the operatively treated (OT) and nonoperatively treated (NOT) cohorts. Results: A total of 61 NBA players with LDH were included, of whom 34 underwent discectomy and 27 were managed nonoperatively. Return-to-play (RTP) rates did not differ between NOT and OT players (77.8% vs 79.4%). When compared with controls, OT players played significantly fewer games and had a lower PER than controls during the first postoperative season, but no difference was seen 2 and 3 years after surgery, with no difference in postoperative career length. In contrast, no difference in games played or PER was seen between NOT players and controls, although NOT players played significantly fewer postindex seasons. Conclusion: NBA players have a high RTP rate regardless of type of treatment for LDH; however, postindex performance differs between surgically and nonoperatively managed patients when compared with players without an LDH. However, further studies with a larger sample size are required for more definitive recommendations. Clinical Relevance: There is a high RTP rate after LDH in the NBA, although postindex performance may differ based on operative

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

    PubMed Central

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

    2010-01-01

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

  12. Management of calcified thoracic disc herniation using ultrasonic bone curette SONO-PET®: technical description.

    PubMed

    Landi, A; Marotta, N; Mancarella, C; Dugoni, D E; Delfini, R

    2011-09-01

    This paper describes the surgical management of a post-traumatic calcified thoracic disc herniation treated using ultrasonic bone curette SONO-PET®. The case described concerns a young man with a symptomatic calcified thoracic disc herniation, who underwent posterolateral approach and transversoarthropediculectomy. Patient underwent posterolateral approach with excellent postoperative results. Neurophysiological monitoring somato-sensory evoked potential (SSEP) and muscle motor evoked potentials (MMEP), inclination of 30° toward the unaffected side of the operating table, the use of Ultrasonic Bone-Curette SONO-PET® and proper reconstruction of the three floors of the back muscles allows the removal of the disc herniation safer and risk's free, and less invasive for the patient.

  13. Discal cyst associated with myxoid change and apoptosis of herniated disc materials: a case report.

    PubMed

    Okada, Kyoji; Saito, Hajime; Nishida, Jun; Miyakoshi, Naohisa; Takahashi, Shu; Nagasawa, Hiroyuki; Suzuki, Norio; Chida, Shuichi

    2007-01-01

    Discal cyst is a lumbar intraspinal cyst communicating with intervertebral disc, and previously reported series described the wall of these cysts as consisting of dense fibrous connective tissue. We report a 29-year-old Japanese male with discal cyst showing unusual histological features. Clinical symptoms in the current case as well as imaging features including discography were similar to those previously reported.However, the wall of the cyst consisted of disc material with myxoid degeneration. In addition, apoptosis of chondrocytes was diffusely observed in the herniated disc material. The current case was considered a histological variant of discal cyst. Myxoid degeneration of herniated disc material with diffuse apoptotic change of chondrocytes was probably associated with the formation of discal cyst.

  14. Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation

    PubMed Central

    Moon, Sang Ho; Lee, Jae Il; Cho, Hyun Seok; Shin, Jin Woo

    2017-01-01

    Background. Lower back pain is a common reason for disability and the most common cause is lumbar disc herniation. Percutaneous epidural adhesiolysis has been applied to relieve pain and increase the functional capacity of patients who present this condition. Objectives. In this study, we retrospectively evaluated the factors which predict the outcome of percutaneous epidural adhesiolysis in patients who were diagnosed with lumbar disc herniation. Methods. Electronic medical records of patients diagnosed with lumbar disc herniation who have received percutaneous epidural adhesiolysis treatment were reviewed. The primary outcome was the factors that were associated with substantial response of ≥4 points or ≥50% of pain relief in the numerical rating scale pain score 12 months after the treatment. Results. Multivariate logistic regression analysis demonstrated that the presence of high-intensity zone (HIZ) at magnetic resonance imaging was a predictor of substantial response to percutaneous epidural adhesiolysis for 12 months (P = 0.007). The presence of a condition involving the vertebral foramen was a predictor for unsuccessful response after 12 months (P = 0.02). Discussion and Conclusion. The presence of HIZ was a predictor of favorable long-term outcome after percutaneous epidural adhesiolysis for the treatment of lower back pain with radicular pain caused by lumbar disc herniation. PMID:28246488

  15. Cervical disc herniation as a trigger for temporary cervical cord ischemia

    PubMed Central

    Acker, Güliz; Schneider, Ulf C.; Grozdanovic, Zarko; Vajkoczy, Peter

    2016-01-01

    Background Disc herniations are only reported in few case reports as a rare cause of acute spinal ischemia. A surgical treatment has not been described so far in these reports with analysis of diffusion weighted magnetic resonance imaging (DWI/MRI) before and after surgery. The aim of our study is to report a case of cervical spinal cord ischemia caused by cervical disc herniation and discuss the literature concerning diagnostic and treatment options. Methods A 72-year-old female patient developed an acute progressive tetraparesis with emphasis on the upper extremities. MRI showed a disc herniation at the cervical segment 5/6 (C5/6) with consecutive spinal canal stenosis and additional signs of spinal cord ischemia in T2-weighted imaging (T2WI) and DWI reaching from C3 to C5 level. With the MRI being highly suggestive for anterior spinal cord ischemia, we hypothesized that this might be caused by compression of the anterior spinal artery through the significant disc herniation. Therefore, we decided to perform an anterior discectomy and fusion at C5/6 level. Results Following surgery, the patient’s symptoms showed immediate regression with complete recovery after two months in correspondence with the normalization in the control MRI scan of cervical cord. Conclusions Assumedly our patient suffered from a partial anterior spinal artery syndrome, possibly caused by a disc herniation-related compression that was reversible following surgery. This was accompanied by a complete resolution of spinal cord signal abnormalities in T2WI and DWI. PMID:27683710

  16. Transcorporeal approach for disc herniation at the C2-C3 level: a technical case report.

    PubMed

    Shim, Chan Shik; Jung, Tag-Geun; Lee, Sang-Ho

    2009-08-01

    The authors describe a less invasive approach for a disc herniation at the high cervical region. A 68-year-old female patient presented with posterior neck and shoulder pain, and tingling sensation and numbness in the left hand after she fell down stairs 2 months before presentation. On neurologic examination, the power of flexion and extension of the left elbow and grasping of the left hand was decreased. Hoffmann sign was positive in both hands. Magnetic resonance imaging showed a huge herniation of the C2-C3 disc compressing the left paramedian area of the spinal cord. After a routine surgical exposure for discectomy of the C3-C4 disc, a drill hole of about 5 mm diameter was made at the middle of the C3 vertebral body. The hole was extended cranioposteriorly to the superoposterior border of the C3 endplate. The posterior disc at the midline of the C2-C3 was removed first then the herniated disc completely removed. Postoperatively, the patient showed improvement of the neck and shoulder pain and numbness of the hand. At 7-month follow-up, she completely recovered from her neurologic symptoms. Compared with the other approaches to high cervical lesion, the current approach was straightforward and less invasive. If there is no need to stabilize the spinal motion segment, this transcorporeal approach can be a useful surgical option as it decreases the extent of tissue dissection of the submandibular retropharyngeal area that might increase the risk of neurovascular injury.

  17. The biomechanics of lumbar disc herniation and the effect of overload and instability.

    PubMed

    Wilder, D G; Pope, M H; Frymoyer, J W

    1988-01-01

    A multipart study has been performed to provide a mechanical explanation for the epidemiologic association between sitting in static (e.g., factory or office) or vibration (e.g., car or truck driving) environments and acute herniated lumbar discs. It was shown that a 1 h exposure to sitting environments caused significant changes in the mechanical properties of the lumbar intervertebral disc. During many of the latter tests, specimens were unstable (exhibited by a sudden, large flexion and/or lateral bend rotation response to an axially applied load). This showed that a motion segment in the lumbar spine could suddenly buckle and apply a tensile impact loading to the posterolateral region of the disc. We also demonstrated that a combined lateral bend, flexion, and axial rotation vibration loading could cause tracking tears proceeding from the nucleus through the posterolateral region of the anulus. It suggests that a mechanism for disc herniation is mechanical changes leading to instability of the motion segment. These experiments complete the argument that lumbar disc herniations can be a direct mechanical consequence of prolonged sitting in static or vibration environments.

  18. Lumbar disc herniation in a child with cystic fibrosis: case report.

    PubMed

    Alexiou, George A; Stefanaki, Kalliopi; Sfakianos, George; Prodromou, Neofytos

    2014-04-01

    We report a case of child with cystic fibrosis and lumbar disc herniation. An 8-year-old boy presented with low back pain that exacerbated on coughing, sitting, walking, or bending and diminished when lying down. The straight leg raising test was positive when the right leg was lifted at 60 degrees. Crossed leg raising test was negative. Lumbar MRI revealed a L5-S1central disc protrusion. Conservative treatment was not effective and the patient underwent surgery. Postoperatively the patient experienced regression of the pain. To the best of our knowledge this is the first reported case of lumbar disc herniation in a child with cystic fibrosis. Although this case might be coincidental, thorough investigation of back pain, which is frequent in patients with cystic fibrosis, should be performed.

  19. Spontaneous Cervical Intradural Disc Herniation Associated with Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Wang, Dachuan; Wang, Haifeng; Shen, Wun-Jer

    2014-01-01

    Intradural herniation of a cervical disc is rare; less than 35 cases have been reported to date. A 52-year-old man with preexisting ossification of posterior longitudinal ligament developed severe neck pain with Lt hemiparesis while asleep. Neurological exam was consistent with Brown-Séquard syndrome. Magnetic resonance images showed a C5-6 herniated disc that was adjacent to the ossified ligament and indenting the cord. The mass was surrounded by cerebrospinal fluid signal intensity margin, and caudally the ventral dura line appears divided into two, consistent with the “Y-sign” described by Sasaji et al. Cord edema were noted. Because of preexisting canal stenosis and spinal cord at risk, a laminoplasty was performed, followed by an anterior C6 corpectomy. Spot-weld type adhesions of the posterior longitudinal ligament to the dura was noted, along with a longitudinal tear in the dura. An intradural extra-arachnoid fragment of herniated disc was removed. Clinical exam at 6 months after surgery revealed normal muscle strength but persistent mild paresthesias. It is difficult to make a definite diagnosis of intradural herniation preoperatively; however, the clinical findings and radiographic signs mentioned above are suggestive and should alert the surgeon to look for an intradural fragment. PMID:25295205

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

    PubMed Central

    Nardi, Pier Vittorio

    2009-01-01

    Prospective case series studies have shown that plasma disc decompression (PDD) using the COBLATION SpineWand device (ArthroCare Corporation, Austin, TX) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations. This prospective, randomized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care (CC) through 1 year. Patients (n = 115) had neck/arm pain >50 on the visual analog scale (VAS) pain scale and had failed at least 30 days of failed CC. Patients were randomly assigned to receive either PDD (n = 62) or CC (n = 58). Clinical outcome was determined by VAS pain score, neck disability index (NDI) score, and SF-36 health survey, collected at 6 weeks, 3 months, 6 months, and 1 year. The PDD group had significantly lower VAS pain scores at all follow-up time points (PDD vs. CC: 6 weeks, −46.87 ± 2.71 vs. −15.26 ± 1.97; 3 months, −53.16 ± 2.74 vs. −30.45 ± 2.59; 6 months, −56.22 ± 2.63 vs. −40.26 ± 2.56; 1 year, −65.73 ± 2.24 vs. −36.45 ± 2.86; GEE, P < 0.0001). PDD patients also had significant NDI score improvement over baseline when compared to CC patients at the 6 weeks (PDD vs. CC: −9.15 ± 1.06 vs. −4.61 ± 0.53, P < 0.0001) and 1 year (PDD vs. CC: −16.70 ± 0.29 vs. −12.40 ± 1.26, P = 0.005) follow-ups. PDD patients showed statistically significant improvement over baseline in SF-36 physical component summary scores when compared to CC patients at 6 weeks and 1 year (PDD vs. CC: 8.86 + 8.04 vs. 4.24 ± 3.79, P = 0.0004; 17.64 ± 10.37 vs. 10.50 ± 10.6, P = 0.0003, respectively). In patients who had neck/arm pain due to a contained cervical disc herniation, PDD was associated with significantly better clinical outcomes than a CC regimen. At 1 year, CC patients appeared to suffer a “relapse, showing signs of decline in most measurements, whereas PDD

  1. Spontaneous regression of a huge subligamentous extruded disc herniation: short report of an illustrative case.

    PubMed

    Gezici, Ali Riza; Ergün, Rüçhan

    2009-10-01

    Herniated nucleus pulposus (HNP) is a common cause of radicular and low-back pain. Although some patients need surgical intervention because of prolonged intolerable leg pain, the majority heal with conservative treatment. Recently, with the advent of imaging diagnostic methods, there is an increasing interest in the phenomenon of spontaneous resorption of the HNP. We presented a case of lumbar HNP at the L4-L5 level in which clinical improvement was associated with a significant decrease in size of a huge subligamentous extruded disc herniation, documented on serial magnetic resonance imaging (MRI) scans.

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

    PubMed Central

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

    2014-01-01

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

  3. Surgical treatment of thoracic disc herniations using a modified transfacet approach

    PubMed Central

    Yang, Xizhong; Liu, Xinyu; Zheng, Yanping

    2014-01-01

    Background: Ideal surgical treatment for thoracic disc herniation (TDH) is controversial due to variations in patient presentation, pathology, and possible surgical approach. Althougth discectomy may lead to improvements in neurologic function, it can be complicated by approach related morbidity. Various posterior surgical approaches have been developed to treate TDH, but the gold standard remains transthoracic decompression. Certain patients have comorbidities and herniation that are not optimally treated with an anterior approach. A transfacet pedicle approach was first described in 1995, but outcomes and complications have not been well described. The aim of this work was to evaluate the clinical effect and complications in a consecutive series of patients with symptomatic thoracic disc herniations undergoing thoracic discectomy using a modified transfacet approach. Materials and Methods: 33 patients with thoracic disc herniation were included in this study. Duration of the disease was from 12 days to 36 months, with less than 1 month in 13 patients. Of these, 15 patients were diagnosed with simple thoracic disc herniation, 6 were associated with ossified posterior longitudinal ligament, and 12 with ossified or hypertrophied yellow ligament. A total of 45 discs were involved. All the herniated discs and the ossified posterior longitudinal ligaments were excised using a modified transfacet approach. Laminectomy and replantation were performed for patients with ossified or hypertrophied yellow ligament. The screw–rod system was used on both sides in 14 patients and on one side in l9 patients. Results: 29 patients were followed up for an average of 37 months (range 12-63 months) and 4 patients were lost to followup. Evaluation was based on Epstein and Schwall criteria.5 15 were classified as excellent and 10 as good, accounting for 86.21% (25/29); 2 patients were classified as improved and 2 as poor. All the patients recovered neurologically after surgery. A

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

    PubMed Central

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

    2015-01-01

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

  5. Junctional disc herniation syndrome in post spinal fusion treated with endoscopic spine surgery.

    PubMed

    Chiu, John C; Clifford, Thomas; Princenthal, Robert; Shaw, Stephen

    2005-01-01

    Fusions of the cervical and lumbar spine are often followed within months or several years by protrusion of discs at the adjacent level or levels. Biomechanical alterations and mobility lost at the fused levels are thought to be transferring the stress to the adjacent segments or discs, which results in accelerated degeneration of the discs and causes disc protrusion. This post-spinal fusion "junctional disc herniation syndrome" (JDHS), or the post-spinal fusion "adjacent segment disease (ASD)" can occur from 15% to 52% of post-spinal fusion, in both superior and/or inferior adjacent levels. The ways in which endoscopic minimally invasive spinal discectomy procedure can be used to treat this JDHS and preserve spinal segmental motion are discussed herein. Also, case illustrations are presented.

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

    PubMed

    Truumees, Eeric

    2015-06-01

    In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with

  7. Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation

    PubMed Central

    Toyoda, Hiromitsu; Terai, Hidetomi; Dohzono, Sho; Hori, Yusuke; Nakamura, Hiroaki

    2016-01-01

    Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH. PMID:27559461

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

    PubMed Central

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

    2012-01-01

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

  9. The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations

    PubMed Central

    Gotecha, Sarang; Ranade, Deepak; Patil, Sujay Vikhe; Chugh, Ashish; Kotecha, Megha; Sharma, Shrikant; Punia, Prashant

    2016-01-01

    Objectives: To study 1)the efficacy of transforaminal percutaneous endoscopic lumbar discectomy in lumbar disc herniations.2) limitations and advantages of the surgical procedure. 3)morbidity and complications associated with the procedure. Materials and Methods: This study was carried out on 120 patients who had single level herniated disc Pre-operative assessment of VAS and MSS scoring systems were documented one day prior to surgery. Post operative results were determined by MacNab criteria and by modified Suezawa and Schreiber clinical scoring system (MSS score). Results: Maximum patients were in the age group of 31 to 40 years and 83.43% of the patients were males. 80% patients had lumbar disc herniation at L4-L5 level, The mean operative time of endoscopic discectomy was 52.28 minutes and the mean hospital stay was 2.1days.8 cases of L5-S I were abandoned due to high iliac bone and hence their disc could not be accessed. Out of 112 patients who underwent operation, 2 patients developed discitis and 1 was found to have dysesthesia. Also recurrent prolapsed intervertebral disc was seen in 6 cases The mean preoperative and 6 months follow-up VAS score was 8.4 and 1.89 respectively. Mean preoperative and 6 months follow-up Modified Suezawa And Schreiber Clinical Scoring System(MSS Score) was 3.47 and 7.92 respectively. MSS score showed excellent and good outcome in 82.12% patients and Modified Macnab Criteria showed excellent and good outcome in 89.3% patients at 6months follow-up. Conclusion: TPELD can be a reasonable alternative to conventional microscopic discectomy for the treatment of patients with LDH. We also conclude that TPELD is not an effective procedure for L5-S 1 disc and an open procedure should be opted for better outcomes. PMID:27891030

  10. Giant intrapelvic malignant peripheral nerve sheath tumor mimicking disc herniation: A case report

    PubMed Central

    Wang, Peng; Chen, Cong; Xin, Xiaotang; Liu, Bo; Li, Wei; Yin, Dezhen; Mu, Weidong

    2016-01-01

    Giant intrapelvic malignant peripheral nerve sheath tumors arising in the sciatic nerve in the pelvic cavity are a rare occurrence and their symptomatology is usually misdiagnosed as intervertebral disc herniation. We herein report the case of a 46-year old woman presenting with pain, hypesthesia and weakness of the left lower extremity due to a giant intrapelvic malignant peripheral nerve sheath tumor of the sciatic nerve. Prior to being referred to our institution, the patient was misdiagnosed as a case of sciatica due to a lumbar disc herniation and underwent an operation unsuccessfully, as there was little symptomatic improvement 2 months after the surgery. A magnetic resonance imaging examination of the pelvic cavity revealed a tumor of the sciatic nerve. The mass was resected via the posterior approach and histopathological examination confirmed the diagnosis of malignant peripheral nerve sheath tumor. Intrapelvic malignant peripheral nerve sheath tumors are an uncommon cause of sciatica and are commonly misdiagnosed as lumbar intervertebral disc herniation. Accurate diagnosis and complete surgical excision prior to metastasis are crucial for effective management of this condition. PMID:27900106

  11. The anatomical basis of sciatica secondary to herniated lumbar disc: a review.

    PubMed

    Spencer, D L

    1999-01-01

    The purpose of this manuscript is to illustrate the key anatomical and biomechanical elements involved in the etiopathogenesis of sciatica, and to demonstrate how periradicular fibrosis contributes to the pathophysiology of recurrent post-operative sciatica. History, etiology, anatomy and diagnosis of herniated inter-vertebral disc are reviewed. The straight leg raising exam is a well accepted test in the diagnosis of lumbar disc herniation. In the post-operative patients, the results of the straight leg raising test are affected by the presence of scar and fibrosis around the lumbar root(s) involved. The mechanisms by which perineural fibrosis and adhesions change and compromise the neural dynamics and causes symptoms to recur in the post-operative patient are discussed. Due to its dramatic clinical relevance, prevention of periradicular fibrosis has high priority in the surgical management of herniated lumbar disc. Such a goal should be obtained by using a combination of appropriate indication to surgery, impeccable operative technique and the use of an effective anti-fibrotic agent.

  12. Pathogenesis of the discal cysts communicating with an adjacent herniated disc. Histological and ultrastructual studies of two cases.

    PubMed

    Kobayashi, Shigeru; Takeno, Kenichi; Uchida, Kenzo; Yayama, Takafumi; Nakajima, Hideaki; Miyazaki, Tsuyoshi; Guerrero, Alexander; Baba, Hisatoshi

    2010-03-01

    Discal cyst of the lumbar spine is a very rare cause of back pain and sciatica. We report two cases of discal cysts communicating with an adjacent herniated disc. From CT and MRI findings, they were diagnosed as having a discal cyst in the epidural space, which compressed the nerve root. After an adequate surgical field was obtained with a microscope and a Casper retractor, the discal cyst could be excised and satisfactory decompression of the adjacent nerve root was obtained. From histological and electron microscopic study, the presence of residual herniated tissues was confirmed in the cyst wall. Macrophages played an important role in the absorption of herniated tissue and the formation of the discal cyst. Hemorrhage in the cyst wall will make the serous hemorrhagic fluid-filled cystic structure in the absorbed spaces of the prolapsed disc. In this study, we confirmed that the discal cyst could have developed from the absorption process of a disc herniation.

  13. A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation

    PubMed Central

    Higashino, Kosaku; Fumitake, Tezuka; Yamashita, Kazuta; Hayashi, Fumio; Sairyo, Koichi

    2016-01-01

    A lesion of the lumbar posterior endplate is sometimes identified in the spinal canal of children and adolescents; it causes symptoms similar to those of a herniated disc. However, the pathology of the endplate lesion and the pathology of the herniated disc are different. We present a rare case of a 23-year-old woman who developed progressive palsy of the lower leg caused by huge lumbar posterior endplate lesion after recurrent disc herniation. PMID:27648326

  14. Combination of Magnetic Resonance Imaging and Electrophysiological Studies in Lumbar Disc Herniation.

    PubMed

    Zhong, Wenxiang; Wang, Jichao; Zhang, Wenchuan; Liu, Pengfei; Visocchi, Massimiliano; Li, Shi-Ting

    2017-01-01

    Objective We aimed to study the clinical value of magnetic resonance imaging (MRI) and electrophysiological studies in the diagnosis of lumbar disc herniation and in the evaluation of the therapeutic effect of discectomy. Methods In this study, 265 patients with LDH were treated with discectomy after assessment by the Japanese Orthopedic Association (JOA) score, MRI, and electrophysiological studies. All the patients were followed-up for 6 years. The effects of the operation were assessed by determining the angle between the nerve root canal and disc protrusion (AN value), the stenotic ratio of the spinal canal, the width of the lateral recess, motor conduction velocity (MCV), sensory conduction velocity (SCV), and nerve action potential (NAP) before and after operation. Results The AN value, stenotic ratio of the spinal canal, and the width of the lateral recess of protruding intervertebral discs showed significant differences from these values for the patients' unaffected intervertebral discs (P < 0.05). The MCV, SCV, and NAP of the affected limb showed significant differences from these values for the patients' unaffected limbs (P < 0.05). In all the patients the values for these indicators showed significant differences before and after operation (P < 0.05). Conclusion MRI and electrophysiological studies can be used in the diagnosis of lumbar disc herniation, and in the evaluation of the effect of surgery.

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

    PubMed Central

    Lee, Sang-Ho; Arbatti, Nikhil J.

    2010-01-01

    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. PMID:20379476

  16. Does local lavage influence functional recovery during lumber discectomy of disc herniation?

    PubMed Central

    Zhu, Ru-Sen; Ren, Yi-Ming; Yuan, Jian-Jun; Cui, Zi-Jian; Wan, Jun; Fan, Bao-You; Lin, Wei; Zhou, Xian-Hu; Zhang, Xue-Li

    2016-01-01

    Abstract Lumbar disc herniation (LDH) is a common disease and lumbar discectomy is the most common surgical procedure carried out for patients with low back pain and leg symptoms. Although most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the effect of local intervertebral lavage during microdiscectomy. In this retrospective study, 410 patients were operated on by microdiscectomy for LDH during 2011 to 2014. Retrospectively, 213 of them (group A) accepted local intervertebral irrigation with saline water before wound closure and 197 patients (group B) only had their operative field irrigated with saline water. Systematic records of visual analog scores (VAS), Oswestry disability Index (ODI) questionnaire scale scores, use of analgesia, and hospital length of stay were done after hospitalization. The majority (80.49%) of the cases were diagnosed with lumber herniation at the levels of L4/5 and L5/S1. Fifty-one patients had herniations at 2 levels. There were significant decreases of VAS scores and ODI in both groups between preoperation and postoperation of different time points. VAS scores decreased more in group A than group B at early stage of postoperation follow-up. However, there were no statistically significant differences between 2 groups in using analgesia, VAS and ODI up to 1 month of follow-up. Microdiscectomy for LDH offers a marked improvement in back and radicular pain. Local irrigation of herniated lumber disc area could relief dick herniation-derived low back pain and leg radicular pain at early stage of post-operation. However, the pain relief of this intervention was not noticeable for a long period. PMID:27759631

  17. Spinal epidural arteriovenous hemangioma mimicking lumbar disc herniation.

    PubMed

    Kim, Kyung Hyun; Song, Sang Woo; Lee, Soo Eon; Lee, Sang Hyung

    2012-10-01

    A spinal epidural hemangioma is rare. In this case, a 51 year-old female patient had low back pain and right thigh numbness. She was initially misdiagnosed as having a ruptured disc with possible sequestration of granulation tissue formation due to the limited number of spinal epidural hemangiomas and little-known radiological findings. Because there are no effective diagnostic tools to verify the hemangioma, more effort should be put into preoperative imaging tests to avoid misdiagnosis and poor decisions).

  18. Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs.

    PubMed

    Gutke, Annelie; Hansson, Eva Roos; Zetherström, Gunilla; Ostgaard, Hans Christian

    2009-07-01

    The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.

  19. Sequencing and bioinformatics analysis of the differentially expressed genes in herniated discs with or without calcification

    PubMed Central

    Shao, Jia; Yu, Miao; Jiang, Liang; Wu, Fengliang; Liu, Xiaoguang

    2017-01-01

    The purpose of this study was to detect the differentially expressed genes between ossified herniated discs and herniated discs without ossification. In addition, we sought to identify a few candidate genes and pathways by using bioinformatics analysis. We analyzed 6 samples each of ossified herniated discs (experimental group) and herniated discs without ossification (control group). Purified mRNA and cDNA extracted from the samples were subjected to sequencing. The NOISeq method was used to statistically identify the differentially expressed genes (DEGs) between the 2 groups. An in-depth analysis using bioinformatics tools based on the DEGs was performed using Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, and protein-protein interaction network analysis. The top 6 DEGs were verified using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). A total of 132 DEGs was detected. A total of 129 genes in the ossified group were upregulated and 3 genes were found to be downregulated as compared to the control group. The top 3 cellular components in GO ontologies analysis were extracellular matrix components. GO functions were mainly related to the glycoprotein in the cell membrane and extracellular matrix. The GO process was related to completing response to stimulus, immune reflex and defense. The top 5 KEGG enrichment pathways were associated with infection and inflammation. Three of the top 20 DEGs [sclerostin (SOST), WNT inhibitory factor 1 (WIF1) and secreted frizzled related protein 4 (SFRP4)] were related to the inhibition of the Wnt pathway. The ossified discs exhibited a higher expression of the top 6 DEGs [SOST, joining chain of multimeric IgA and IgM (IGJ; also known as JCHAIN), defensin alpha 4 (DEFA4), SFRP4, proteinase 3 (PRTN3) and cathepsin G (CTSG)], with the associated P-values of 0.045, 0.000, 0.008, 0.010, 0.015 and 0.002, respectively, as calculated by the independent sample t

  20. [Medical legal issues associated with the evaluation of herniated discs in seafarers to merchant ships].

    PubMed

    Onofri, E; Salesi, M; Massoni, F; Rosati, M V; Ricci, S

    2012-01-01

    "Seafarer" means person employed with any job on board a ship offshore, whether publicly or privately, excluding ships of war. Day by day a seafarer is forced to confront a reality in constant motion and live in environments that require awkward movements, and restricting the normal mobility of the person. In order to verify the frequency of herniated discs in this particular category of workers, given the recent introduction of INAIL tabulated diseases, a study was conducted on a sample of seafarers. Data analysis showed that 48.3% of the seafarers of the sample has herniated lumbar disc, and 34.5% of these duties in the deck, and 65.5% of the machine. The study of sample, varied as to age and task being performed, supports the assertion that the individual risk factors, especially age and obesity, are not strongly implicated in the genesis of disk herniation suffered by seafarers while the work factors (vibrations) play a more significant role in the onset of this disease. This consideration is part of a context, that of legal medical evaluation and in particular the causal relationship, which currently seems rather lacking in terms of literature and scientific production.

  1. The surgical treatment of far lateral lumbar disc herniation: 33 cases.

    PubMed

    Celikoglu, Erhan; Kiraz, Ilker; Is, Merih; Cecen, Aycicek; Ramazanoğlu, Ali

    2014-12-01

    Surgical approaches to far lateral disc herniation are challenging because of the anatomical limitations in the region. We describe an extraforaminal approach for far lateral lumbar disc herniation (FLLDH) in a group of patients and discuss the results in patients with far lateral disc protrusion or extrusion operated on by an approach to the extraforaminal region via an intertransverse route with median or paramedian incisions. The two methods are compared in terms of the pre- and postoperative visual analogue scale (VAS) pain scores, duration of the operation, amount of bleeding, and long-term functional recovery. In addition, data on age, incidence, radiological features and clinical signs and symptoms are compared with reported series. Between January 2006 and January 2011, 33 patients (18 females, 15 males; mean age, 51.2 years) underwent surgery for FLLDH. The majority of patients had herniation at disc levels L3-4 (12 patients) or L4-5 (15 patients). All patients were operated on via either median-paramuscular (20 patients, 61%) or paramedian-intermuscular (13 patients, 39%) approaches. Overall, the mean VAS score improved from 7.3 preoperatively to 2.8 in the short-term. Analyzing the long-term functional outcome of surgery according to the MacNab Criteria, the recovery was excellent, good, fair, and poor in 18, 11, 4, and 0 patients, respectively. The far-lateral approach for FLLDH is a safe, effective procedure that avoids the risk of secondary spinal instability. In treating FLLDH, the use of a long median incision together with an extraforaminal approach is safer and less invasive than a laminectomy together with a medial or total facetectomy.

  2. Spinal manipulation results in immediate H-reflex changes in patients with unilateral disc herniation.

    PubMed

    Floman, Y; Liram, N; Gilai, A N

    1997-01-01

    The aim of this clinical investigation was to determine whether the abnormal H-reflex complex present in patients with S1 nerve root compression due to lumbosacral disc herniation is improved by single-session lumbar manipulation. Twenty-four patients with unilateral disc herniation at the L5-S1 level underwent spinal H-reflex electro-physiological evaluation. This was carried out before and after single-session lumbar manipulation in the side-lying position. Eligibility criteria for inclusion in the study were: predominant sciatica, no motor or sphincteric involvement, unilateral disc herniation at the L5-S1 level on CT or MR imaging, age between 20 and 50 years. H-reflex responses were recorded bilaterally from the gastrosoleous muscle following stimulation of tibial sensory fibers in the popliteal fossa. H-reflex amplitude in millivolts (HR-A) and H-reflex latency in milliseconds (HR-L) were measured from the spinal reflex response. Pre- and post-manipulation measurements were compared between the affected side and the healthy side. Statistical evaluation was performed by the Wilcoxon matched-pairs test (SPSS). Thirteen patients displayed abnormal H-reflex parameters prior to lumbar manipulation, indicating an S1 nerve root lesion. The mean amplitude was found to be significantly lower on the side of disc herniation than on the normal, healthy side (P = 0.0037). Following manipulation, the abnormal HR-A increased significantly on the affected side while the normal HR-A on the healthy side remained unchanged (P = 0.0045). There was a significant difference between latencies on the affected side and those on the healthy side (P = 0.003). Following manipulation there was a trend toward decreased HR-L. However, this trend did not reach statistical significance (P = 0.3877). Eight patients displayed no H-reflex abnormalities before or after manipulation. Their respective HR-A and HR-L values did not change significantly following manipulation. Three additional

  3. A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification

    PubMed Central

    Ozer, A. F.; Keskin, F.; Oktenoglu, T.; Suzer, T.; Ataker, Y.; Gomleksiz, C.; Sasani, M.

    2013-01-01

    Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations. PMID:23653862

  4. Inequality in leg length is important for the understanding of the pathophysiology of lumbar disc herniation

    PubMed Central

    Balik, Mehmet Sabri; Kanat, Ayhan; Erkut, Adem; Ozdemir, Bulent; Batcik, Osman Ersagun

    2016-01-01

    Objective: Inequality in leg length may lead to to abnormal transmission of load across the endplates and degeneration lumbar spine and the disc space. There has been no study focusing on lumbar disc herniation (LDH) and leg length discrepancy. This subject was investigated in this study. Materials and Methods: Consecutive adult patients with leg length discrepancy and low back pain (LBP) admitted to our department were respectivelly studied. Results: A total number of 39 subjects (31 women and eight men) with leg length discrepancy and LBP and 43 (25 females and 18 males) patients with LBP as a control group were tested. Occurrence of disc herniation is statistically different between patients with hip dysplasia and control groups (P < 0.05). Conclusion: The results of this study showed a statistically significant association between leg length discrepancy and occurrence of LDH. The changes of spine anatomy with leg length discrepancy in hip dysplastic patients are of importance in understanding the nature of LDH. PMID:27217654

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

    PubMed Central

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

    2012-01-01

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

  6. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study

    PubMed Central

    Gugliotta, Marinella; da Costa, Bruno R; Dabis, Essam; Theiler, Robert; Jüni, Peter; Reichenbach, Stephan; Landolt, Hans; Hasler, Paul

    2016-01-01

    Objectives Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. Methods A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. Results Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (−0.97; 95% CI −1.89 to −0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (−3.7; 95% CI −7.4 to −0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. Conclusions Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up. PMID:28003290

  7. Extreme lateral lumbar disc herniation in a 12-year child: case report and review of the literature.

    PubMed

    Jiang, Sheng-Dan; Jiang, Lei-Sheng; Dai, Li-Yang

    2010-07-01

    Extreme lateral lumbar disc herniations (ELLDHs) occur more frequently among elderly patients, with a peak incidence in the sixth decade, and are rarely found in children. The patient presented is a 12-year-old boy with a 3-month history of right-sided leg pain. Computerized tomography and magnetic resonance imaging demonstrated an extreme lateral disc herniation on the right at L4-L5 with compression of the L4 nerve root. He subsequently underwent removal of extreme lateral herniated disc through an intertransverse approach under general anesthesia. At 11-month follow-up, the patient maintained resolution of preoperative symptoms and a neurological examination revealed no sensory or motor deficit. Surgical intervention may be indicated for patients with ELLDHs that fail with conservative treatment.

  8. Brucellar discitis as a cause of lumbar disc herniation: a case report.

    PubMed

    Yilmaz, Cem; Akar, Aykan; Civelek, Erdinç; Köksay, Berkay; Kabatas, Serdar; Cansever, Tufan; Caner, Hakan

    2010-01-01

    Brucellosis is an infectious disease spread by consumption of non-pasteurized milk products or through contact with infected animals. Spinal involvement is one of the most important complications and the lumbar area is the most frequently affected site. Among the neurological consequences, nerve root compression can be a result of epidural abscess, granuloma or discitis secondary to vertebral body involvement. In this case report we present a 50-year-old male patient with brucellar discitis without spondylitis which caused lumbar disc herniation. We want to emphasize that discitis should also be considered in differential diagnosis of nerve root compression in suspected cases.

  9. Co-existence of L5-S1 disc herniation and conus medullaris ependymoma

    PubMed Central

    Minoğlu, Mustafa; Akkol, İsmail; Özdemir, Nail; Yıldırım, Levent

    2014-01-01

    INTRODUCTION The lumbar disc herniations are seen very common than spinal ependymomas in the neurosurgery polyclinic routine. PRESENTATION OF CASE In our case, both pathologies were seen at the most frequently located levels compatible with the literature. Aim of this case report is, to remind once more that, different pathologies can be found at the same time in a single patient; differential diagnosis must be done very carefully. DISCUSSION The routine Computed Tomography (CT) imaging for low back pain can not show the conus medullaris pathology. Spinal tumors or other similar pathologies should be kept in mind for differential diagnosis. A good medical history and a good physical examination must be completed before the final diagnosis. CONCLUSION Viewing of spinal canal with Magnetic Resonance Imaging (MRI) will be useful for the patients who we intend to do disc surgery. PMID:25460457

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

    PubMed

    Boucher, Pierre; Robidoux, Sébastien

    2014-02-01

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

  11. The implantation of non-cell-based materials to prevent the recurrent disc herniation: an in vivo porcine model using quantitative discomanometry examination

    PubMed Central

    Wang, Yao-Hung; Kuo, Tzong-Fu

    2007-01-01

    Recurrent disc herniation is frequently observed due to leakage of nucleus pulposus through injured anulus fibrosus. There is no effective treatment to prevent recurrent disc herniation yet. In this study, we proposed to implant non-cell-based materials into the porcine disc to stimulate the growth of fibrous tissue and thereby increase the disc functional integrity. The disc herniation was simulated by anular punctures using the spinal needles. Four clinically used implantation materials, i.e., gelfoam, platinum coil, bone cement and tissue glue, were delivered into the discs via percutaneous spinal needles. Two months after the surgery, the swine were killed. The degree of disc integrity of intact, naturally healed and implanted discs, was examined by quantitative discomanometry apparatus. We found the disc injury could not recover after 2 months of healing, and the disc implantation affected the degree of disc integrity. The disc integrity of gelfoam-implanted discs was better than that of coil-, bone cement-, and glue-implanted discs. The implantation of non-cell-based material was proved to be a potentially clinically applicable method to recover the integrity of injured discs and to prevent recurrent disc herniation. PMID:17252217

  12. Cervical Radiculopathy Due to Disc Herniation with Adjacent Facet Hypertrophy: Case Report

    PubMed Central

    YAMAHATA, Hitoshi; YASUDA, Muneyoshi; AOYAMA, Tatsuro; OSUKA, Koji; ARITA, Kazunori; TAKAYASU, Masakazu

    2014-01-01

    We report a rare case of cervical radiculopathy associated with facet hypertrophy and disc herniation. The patient was a 38-year-old woman with sudden-onset left arm pain. As conservative therapy failed to alleviate her symptoms she was referred to us. On physical examination she manifested no neurological deficits except pain and dysesthesia in the left C7 territory. Computed tomography revealed hypertrophic ossified changes in the left T1 facet joint with encroachment on the spinal canal. Magnetic resonance imaging showed compression of the spinal cord at C6/7 by disc herniation at C6/7. Anterior cervical decompression and fusion by corpectomy (C7 corpectomy and C6/T1 fixation with a titanium cage) ameliorated her pain. Facet hypertrophy in a morphologically normal cervicothoracic spine is extremely rare and its etiology is unknown. We speculate the possibility that our patient harbored a congenital anomaly and that the morphologic changes were the consequence of an injury she sustained in a traffic accident. PMID:24477059

  13. Sequence variant at 8q24.21 associates with sciatica caused by lumbar disc herniation

    PubMed Central

    Bjornsdottir, Gyda; Benonisdottir, Stefania; Sveinbjornsson, Gardar; Styrkarsdottir, Unnur; Thorleifsson, Gudmar; Walters, G. Bragi; Bjornsson, Aron; Olafsson, Ingvar H.; Ulfarsson, Elfar; Vikingsson, Arnor; Hansdottir, Ragnheidur; Karlsson, Karl O.; Rafnar, Thorunn; Jonsdottir, Ingileif; Frigge, Michael L.; Kong, Augustine; Oddsson, Asmundur; Masson, Gisli; Magnusson, Olafur T.; Gudbjartsson, Tomas; Stefansson, Hreinn; Sulem, Patrick; Gudbjartsson, Daniel; Thorsteinsdottir, Unnur; Thorgeirsson, Thorgeir E.; Stefansson, Kari

    2017-01-01

    Lumbar disc herniation (LDH) is common and often debilitating. Microdiscectomy of herniated lumbar discs (LDHsurg) is performed on the most severe cases to resolve the resulting sciatica. Here we perform a genome-wide association study on 4,748 LDHsurg cases and 282,590 population controls and discover 37 highly correlated markers associating with LDHsurg at 8q24.21 (between CCDC26 and GSDMC), represented by rs6651255[C] (OR=0.81; P=5.6 × 10−12) with a stronger effect among younger patients than older. As rs6651255[C] also associates with height, we performed a Mendelian randomization analysis using height polygenic risk scores as instruments to estimate the effect of height on LDHsurg risk, and found that the marker's association with LDHsurg is much greater than predicted by its effect on height. In light of presented findings, we speculate that the effect of rs6651255 on LDHsurg is driven by susceptibility to developing severe and persistent sciatica upon LDH. PMID:28223688

  14. Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation.

    PubMed

    Galm, R; Fröhling, M; Rittmeister, M; Schmitt, E

    1998-01-01

    A dysfunction of a joint is defined as a reversible functional restriction of motion presenting with hypomobility according to manual medicine terminology. The aim of our study was to evaluate the frequency and significance of sacroiliac joint (SIJ) dysfunction in patients with low back pain and sciatica and imaging-proven disc herniation. We examined the SIJs of 150 patients with low back pain and sciatica; all of these patients had herniated lumbar disks, but none of them had sensory or motor losses. Forty-six patients, hereinafter referred to as group A, were diagnosed with dysfunction of the SIJ. The remaining 104 patients, hereinafter referred to as group B, had no SIJ dysfunction. Dysfunctions were resolved with mobilizing and manipulative techniques of manual medicine. Regardless of SIJ findings, all patients received intensive physiotherapy throughout a 3-week hospitalisation. At the 3 weeks follow-up, 34 patients of group A (73.9%) reported an improvement of lumbar and ischiadic pain, 5 patients were pain free. Improvement was recorded in 57 of the group B patients (54.8%); however, nobody in group B was free of symptoms. We conclude that in the presence of lumbar and ischiadic symptoms our presented data suggest consideration of SIJ dysfunction, requiring manual medicine examination and, in the presence of SIJ dysfunction, appropriate therapy, regardless of intervertebral disc pathomorphology. This could avoid wrong indications for nucleotomy.

  15. Pathological mechanism of lumbar disc herniation resulting in neurogenic muscle hypertrophy.

    PubMed

    Walcott, Brian P; Nahed, Brian V; Redjal, Navid; Stein, Thor D; Kahle, Kristopher T; Coumans, Jean-Valery

    2011-12-01

    We present a 33-year-old man with 5-year history of low back pain who presented with an enlarging right calf. The patient underwent an extensive workup including biopsy without diagnosis. The patient's examination was significant for diminished pinprick sensation in the right L5/S1 dermatome. Reflexes were absent in the right ankle. The circumference of the right calf (58 cm) was twice that of the left. MRI revealed a herniated lumbar disc at the L5/S1 level. He then underwent a L5/S1 microdiscectomy. Following this surgery, the patient noted complete resolution of all sensory deficits in his lower extremity. His calf circumference had decreased by 5 cm at 4 months and by a total of 8 cm at his 2-year post-operative visit. Histological examination of the affected muscle demonstrated severe grouped atrophy of both type I and type II fibers. There was also evidence of compensatory fiber hypertrophy as well as fiber splitting. We concluded that the patient suffered from a herniated lumbar disc causing radiculopathy with calf hypertrophy (neurogenic hypertrophy). To our knowledge this is the first report of both grouped atrophy and compensatory hypertrophy of both muscle fiber types seen in this phenomenon.

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  18. The Association Between Modic Changes of Lumbar Endplates and Spontaneous Absorption of Herniated Intervertebral Discs.

    PubMed

    Ding, Lingzhi; Teng, Xiao; Fan, Shunwu; Zhao, Fengdong

    2015-04-01

    Herniated disc (HD) is one of the most common causes of lower back pain. Treatment for HD includes conservative therapy and surgical intervention. Following conservative treatment, spontaneous absorption of HD occurs in some patients. To assess whether modic changes are associated with spontaneous absorption of HD, 85 patients with or without modic changes were followed up after 6 months of conservative treatment. As result, we found modic changes of lumbar endplates are associated with poor absorption of HD after conservative treatment. In addition, patients with modic changes exhibit significantly increased cartilage content and decreased neovascularization and macrophage infiltration in HD tissues, all of which are known to impair spontaneous absorption of herniated tissues. At molecular level, modic changes are associated with decreased expression of matrix metalloproteinase-3 gene, which is a key matrix-degrading enzyme for tissue absorption. Our study established a strong association between modic changes of lumbar endplates and spontaneous absorption of lumbar HD, which provided a potential novel method for prediction of spontaneous absorption.

  19. Cervical intervertebral disc herniation treatment via radiofrequency combined with low-dose collagenase injection into the disc interior using an anterior cervical approach

    PubMed Central

    Wang, Zhi-Jian; Zhu, Meng-Ye; Liu, Xiao-Jian; Zhang, Xue-Xue; Zhang, Da-Ying; Wei, Jian-Mei

    2016-01-01

    Abstract This study aimed to determine the therapeutic effect of radiofrequency combined with low-dose collagenase injected into the disc interior via an anterior cervical approach for cervical intervertebral disc herniation. Forty-three patients (26–62-year old; male/female ratio: 31/12) with cervical intervertebral disc herniation received radiofrequency combined with 60 to 100 U of collagenase, injected via an anterior cervical approach. The degree of nerve function was assessed using the current Japanese Orthopaedic Association (JOA) scoring system at 3 and 12 months postoperation. A visual analogue scale (VAS) was used to evaluate the degree of pain preoperation and 7 days postoperation. The preoperative and 3 month postoperative protrusion areas were measured and compared via magnetic resonance imaging (MRI) and picture archiving and communication systems (PACS). Compared with the preoperative pain scores, the 7-day postoperative pain was significantly reduced (P <0.01). The excellent and good rates of nerve function amelioration were 93.0% and 90.7% at 3 and 12 months postoperation, respectively, which was not significantly different. Twenty-seven cases exhibited a significantly reduced protrusion area (P <0.01) at 3 months postoperation. No serious side effects were noted. To our knowledge, this is the first study to demonstrate that the use of radiofrequency combined with low-dose collagenase injection into the disc interior via an anterior cervical approach is effective and safe for the treatment of cervical intervertebral disc herniation. PMID:27336892

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

    PubMed Central

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

    2012-01-01

    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. PMID:22514781

  1. Ten Important Tips in Treating a Patient with Lumbar Disc Herniation

    PubMed Central

    Hejrati, Hamid; Ariamanesh, Shahrara

    2016-01-01

    Lumbar disc herniation is a common spinal disorder that usually responds favorably to conservative treatment. In a small percentage of the patients, surgical decompression is necessary. Even though lumbar discectomy constitutes the most common and easiest spine surgery globally, adverse or even catastrophic events can occur. Appropriate patient selection and effective neural decompression constitute the most important points for better surgical outcomes and avoidance of unpleasant complications. Other important tips include timely performance of magnetic resonance imaging, correct interpretation of scan data, preoperative detection of underlying instability, exclusion of non-discogenic sciatica, determination of the main cause of clinical pathology, avoidance of the wrong side or level, and being sure that the more detailed procedure does not necessarily mean the more effective procedure. PMID:27790328

  2. Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome.

    PubMed

    Carvalho, Sandrina; Sanches, Madalena; Alves, Rosário; Selores, Manuela

    2015-01-01

    Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-year old woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900 mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries.

  3. Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome*

    PubMed Central

    Carvalho, Sandrina; Sanches, Madalena; Alves, Rosário; Selores, Manuela

    2015-01-01

    Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-yearold woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries. PMID:26131874

  4. Thoracic disc herniation: An unusual complication after prone positioning in spinal surgery

    PubMed Central

    Ebrahim, Mohammed Zahier; Vlok, Adriaan J.

    2016-01-01

    Neurological complications of the prone position have been well documented. Post-operative paraplegia and neurological deterioration unrelated to the site of surgery after proning in spinal surgery is a rare but potentially devastating complication. We describe the case of a 47 year old female who underwent an L4/5 discectomy and posterior instrumented fusion. A few hours after surgery she developed bilateral lower limb weakness with a T11 sensory level. Post-operative MRI revealed an acute disc herniation at the T11/12 level with associated spinal cord compression. This was not present on the pre-operative imaging. A subsequent T11/12 discectomy and instrumented fusion was performed and the patient's motor and sensory function returned to normal.

  5. The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation

    PubMed Central

    Ulutaş, Murat; Çınar, Kadir; Seçer, Mehmet

    2017-01-01

    Abstract Persistence of postoperative radicular pain after surgery for multifocal disc herniation (MFDH) is a clinical problem. This study aims to evaluate the effects of a combined treatment approach compared with unilateral stabilization on early postoperative radicular pain in patients with MFDH. Age, sex, level of operation, clinical findings, and radicular pain visual analogue scale (VAS) scores before surgery in the early postoperative period and at 3 months after surgery were retrospectively reviewed for 20 cases of multifocal lumbar disc herniation. The combined approach (translaminar and far lateral) was used for 13 cases. Seven cases underwent transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular stabilization following total facetectomy. The mean age of the sample was 49.4 ± 10.1 years and the female-to-male ratio was 8:12. The mean VAS scores for radicular pain in cases treated with the combined approach were 8.2, 4.07, and 2.3 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean score for radicular pain improved by 50.4% in the early postoperative period and by 72% in the late postoperative period. The mean VAS scores for radicular pain in cases who underwent TLIF and unilateral stabilization after facetectomy were 8.4, 2.1, and 1.4 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean VAS score for radicular pain improved by 75% in the early postoperative period and by 83.3% in the late postoperative period. The combined approach is an effective alternative in cases with MFDH. TLIF and unilateral segmental stabilization provide substantial decompression and eliminate mechanical compression by conserving the height of the intervertebral foramen in the event that sufficient decompression is unable to obtain. We suggest that elimination of chemical mediators, particularly those causing pain in the dorsal ganglion, contributes to

  6. The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation.

    PubMed

    Ulutaş, Murat; Çınar, Kadir; Seçer, Mehmet

    2017-03-01

    Persistence of postoperative radicular pain after surgery for multifocal disc herniation (MFDH) is a clinical problem. This study aims to evaluate the effects of a combined treatment approach compared with unilateral stabilization on early postoperative radicular pain in patients with MFDH.Age, sex, level of operation, clinical findings, and radicular pain visual analogue scale (VAS) scores before surgery in the early postoperative period and at 3 months after surgery were retrospectively reviewed for 20 cases of multifocal lumbar disc herniation. The combined approach (translaminar and far lateral) was used for 13 cases. Seven cases underwent transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular stabilization following total facetectomy.The mean age of the sample was 49.4 ± 10.1 years and the female-to-male ratio was 8:12. The mean VAS scores for radicular pain in cases treated with the combined approach were 8.2, 4.07, and 2.3 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean score for radicular pain improved by 50.4% in the early postoperative period and by 72% in the late postoperative period. The mean VAS scores for radicular pain in cases who underwent TLIF and unilateral stabilization after facetectomy were 8.4, 2.1, and 1.4 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean VAS score for radicular pain improved by 75% in the early postoperative period and by 83.3% in the late postoperative period.The combined approach is an effective alternative in cases with MFDH. TLIF and unilateral segmental stabilization provide substantial decompression and eliminate mechanical compression by conserving the height of the intervertebral foramen in the event that sufficient decompression is unable to obtain. We suggest that elimination of chemical mediators, particularly those causing pain in the dorsal ganglion, contributes to the absence

  7. Biomechanical analysis of press-extension technique on degenerative lumbar with disc herniation and staggered facet joint.

    PubMed

    Du, Hong-Gen; Liao, Sheng-Hui; Jiang, Zhong; Huang, Huan-Ming; Ning, Xi-Tao; Jiang, Neng-Yi; Pei, Jian-Wei; Huang, Qin; Wei, Hui

    2016-05-01

    This study investigates the effect of a new Chinese massage technique named "press-extension" on degenerative lumbar with disc herniation and facet joint dislocation, and provides a biomechanical explanation of this massage technique. Self-developed biomechanical software was used to establish a normal L1-S1 lumbar 3D FE model, which integrated the spine CT and MRI data-based anatomical structure. Then graphic technique is utilized to build a degenerative lumbar FE model with disc herniation and facet joint dislocation. According to the actual press-extension experiments, mechanic parameters are collected to set boundary condition for FE analysis. The result demonstrated that press-extension techniques bring the annuli fibrosi obvious induction effect, making the central nucleus pulposus forward close, increasing the pressure in front part. Study concludes that finite element modelling for lumbar spine is suitable for the analysis of press-extension technique impact on lumbar intervertebral disc biomechanics, to provide the basis for the disease mechanism of intervertebral disc herniation using press-extension technique.

  8. Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality.

    PubMed

    Iwase, Satoshi; Inukai, Yoko; Nishimura, Naoki; Sato, Maki; Sugenoya, Junichi

    2014-01-01

    Sweating is an important mechanism for ensuring constant thermoregulation, but hyperhidrosis may be disturbing. We present five cases of hemifacial hyperhidrosis as a compensatory response to an/hypohidrosis caused by cervical disc herniation. All the patients complained of hemifacial hyperhidrosis, without anisocoria or blepharoptosis. Sweat function testing and thermography confirmed hyperhidrosis of hemifacial and adjacent areas. Neck MRI showed cervical disc herniation. Three of the patients had lateral compression with welldemarcated hypohidrosis below the hyperhidrosis on the same side as the cervical lesion. The rest had paramedian compression with poorly demarcated hyperhidrosis and hypohidrosis on the contralateral side. Although MRI showed no intraspinal pathological signal intensity, lateral dural compression might influence the circulation to the sudomotor pathway, and paramedian compression might influence the ipsilateral sulcal artery, which perfuses the sympathetic descending pathway and the intermediolateral nucleus. Sweat function testing and thermography should be performed to determine the focus of the hemifacial hyperhidrosis, and the myelopathy should be investigated on both sides.

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

    PubMed Central

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

    2015-01-01

    Abstract The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 4–15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 h. Magnetic resonance imaging showed that L4–L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging. PMID:25816037

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

    The aim of the study was to introduce a method of one stage laminoplasty and posterior herniotomy for myelopathy caused by cervical stenosis with cervical disc herniation and to evaluate the clinical efficacy of this surgery. From 1999 to 2008, 18 patients with myelopathy caused by cervical stenosis with cervical disc herniation who underwent this procedure were included. The average age was 63 years (range 48-74 years), and the average follow-up period was 46 months (range 3-108 months). Neurologic status was evaluated using the JOA scoring system. Neurological symptoms improvement was seen in all patients after surgery. The average JOA score was 14.22±1.86 by final follow-up, which was higher than preoperative values (P<0.01), and the average improvement in neurological function was 76.63%. Neurologic examination showed that excellent results had been obtained by 10 patients, good results by 8 patients, with no fair or poor results. 2 patients developed cerebrospinal fluid leakage after surgery and recovered during the follow-up period. One patient with cervical disc herniation developed postoperative C5 palsy on the axle side on the third day after surgery. She completely recovered by 1 month after surgery. No other patients experienced postoperative neurologic complications. Complete anterior and posterior decompression of the spinal cord was achieved after surgery. We concluded that one stage laminoplasty and posterior herniotomy is an effective, reliable, and safe procedure for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation. PMID:26309625

  13. Clinical Efficacy of Selective Focal Ablation by Navigable Percutaneous Disc Decompression Device in Patients With Cervical Herniated Nucleus Pulposus

    PubMed Central

    2017-01-01

    Objective To evaluate the clinical efficacy and safety following percutaneous disc decompression, using navigable disc decompression device for cervical herniated nucleus pulposus (HNP). Methods Twenty subjects diagnosed with cervical HNP and refractory to conservative management were enrolled for the study. The herniated discs were decompressed under fluoroscopic guidance, using radiofrequency ablation device with navigable wand. The sagittal and axial plain magnetic resonance images of the clinically significant herniated disc, decided the space between the herniated base and outline as the target area for ablation. Clinical outcome was determined by Numeric Rating Scale (NRS), Neck Disability Index (NDI), and Bodily Pain scale of Short Form-36 (SF-36 BP), assessed after 48 weeks. After the procedure, we structurally matched the magnetic resonance imaging (MRI) and C-arm images through bony markers. The wand position was defined as being ‘correct’ if the tip was placed within the target area of both AP and lateral views; if not, the position was stated as ‘incorrect’. Results The average NRS fell from 7 to 1 at 48 weeks post procedure (p<0.05). In addition, statistically significant improvement was noted in the NDI and SF-36BP (p<0.05). The location of the wand tip resulted in 16 correct and 4 incorrect placements. Post-48 weeks, 3 of the incorrect tip cases and 1 correct tip case showed unsuccessful outcomes. Conclusion The study demonstrated the promising results and safety of the procedure. Thus, focal plasma ablation of cervical HNP with navigable wand can be another effective treatment option. PMID:28289639

  14. Intraregional differences of perioperative management strategy for lumbar disc herniation: is the Devil really in the details?

    PubMed Central

    Bongetta, Daniele; Poli, Jacopo C.; Verlotta, Mariarosaria; Pugliese, Raffaelino; Gaetani, Paolo

    2017-01-01

    Background This study intends to evaluate whether regional common habits or differences in case-volume between surgeons are significative variables in the perioperative management of patients undergoing surgery for lumbar disc herniation. Methods An e-mail survey was sent to all neurosurgeons working in Lombardy, Italy's most populated region. The survey consisted of 17 questions about the perioperative management of lumbar disc herniation. Results Forty-seven percent (47%) out of 206 Lombard neurosurgeons answered the survey. Although in some respects there is clear evidence in current literature on which is the best practice to adopt for an optimal management strategy, we noticed substantial differences between respondents, not only between hospitals but also between surgeons from the same hospital. Still, no differences were evident in a high vs low case-volume comparison. Conclusion We identified no regional clusterization as for practical principles in the perioperative management of lumbar disc herniation and neither was case-volume a significative variable. Other causes may be relevant in the variability between the perioperative management and the outcomes achieved by different specialists. PMID:28377859

  15. Microstructural changes in compressed nerve roots treated by percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation

    PubMed Central

    Wu, Weifei; Liang, Jie; Chen, Ying; Chen, Aihua; Wu, Bin; Yang, Zong

    2016-01-01

    Abstract To investigate the microstructural changes in compressed nerves using diffusion tensor imaging (DTI) of herniated disc treated with percutaneous transforaminal endoscopic discectomy. Diffusion tensor imaging has been widely used to visualize peripheral nerves, and the microstructure of compressed nerve roots can be assessed using DTI. However, the microstructural changes after surgery are not well-understood in patients with lumbar disc herniation. Thirty-four consecutive patients with foraminal disc herniation affecting unilateral sacral 1 (S1) nerve roots were enrolled in this study. DTI with tractography was performed on S1 nerve roots before and after surgery. The mean fractional anisotropy (FA) and apparent diffusion coefficient values were calculated from tractography images. In compressed nerve roots, the FA value before surgery was significantly lower than that after surgery (P = 0.000). A significant difference in FA values was found between the compressed and normal sides before surgery (P = 0.000). However, no significant difference was found between the compressed and normal sides after surgery (P = 0.057). A significant difference in apparent diffusion coefficient values was found before and after surgery at the compressed side (P = 0.023). However, no significant difference was found between the compressed and normal sides after surgery (P = 0.203). We show that the diffusion parameters of compressed nerve roots were not significantly different before and after percutaneous transforaminal endoscopic discectomy, indicating that the microstructure of the nerve root recovered after surgery. PMID:27749591

  16. Far lateral microdiscectomy: a minimally-invasive surgical technique for the treatment of far lateral lumbar disc herniation

    PubMed Central

    Phan, Kevin; Dunn, Alexander E.; Rao, Prashanth J.

    2016-01-01

    Lumbar disc herniation arises when the annulus fibrosus of the vertebral disc fails, thus allowing displacement of the nucleus pulposus and other tissue. The term far lateral is used variably in the literature and usually refers to an extraforaminal displacement in the peridiscal zone peripheral to the sagittal plane of the most lateral part of the pedicle at the same level. Non-surgical treatments of far lateral disc herniation include physical therapy, anti-inflammatory medication, and corticosteroid injections. Where these conservative measures fail, surgical intervention may be required. Several surgical techniques for the treatment of far lateral herniations have been investigated, including total or medial facetectomy, laminectomy, hemilaminectomy, approaches through the pars interarticularis, and lateral approaches between the transverse processes via the intertransverse muscle and ligament. We present our far lateral microdiscectomy technique which involves accessing the nerve root lateral to the foramen through a small paramedian incision and use of an operating microscope. Far lateral microdiscectomy offers the prospect of better long-term results than other surgical techniques because of less extensive muscle dissection and preservation of the integrity of the facet joint. PMID:27683697

  17. Histopathological Analysis of Ligamentum Flavum in Lumbar Spinal Stenosis and Disc Herniation

    PubMed Central

    Yüksel, Kasım Zafer

    2017-01-01

    Study Design Histopathological analyses were performed in ligamentum flavum (LF) hypertrophy patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). Purpose The aim of the present study was to evaluate histopathological changes in LF patients with LSS and LDH. Overview of Literature LSS is the most common spinal disorder in elderly patients. This condition causes lower back and leg pain and paresis, and occurs as a result of degenerative changes in the lumbar spine, including bulging of the intervertebral discs, bony proliferation of the facet joints, and LF thickening; among these, LF thickening is considered a major contributor to the development of LSS. Methods A total of 71 patients operated with the surgical indications of LSS and LDH were included. LF samples were obtained from 31 patients who underwent decompressive laminectomy for symptomatic degenerative LSS (stenotic group) and from 40 patients who underwent lumbar discectomy for LDH (discectomy group). LF materials were examined histopathologically, and other specimens were examined for collagen content, elastic fiber number and array, and presence of calcification. Results The stenotic and discectomy groups did not differ with regard to mean collagen concentration or mean elastic fiber number (p=0.430 and p=0.457, respectively). Mean elastic fiber alignment was 2.36±0.99 in the stenotic group and 1.38±0.54 in the discectomy group (p<0.001). Mean calcification was 0.39±0.50 in the stenotic group, whereas calcification was not detected (0.00±0.00) in the discectomy group; a statistically significant difference was detected (p<0.001) between groups. Conclusions LF hypertrophy in spinal stenosis may occur as a result of elastic fiber misalignment along with the development of calcification over time. Further studies determining the pathogenesis of LSS are needed. PMID:28243372

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

    PubMed Central

    VanGelder, Leonard H.; Vaughn, Daniel W.

    2013-01-01

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

  19. The outcome of lumbar disc herniation surgery is worse in old adults than in young adults

    PubMed Central

    Strömqvist, Fredrik; Strömqvist, Björn; Jönsson, Bo; Karlsson, Magnus K

    2016-01-01

    Background and purpose The outcome of surgical treatment of lumbar disc herniation (LDH) has been thoroughly evaluated in middle-aged patients, but less so in elderly patients. Patients and methods With validated patient-reported outcome measures (PROMs) and using SweSpine (the national Swedish Spine Surgery Register), we analyzed the preoperative clinical status of LDH patients and the 1-year postoperative outcome of LDH surgery performed over the period 2000–2012. We included 1,250 elderly patients (≥ 65 years of age) and 12,840 young and middle-aged patients (aged 20–64). Results Generally speaking, elderly patients were referred for LDH surgery with worse PROM scores than young and middle-aged patients, they improved less by surgery, they experienced more complications, they had inferior 1-year postoperative PROM scores, and they were less satisfied with the outcome (with all differences being statistically significant). Interpretation Elderly patients appear to have a worse postoperative outcome after LDH surgery than young and middle-aged patients, they are referred to surgery with inferior clinical status, and they improve less after the surgery. PMID:27391663

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

    PubMed

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

    2016-02-18

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

  1. Thoracic Infectious Spondylitis After Surgical Treatments of Herniated Lumbar Intervertebral Disc

    PubMed Central

    Kim, Jin-Hyun; Kang, Jung-Il; Kim, Min Jeong; Lee, Jongmin; Lee, In-Sik; Jung, Heeyoune

    2013-01-01

    The postoperative infectious spondylitis has been reported to occur among every 1% to 12%. It is difficult to early diagnose in some cases. If the diagnosis is delayed, it can be a life-threatening condition. We report a 32-year-old male patient with postoperative infectious spondylitis. He had surgical treatments for traumatic intervertebral disc herniations in L3-4 and L4-5. Three weeks after surgery, he complained for fever and paraplegia. Cervicothoracic magnetic resonance imaging showed the collapsed T2 and T3 vertebral body with changes of bone marrow signal intensity. Moreover, it showed anterior and posterior epidural masses causing spinal cord compressions which suggested infectious spondylitis. After the use of antibiotics and surgical decompressions T2-T3, his general conditions were improved and muscle power of lower extremities began to be gradually restored. However, we could not identify the exact organisms that may be the cause of infectious spondylitis. It could be important that the infectious spondylitis, which is presented away from the primary operative level, should be observed in patients with fevers of unknown origin and paraplegia. PMID:24236263

  2. Facet tropism: possible role in the pathology of lumbar disc herniation in adolescents.

    PubMed

    Wang, Honggang; Zhou, Yue

    2016-07-01

    OBJECTIVE The role of facet tropism (FT) in lumbar disc herniation (LDH) is ambiguous. The present study aimed to investigate the association between FT and LDH in adolescents. METHODS This study included 65 adolescents with LDH with 1- or 2-level LDH, or both. Facet angles were measured with MRI. FT was defined as asymmetry of 10° between the left and right side. The same levels of 30 healthy persons who had no lumbar lesions were used as controls. Statistical analysis was performed using the chi-square test. RESULTS FT was identified in 16 of 39 patients with LDH in L4-5 and in 3 of 30 controls (p = 0.006, OR 6.261, 95% CI 1.619-24.217). It was also identified in 12 of 27 patients with LDH in L5-S1 and in 4 of 30 controls (p = 0.017, OR 5.200, 95% CI 1.420-19.039). One patient had LDH in both L4-5 and L5-S1. CONCLUSIONS FT is associated with LDH in both L4-5 and L5-S1 levels in adolescents.

  3. The Factors That Affect Improvement of Neurogenic Bladder by Severe Lumbar Disc Herniation in Operation

    PubMed Central

    Jeon, Joon Bok; Kim, Do Keun; Kim, Ji-Yong

    2016-01-01

    Objective This study analyzed retrospectively the bladder function of patients after early surgery for cauda equina syndrome (CES) performed within 24 or 48 hours, or after 48 hours of the onset of autonomic symptoms. Methods We retrospectively reviewed the clinical data of 31 patients after decompression surgery for lumbar disc herniation (LDH) who had been diagnosed with CES between January 2001 and December 2014 at Inha University Hospital. The following factors were assessed to evaluate the influence of time to surgery: bladder function, rectal incontinence, sexual dysfunction, LDH level, and degree of spinal canal compression. Results After decompression, the outcome group was categorized into normal bladder function and abnormal bladder function. The patients operated on within 48 hours showed an improved postoperative outcome. Among 16 patients operated on within 48 hours, 13 (81%) recovered normal bladder function. In contrast, among 15 patients with decompression after 48 hours, 6 (40%) recovered normal bladder function. Among 21 patients with mild bladder dysfunction at admission, 16 (76%) recovered normal bladder function after decompression. Conclusion Our study suggests that patients who have decompression surgery within 48 hours of the onset of bladder dysfunction, improve their chances of recovering bladder function than those who have a late operation (>48 hours). Also, patients with mild bladder dysfunction are more likely to recover bladder function after decompression, than patients with severe bladder dysfunction. PMID:27799991

  4. 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 ...

  5. The cauda equina syndrome in pregnant woman with a massive disc herniation.

    PubMed

    Antón Capitán, B; Malillos Torán, M

    Low back pain during pregnancy is a common cause of medical consultation. Although back pain is very common, the incidence of low back pain secondary to lumbar disk herniation in pregnancy is low (1: 10,000). Cauda equina syndrome from lumbar disk herniation is a serious complication. The delay in diagnosis and treatment can be a cause of chronic disability secondary to neurological sequelae. Numerous cases of disk herniation in pregnancy have been reported, however the association of a cauda equina syndrome as a result of disk herniation is rare. A case is presented of cauda equina syndrome in a pregnant woman at 12-week gestation.

  6. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    PubMed Central

    Lühmann, Dagmar; Burkhardt-Hammer, Tatjana; Borowski, Cathleen; Raspe, Heiner

    2005-01-01

    Introduction In up to 30% of patients undergoing lumbar disc surgery for herniated or protruded discs outcomes are judged unfavourable. Over the last decades this problem has stimulated the development of a number of minimally-invasive operative procedures. The aim is to relieve pressure from compromised nerve roots by mechanically removing, dissolving or evaporating disc material while leaving bony structures and surrounding tissues as intact as possible. In Germany, there is hardly any utilisation data for these new procedures – data files from the statutory health insurances demonstrate that about 5% of all lumbar disc surgeries are performed using minimally-invasive techniques. Their real proportion is thought to be much higher because many procedures are offered by private hospitals and surgeries and are paid by private health insurers or patients themselves. So far no comprehensive assessment comparing efficacy, safety, effectiveness and cost-effectiveness of minimally-invasive lumbar disc surgery to standard procedures (microdiscectomy, open discectomy) which could serve as a basis for coverage decisions, has been published in Germany. Objective Against this background the aim of the following assessment is: Based on published scientific literature assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery compared to standard procedures. To identify and critically appraise studies comparing costs and cost-effectiveness of minimally-invasive procedures to that of standard procedures. If necessary identify research and evaluation needs and point out regulative needs within the German health care system. The assessment focusses on procedures that are used in elective lumbar disc surgery as alternative treatment options to microdiscectomy or open discectomy. Chemonucleolysis, percutaneous manual discectomy, automated percutaneous lumbar discectomy, laserdiscectomy and endoscopic procedures accessing the disc by a posterolateral or

  7. Nuclear factor-kappa B decoy suppresses nerve injury and improves mechanical allodynia and thermal hyperalgesia in a rat lumbar disc herniation model

    PubMed Central

    Suzuki, Munetaka; Inoue, Gen; Gemba, Takefumi; Watanabe, Tomoko; Ito, Toshinori; Koshi, Takana; Yamauchi, Kazuyo; Yamashita, Masaomi; Orita, Sumihisa; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Takaso, Masashi; Aoki, Yasuchika; Takahashi, Kazuhisa

    2009-01-01

    Nuclear factor-kappa B (NF-κB) is a gene transcriptional regulator of inflammatory cytokines. We investigated the transduction efficiency of NF-κB decoy to dorsal root ganglion (DRG), as well as the decrease in nerve injury, mechanical allodynia, and thermal hyperalgesia in a rat lumbar disc herniation model. Forty rats were used in this study. NF-κB decoy–fluorescein isothiocyanate (FITC) was injected intrathecally at the L5 level in five rats, and its transduction efficiency into DRG measured. In another 30 rats, mechanical pressure was placed on the DRG at the L5 level and nucleus pulposus harvested from the rat coccygeal disc was transplanted on the DRG. Rats were classified into three groups of ten animals each: a herniation + decoy group, a herniation + oligo group, and a herniation only group. For behavioral testing, mechanical allodynia and thermal hyperalgesia were evaluated. In 15 of the herniation rats, their left L5 DRGs were resected, and the expression of activating transcription factor 3 (ATF-3) and calcitonin gene-related peptide (CGRP) was evaluated immunohistochemically compared to five controls. The total transduction efficiency of NF-κB decoy–FITC in DRG neurons was 10.8% in vivo. The expression of CGRP and ATF-3 was significantly lower in the herniation + decoy group than in the other herniation groups. Mechanical allodynia and thermal hyperalgesia were significantly suppressed in the herniation + decoy group. NF-κB decoy was transduced into DRGs in vivo. NF-κB decoy may be useful as a target for clarifying the mechanism of sciatica caused by lumbar disc herniation. PMID:19308465

  8. Nuclear factor-kappa B decoy suppresses nerve injury and improves mechanical allodynia and thermal hyperalgesia in a rat lumbar disc herniation model.

    PubMed

    Suzuki, Munetaka; Inoue, Gen; Gemba, Takefumi; Watanabe, Tomoko; Ito, Toshinori; Koshi, Takana; Yamauchi, Kazuyo; Yamashita, Masaomi; Orita, Sumihisa; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Takaso, Masashi; Aoki, Yasuchika; Takahashi, Kazuhisa; Ohtori, Seiji

    2009-07-01

    Nuclear factor-kappa B (NF-kappaB) is a gene transcriptional regulator of inflammatory cytokines. We investigated the transduction efficiency of NF-kappaB decoy to dorsal root ganglion (DRG), as well as the decrease in nerve injury, mechanical allodynia, and thermal hyperalgesia in a rat lumbar disc herniation model. Forty rats were used in this study. NF-kappaB decoy-fluorescein isothiocyanate (FITC) was injected intrathecally at the L5 level in five rats, and its transduction efficiency into DRG measured. In another 30 rats, mechanical pressure was placed on the DRG at the L5 level and nucleus pulposus harvested from the rat coccygeal disc was transplanted on the DRG. Rats were classified into three groups of ten animals each: a herniation + decoy group, a herniation + oligo group, and a herniation only group. For behavioral testing, mechanical allodynia and thermal hyperalgesia were evaluated. In 15 of the herniation rats, their left L5 DRGs were resected, and the expression of activating transcription factor 3 (ATF-3) and calcitonin gene-related peptide (CGRP) was evaluated immunohistochemically compared to five controls. The total transduction efficiency of NF-kappaB decoy-FITC in DRG neurons was 10.8% in vivo. The expression of CGRP and ATF-3 was significantly lower in the herniation + decoy group than in the other herniation groups. Mechanical allodynia and thermal hyperalgesia were significantly suppressed in the herniation + decoy group. NF-kappaB decoy was transduced into DRGs in vivo. NF-kappaB decoy may be useful as a target for clarifying the mechanism of sciatica caused by lumbar disc herniation.

  9. Altered expression of metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 in cervical disc herniation patients.

    PubMed

    Zhuang, H M; Xu, G T; Wen, S F; Guo, Y Y; Huang, Q

    2016-04-26

    The aim of the current study was to examine matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) expression in patients with cervical disc herniation (CDH). A total of 127 specimens from CDH patients undergoing posterior spinal surgery were obtained for the case group, which was divided into three subgroups: lateral protrusion (N = 102), median protrusion (N = 18), and paramedian protrusion (N = 7). Another 55 specimens from subjects who had cervical spine trauma and underwent spinal canal decompression were obtained for the control group. Routine hematoxylin and eosin staining was performed for pathological diagnosis. Immunohistochemical (IHC) analysis was used to determine MMP-2 and TIMP-2 expression. Under light microscopy, MMP-2-positive cells presented brown-yellow or dark brown staining in the cell membrane or cytoplasm. MMP-2 expression in the case group was significantly higher than that in controls (P < 0.05). Furthermore, MMP-2 expression in the lateral and median protrusion groups was significantly higher compared to that in the paramedian protrusion group (both P < 0.05), while there was no apparent difference in MMP-2 expression between the lateral and median protrusion groups (P > 0.05). IHC results showed that TIMP-2 expression in cases was significantly lower than that in controls (P < 0.05). Spearman correlation analysis indicated that MMP- 2 was negatively correlated with TIMP-2 expression (r = -0.418, P < 0.001). In conclusion, MMP-2 expression increased, whereas TIMP- 2 expression decreased in CDH patients, suggesting that MMP-2 and TIMP-2 expression may contribute to CDH development.

  10. Correlative analyses of isolated upper lumbar disc herniation and adjacent wedge-shaped vertebrae

    PubMed Central

    Xu, Jia-Xin; Yang, Si-Dong; Wang, Bao-Lin; Yang, Da-Long; Ding, Wen-Yuan; Shen, Yong

    2015-01-01

    Background: Upper lumbar disc herniation (ULDH) is easy to be misdiagnosed due to its special anatomical and atypical clinical features. Few studies have identified the relationship between ULDH and adjacent wedge-shaped vertebrae (WSV). Hypothesis: WSV may have some indicative relations withULDH. Patients and methods: Between January 2003 and October 2013, 47 patients (27 males and 20 females; mean age, 41.2 years) with single-level ULDH (as study group) and 47 sex- and age-matched healthy volunteers (as control group) were studied by radiograph. The two groups were compared with respect to age, sexual proportion, body mass index (BMI), kyphotic angle, and the proportion of WSV. Also, correlative analyses were conducted in the study group to investigate the relation between the kyphotic angle of target vertebrae and other factors including age, BMI, Cobb angle, JOA score and bone mineral density (BMD). Results: The average kyphotic angle in the study group was 11° (4°-22°), while the average kyphotic angle in the control group was 2° (0°-7°). Obviously, the mean kyphotic angle in the study group was statistically larger than that in the control group (t=13.797, P<0.001). The proportion of WSV in the study group was significantly larger than that in the control group (x2=36.380, P<0.0001). The correlations between kyphotic angles and other items (i.e., age, BMI, BMD, Cobb angle and JOA score) in the study group and the control group were low or uncorrelated. Conclusions: WSV are indicatively associated with adjacent ULDH. Thus, ULDH should be alerted when WSV are first found in radiograph and accompanied by clinical symptoms. PMID:25785106

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

    PubMed Central

    Strömqvist, Björn

    2006-01-01

    A prospective and controlled study of training after surgery for lumbar disc herniation (LDH). The objective was to determine the effect of early neuromuscular customized training after LDH surgery. No consensus exists on the type and timing of physical rehabilitation after LDH surgery. Patients aged 15–50 years, disc prolapse at L4–L5 or L5–S1. Before surgery, at 6 weeks, 4, and 12 months postoperatively, the following evaluations were performed: low back pain and leg pain estimated on a visual analog scale, disability according to the Roland–Morris questionnaire (RMQ) and disability rating index (DRI). Clinical examination, including the SLR test, was performed using a single blind method. Consumption of analgesics was registered. Twenty-five patients started neuromuscular customized training 2 weeks after surgery (early training group=ETG). Thirty-one patients formed a control group (CG) and started traditional training after 6 weeks. There was no significant difference in pain and disability between the two training groups before surgery. Median preoperative leg pain was 63 mm in ETG and 70 mm in the CG. Preoperative median disability according to RMQ was 14 in the ETG and 14.5 in the CG. Disability according to DRI (33/56 patients) was 5.3 in the ETG vs. 4.6 in the CG. At 6 weeks, 4 months, and 12 months, pain was significantly reduced in both groups, to the same extent. Disability scores were lower in the ETG at all follow-ups, and after 12 months, the difference was significant (RMQ P=.034, DRI P=.015). The results of the present study show early neuromuscular customized training to have a superior effect on disability, with a significant difference compared to traditional training at a follow-up 12 months after surgery. No adverse effects of the early training were seen. A prospective, randomized study with a larger patient sample is warranted to ultimately demonstrate that early training as described is beneficial for patients undergoing LDH

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

    PubMed Central

    Chun, Eun Hee

    2016-01-01

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

  13. Translaminar Microendoscopic Herniotomy for Cranially Migrated Lumbar Disc Herniations Encroaching on the Exiting Nerve Root in the Preforaminal and Foraminal Zones

    PubMed Central

    Tono, Osamu; Senba, Hideyuki; Kitamura, Takahiro; Komiya, Norihiro; Oga, Masayoshi; Shidahara, Satoshi

    2013-01-01

    Study Design Case series. Purpose The aim of this study was to describe translaminar microendoscopic herniotomy (TL-MEH) for cranially migrated lumbar disc herniations encroaching on the exiting nerve root in the preforaminal and foraminal zones and to report preliminary results of the procedure. Overview of Literature Conventional interlaminar approaches for preforaminal and foraminal lumbar disc herniations result in extensive removal of the lamina and facet joint to remove disc fragments safely. More destructive approaches increase the risk of postoperative segmental instability. Methods TL-MEH is a minimally invasive procedure for herniotomy via the translaminar approach using a microendoscopic technique. TL-MEH was performed in seven patients with a cranially migrated lumbar disc herniation encroaching on the exiting nerve root. The disc fragments were located in the preforaminal zone in four patients, and in the preforaminal and foraminal zones in three. Results All patients experienced immediate relief from symptoms after surgery and satisfactory results at the final follow-up. Surgical complications, such as a dural tear, nerve injury, and surgical site infection, were not investigated. Conclusions TL-MEH seemed to be an effective and safe alternative minimally invasive surgical option for patients with a cranially migrated lumbar disc herniation encroaching the exiting nerve root in the preforaminal and foraminal zones. PMID:24066214

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

    PubMed Central

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-01-01

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

  15. Clinical and magnetic resonance imaging features of compressive cervical myelopathy with traumatic intervertebral disc herniation in cynomolgus macaque (Macaca fascicularis)

    PubMed Central

    Choi, Yun-Jung; Park, Hye-Jin; Sohn, Chul-Ho; Jung, Kyeong Cheon; Park, Seong Hoe

    2016-01-01

    Intervertebral disc herniation (IVDH) with nucleus pulposus extrusion, traumatic or not, is a devastating clinical condition accompanied by neurological problems. Here we report a cynomolgus macaque suffering from acute and progressive neurological dysfunction by a blunt trauma due to neck collar, an animal handling device. Tetraplegia, urinary incontinence, decreased proprioception, and imperception of pain were shown on physical and neurological examinations. MRI sagittal T2 weighted sequences revealed an extensive protrusion of disc material between C2 and C3 cervical vertebra, and this protrusion resulted in central stenosis of the spinal cord. Histopathologic findings showed a large number of inflammatory cells infiltrated at sites of spinal cord injury (SCI). This case is the first report of compressive cervical SCI caused by IVDH associated with blunt trauma. PMID:28053621

  16. Clinical and magnetic resonance imaging features of compressive cervical myelopathy with traumatic intervertebral disc herniation in cynomolgus macaque (Macaca fascicularis).

    PubMed

    Choi, Yun-Jung; Park, Hye-Jin; Sohn, Chul-Ho; Jung, Kyeong Cheon; Park, Seong Hoe; Lee, Jae-Il

    2016-12-01

    Intervertebral disc herniation (IVDH) with nucleus pulposus extrusion, traumatic or not, is a devastating clinical condition accompanied by neurological problems. Here we report a cynomolgus macaque suffering from acute and progressive neurological dysfunction by a blunt trauma due to neck collar, an animal handling device. Tetraplegia, urinary incontinence, decreased proprioception, and imperception of pain were shown on physical and neurological examinations. MRI sagittal T2 weighted sequences revealed an extensive protrusion of disc material between C2 and C3 cervical vertebra, and this protrusion resulted in central stenosis of the spinal cord. Histopathologic findings showed a large number of inflammatory cells infiltrated at sites of spinal cord injury (SCI). This case is the first report of compressive cervical SCI caused by IVDH associated with blunt trauma.

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

    PubMed Central

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

    2012-01-01

    Background While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%–50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Methods A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain. Results One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1) or local anesthetic mixed with nonparticulate betamethasone (group 2). The primary outcome of significant pain relief and improvement in functional status (≥50%) was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 37–39 weeks in the successful group over a period of 52 weeks. Conclusion Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain. PMID:22826642

  18. Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality

    PubMed Central

    Iwase, Satoshi; Inukai, Yoko; Nishimura, Naoki; Sato, Maki; Sugenoya, Junichi

    2014-01-01

    Summary Sweating is an important mechanism for ensuring constant thermoregulation, but hyperhidrosis may be disturbing. We present five cases of hemifacial hyperhidrosis as a compensatory response to an/hypohidrosis caused by cervical disc herniation. All the patients complained of hemifacial hyperhidrosis, without anisocoria or blepharoptosis. Sweat function testing and thermography confirmed hyperhidrosis of hemifacial and adjacent areas. Neck MRI showed cervical disc herniation. Three of the patients had lateral compression with well-demarcated hypohidrosis below the hyperhidrosis on the same side as the cervical lesion. The rest had paramedian compression with poorly demarcated hyperhidrosis and hypohidrosis on the contralateral side. Although MRI showed no intraspinal pathological signal intensity, lateral dural compression might influence the circulation to the sudomotor pathway, and paramedian compression might influence the ipsilateral sulcal artery, which perfuses the sympathetic descending pathway and the intermediolateral nucleus. Sweat function testing and thermography should be performed to determine the focus of the hemifacial hyperhidrosis, and the myelopathy should be investigated on both sides. PMID:25014051

  19. Randomized clinical trial comparing lumbar percutaneous hydrodiscectomy with lumbar open microdiscectomy for the treatment of lumbar disc protrusions and herniations

    PubMed Central

    Cristante, Alexandre Fogaça; Rocha, Ivan Diasda; Marcon, Raphael Martus; de Barros Filho, Tarcísio Eloy Pessoa

    2016-01-01

    OBJECTIVES: Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates. METHODS: In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860. RESULTS: During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes). Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138). The rates of infection, pain, recurrence and satisfaction were similar between the two groups. CONCLUSION: Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups. PMID:27276397

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

    SciTech Connect

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

    2010-08-15

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

  1. Herniated disk

    MedlinePlus

    Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk; Herniated nucleus pulposus: Low back pain - herniated disk; LBP - herniated disk; Sciatica - herniated disk; Herniated disk

  2. Sciatica caused by disc herniation: Why is Chymopapain Chemonucleolysis denied to our patients?

    PubMed Central

    2016-01-01

    Background This study was undertaken to assess the long term outcome on the quality of life of patients with sciatica following treatment with chemonucleolysis, and to assess the complications. Methods This is a retrospective review carried out in a consecutive group of patients suffering from sciatica treated by chemonucleolysis. Patients were followed up by questionnaires to obtain Macnab score; satisfaction, SF 36, and case note review for complications and repeat spinal surgery. Results Six hundred and five patients (56% males, 44% females) treated over a ten year period from 1991 to 2000 were followed up. Average age was 47 years (range 17 - 88 years). The duration of symptoms prior to treatment averaged 10 months (range 1 - 20 months) and the herniation was confirmed by Myelogram (7%), CT Scan (34%), or MRI (59%). There were 578 single level and 27 double levels treated. Eighty five percent of herniations were typical single level, and 15% were atypical that is: patients with dominant back pain with sciatica, recurrent herniations following surgery at the same level, recurrent herniations at another level following chemonucleolysis, double levels treated patients with mainly neurological deficits and one cauda equina syndrome. Average follow up was 62 months (range 12 - 123) with a 78% satisfaction rate, with a 14% surgical intervention rate made up of 9% decompression, 1% repeat chemonucleolysis at another level and 4% fusion rate. SF-36 scores generally correlated with age and sex on scores for the normal local population. Conclusions This is a retrospective study and showed that chemonucleolysis was effective with a high satisfaction rate. It restores quality of life close to that expected in the population, and is safe with no complications related to the procedure. It is a cost effective daycase procedure with a lasting result.

  3. MRI DWI/ADC signal predicts shrinkage of lumbar disc herniation after O2–O3 discolysis

    PubMed Central

    Perri, Marco; Grattacaso, Giuseppe; Di Tunno, Valeria; Marsecano, Claudia; Di Cesare, Ernesto; Gallucci, Massimo

    2015-01-01

    Purpose Evaluate the discal morpho-structural changes as a predictive sign in the clinical outcome after ozone therapy in lumbar disc herniation using the T2–shine through effect in diffusion-weighted imaging (DWI). Method One hundred and fifty-four patients suffering from lumbosciatica (89 men and 65 women; age range, 23–62 years) were included, previous MR study performed with FSE-T2 and T2-fat, SE-T1 and DWI sequences, and were randomly assigned to two groups. Seventy-seven patients (control group) underwent conservative treatment with intraforaminal injection of steroid and anaesthetic. The remaining 77 patients (study group) underwent the same treatment with the addition of oxygen–ozone (O2–O3). During the following six months, a MRI follow-up with the same sequences was performed. An intervertebral disc volumetric analysis (IDVA), DWI signal score and post treatment clinical outcome evaluation were performed for an assessment of hernia reduction. χ2 test, Student's t test and analysis of covariance were used for comparison of variables. Results In the study group, 58 of 77 patients had a successful outcome (responders). In the responders group, DWI T2–shine through effect was present during MRI follow-up and in particular in 53 of 77 patients in six months of follow-up (p < 0.05). Moreover, in the same group a statistically significant disc shrinkage was shown by IDVA in sixth months of follow-up (p < 0.05). Conclusions T2–shine through effect in DWI is present before morphological disc reduction and moreover could be considered as a predictive sign of response to oxygen–ozone treatment. PMID:25923680

  4. Lumbar Disc Herniation Causing Cauda Equina Syndrome in a Paediatric Patient. A Case Report.

    PubMed

    Irshad, Mohamad; Ahmad, Khurshid; Malla, Hilal Ahmad

    2016-08-30

    Lumbar disc disease occurs mainly in the adult population. A disc prolapse in the paediatric population is very rare. Cauda equine syndrome resulting from compression of the cauda equina is a rare syndrome and is one of the few spinal surgical emergencies. Here we present a 13-year-old boy with pain in the lumbar region radiating bilaterally to the lower limbs, with asymmetrical weakness of lower the limbs, perianal hypoaesthesia and urinary retention. MRI of lumbar spine confirmed disc protrusion at the L3-L4 level with severe spinal canal stenosis. Patient was treated with microdiscectomy at the L3-L4 level. Postoperatively, his neurological deficit disappeared gradually. Although very rare, lumbar disc prolapse in the paediatric age group can lead to cauda equina syndrome. Early diagnosis and treatment can prevent life-long disability.

  5. Motor control exercise for symptomatic lumbar disc herniation: protocol for a systematic review and meta-analysis

    PubMed Central

    Pourahmadi, Mohammad Reza; Taghipour, Morteza; Ebrahimi Takamjani, Ismail; Sanjari, Mohammad Ali; Mohseni-Bandpei, Mohammad Ali; Keshtkar, Abbas Ali

    2016-01-01

    Introduction Lumbar disc herniation (LDH) is a common condition in adults and can impose a heavy burden on both the individual and society. It is defined as displacement of disc components beyond the intervertebral disc space. Various conservative treatments have been recommended for the treatment of LDH and physical therapy plays a major role in the management of patients. Therapeutic exercise is effective for relieving pain and improving function in individuals with symptomatic LDH. The aim of this systematic review is to evaluate the effectiveness of motor control exercise (MCE) for symptomatic LDH. Methods and analysis We will include all clinical trial studies with a concurrent control group which evaluated the effect of MCEs in patients with symptomatic LDH. We will search PubMed, SCOPUS, PEDro, SPORTDiscus, CINAHL, CENTRAL and EMBASE with no restriction of language. Primary outcomes of this systematic review are pain intensity and functional disability and secondary outcomes are functional tests, muscle thickness, quality of life, return to work, muscle endurance and adverse events. Study selection and data extraction will be performed by two independent reviewers. The assessment of risk of bias will be implemented using the PEDro scale. Publication bias will be assessed by funnel plots, Begg's and Egger's tests. Heterogeneity will be evaluated using the I2 statistic and the χ2 test. In addition, subgroup analyses will be conducted for population and the secondary outcomes. All meta-analyses will be performed using Stata V.12 software. Ethics and dissemination No ethical concerns are predicted. The systematic review findings will be published in a peer-reviewed journal and will also be presented at national/international academic and clinical conferences. Trial registration number CRD42016038166. PMID:27678542

  6. Correlation of 1.5 Tesla Magnetic Resonance Imaging with Clinical and Intraoperative Findings for Lumbar Disc Herniation

    PubMed Central

    Bhave, Arvind; Patil, Sanjay

    2016-01-01

    Study Design A single-center prospective study. Purpose A magnetic resonance imaging (MRI) scan is undeniably the gold standard for the diagnosis of a lumbar disc prolapse. Unfortunately it shares a strong association with incidental findings. In this study, we aimed to determine the extent to which a 1.5 Tesla MRI correlates with the clinical features and intraoperative findings in cases of lumbar disc prolapse. Overview of Literature Few studies have correlated MRI with clinical findings, and none have extended this correlation to intraoperative findings. Methods Over a 2-year period, 50 consecutive patients with lumbar disc herniation requiring discectomy were studied. The MRI findings we observed consisted of the prolapse level, type, position, migration, high-intensity zones (HIZ), lateral recess, and foraminal stenosis. A logistic regression analysis was performed to determine the significance for the various MRI findings. Finally, the MRI observations were confirmed with intraoperative findings and inferences were drawn. Results MRI scan sensitivity and specificity for determining surgically significant levels was 100% and 94.94%, respectively. Straight leg raising test was positive in 74% of patients, with 85%, 43%, and 75% for paracentral, central, and foraminal levels, respectively. A foraminal compromise was the only MRI parameter to share a significant association with neurological deficits. Patients with a HIZ on the MRI had a significant increase in back pain and 63% exhibited identifiable annular tears intraoperatively. The intraoperative anatomical findings correlated extensively with the MRI findings. Conclusions MRI findings strongly correlate with intraoperative features and can serve as a useful tool when planning surgery due to the accurate depiction of the morphometric features. However, the decision for surgery should be made only when detailed clinical findings in conjunction with MRI findings allow for an accurate identification of the

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

    PubMed Central

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

    2016-01-01

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

  8. Lumbar disc herniation: Is there an association between histological and magnetic resonance imaging findings?

    PubMed Central

    Majeed, Shiju A; Seshadrinath, N Arun Kumar; Binoy, Kavitha Ravi; Raji, Laila

    2016-01-01

    Background: Although validated radiological scoring systems and histological scoring system of surgically removed degenerated disc are used in assessment of progression of intervertebral disc degeneration, there have not been many studies that integrate these two aspects of assessments. The data available in this respect are very limited. This clinical study was designed to find the correlation between quantitative radiological score (Pfirmann grading system and Modic changes [MC]) and quantitative histological degeneration score (HDS). Materials and Methods: A cohort of 77 patients (45 males, 32 females; mean age of 38 years [range 18–58 years]) who presented with complaints of discogenic pain or radiculopathy at single level were assessed radiologically. They were graded according to the radiological pattern. The surgically excised disc specimen was graded according to HDS. The degree of radiological changes were correlated with the degree of histological changes. Results: Though the overall HDS (0–15) did not show statistically significant correlation with Pfirmann grading system, there were positive association found between mucoid degeneration, chondrocyte proliferation with the Pfirmann grading and mucoid degeneration, which were statistically significant. Female sex also had a higher association with instability pattern. Conclusion: The study shows that the Pfirmann grading system, MCs and HDS can reliably be used as scoring systems for assessing lumbar disc degeneration. The radiological assessment can be used as a noninvasive tool to assess the probable change in content rather than the microstructure of a disc undergoing degeneration. PMID:27293282

  9. Surgical planning and Neurologic Outcome after anterior approach to remove a disc herniation at the C7-T1 Level in 19 patients.

    PubMed

    Falavigna, Asdrubal; Righesso, Orlando; Betemps, Alejandro; de Los Rios, Pablo Fernando Vela; Guimarães, Rangel; Ziegler, Marcus; de Souza, Olivia Egger; da Silva, Pedro Guarise; Riew, Daniel K

    2013-11-18

    Study Design. Retrospective cohort study.Objective. The purpose of this study was to report the neurological presentation, outcome and surgical planning in a series of patients with a symptomatic single level C7-T1 disc herniation who underwent anterior surgical discectomy and fusion.Summary of Background Data. Disc herniations at C7-T1 are uncommon and there are few large series in the literature describing anterior treatment of such herniations.Methods. We performed a retrospective study of patients who underwent surgery for a C7-T1 disc herniation and reviewed the medical records, operative reports, and imaging studies. The surgeons' view line was drawn and its relation to the manubrium and the great vessels was determined on T1 sagittal magnetic resonance imaging (MRI). The location of the herniated disc in the spinal canal was determined using a T2 axial MRI and classified as central, foraminal and central/foraminal. Loss of muscle strength was evaluated preoperatively and at the last follow-up according to the classification of the Medical Research Council (MRC). The disc space was approached anteriorly by a standard cervical supramanubrial Smith-Robinson approach.Results. We identified 19 patients who had undergone C7-T1 discectomy and fusion. The mean age of the sample was 54.26 (±8.65) years. There was a higher proportion of male patients (57.9%, 11/19). The clinical presentation was predominantly motor deficit in 15/19 cases (78.9%) in intrinsic hand muscles, and usually improved after surgery. The mean follow-up period was 27.05 (± 15.10) months. All the patients underwent an anterior cervical supramanubrial approach with microdiscectomy and fusion. Anterior cervical plate fixation was used in 9/19 cases (47.3%). In the rest of the cases, a stand-alone intervertebral device was placed.Conclusion. An anterior cervical supramanubrial approach was easily accomplished in all patients. Motor deficit was the most common surgical indication.

  10. Comparative analysis of the influence of Fructus Ligustri Lucidi on a rat lumbar disc herniation model.

    PubMed

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

    2015-07-01

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

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

    PubMed

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

    2013-01-01

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

  12. Lumbar disc herniations: the predictive value of the Health Attribution Test (HAT) and the Minnesota Multiphasic Personality Inventory (MMPI).

    PubMed

    Herron, L D; Turner, J A; Weiner, P

    1988-01-01

    Ninety-one patients who were treated for lumbar disc herniation with chymopapain chemonucleolysis were evaluated preoperatively by means of the Health Attribution Test (HAT) and the Minnesota Multiphasic Personality Inventory (MMPI). There were 54 good, 10 fair, and 27 poor results after chemo-nucleolysis. Nineteen patients subsequently underwent lumbar laminectomy and discectomy and the ultimate outcome for the entire series including these laminectomy patients was 66 good, 10 fair, and 15 poor results. The fair/poor chemonucleolysis outcome patients scored significantly lower than did the good outcome patients on the HAT Powerful Others and significantly higher on the Chance scale. Patients with fair or poor outcomes after chemonucleolysis only scored significantly higher on the Hypochondriasis, Hysteria, Psychopathic Deviate, Paranoia, and Hypomania scales in preoperative MMPI testing. Good versus fair/poor ultimate outcome patients differed significantly on preoperative MMPI Hypochondriasis, Hysteria, Psychopathic Deviate, Paranoia, Psychasthenia, Schizophrenia, Hypomania, and Social Introversion scales. These groups also differed significantly on preoperative HAT Internal and Chance scales. Further analyses found the MMPI to be a slightly better predictor of chemonucleolysis outcome and much better predictor of ultimate outcome than the HAT.

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

    PubMed Central

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

    2013-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2015-01-01

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

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

    PubMed

    Ganiyu, Sokunbi Oluwaleke; Gujba, Kachalla Fatimah

    2015-02-01

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

  16. Lumbar discal cyst with spontaneous regression and subsequent occurrence of lumbar disc herniation.

    PubMed

    Takeshima, Yasuhiro; Takahashi, Toshiyuki; Hanakita, Junya; Watanabe, Mizuki; Kitahama, Yoshihiro; Kuraishi, Keita; Uesaka, Toshio; Minami, Manabu; Nakase, Hiroyuki

    2011-01-01

    A 39-year-old man presented with an extremely rare discal cyst at the L3-4 level manifesting as a left L4 radiculopathy. Two months after onset, he suffered right L4 radiculopathy with new lumbar disc protrusion. Five months after medical treatment, the patient's symptoms improved, and the discal cyst showed complete regression on magnetic resonance imaging. Most cases of discal cyst are surgically treated, with only two previous cases of spontaneous regression. The present case suggests clinical and radiological recovery of symptomatic lumbar discal cyst can be obtained by only conservative therapy.

  17. Cut-Off Value for Pain Sensitivity Questionnaire in Predicting Surgical Success in Patients with Lumbar Disc Herniation

    PubMed Central

    Azimi, Parisa; Benzel, Edward C.

    2016-01-01

    Various factors related to predict surgical success were studied; however, a standard cut-off point for the Pain Sensitivity Questionnaire (PSQ) measure has not yet been established for a favorable surgical outcome for lumbar disc herniation (LDH). This study was to find the optimal cut-off point on the PSQ to distinguish surgical success in patients with LDH. A total of 154 patients with LDH consecutively referred to our clinic were enrolled into this prospective study between February 2011 and January 2014. All participants completed the PSQ. Patients completed the Oswestry Disability Index (ODI) score before surgery, and at 2 years after surgery. Surgical success was defined as a 13-point improvement from the baseline ODI scores. The cut-off value for PSQ was determined by the receiver-operating characteristic curve (ROC). The mean age of patients was 49.3±9.6 years, and there were 80 women. The mean time for follow-up assessment was 31±5 months (range 24–35). Post-surgical success was 79.9% (n = 123) at 2 years follow up. The mean score for the total PSQ, PSQ-minor, and PSQ-moderate were 6.0 (SD = 1.6), 5.4 (SD = 1.9) and 6.5 (SD = 1.7), respectively. Total PSQ score was also significantly correlated with the total scores of the ODI. The optimal total PSQ cut-off point was determined as > 5.2 to predict surgical success in LDH patients, with 80.0% sensitivity and 75.6% specificity (AUC-0.814, 95% CI 0.703–0.926). This study showed that the PSQ could be considered a parameter for predicting surgical success in patients with LDH, and can be useful in clinical practice. PMID:27494617

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

    PubMed

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

    2015-12-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    2015-01-01

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

  1. Clinical efficacy of lumbar interbody fusion using a channel system combined with ozone therapy for the treatment of central-type L3-L4 lumbar disc herniation

    PubMed Central

    Wang, Yu; Sun, Hong; Qin, Shuzhen

    2017-01-01

    The clinical efficacy of minimally invasive lumbar interbody fusion via the intervertebral foramen combined with ozone (O3) therapy for the treatment of L3-L4 central-type lumbar disc herniation was explored. We recruited patients with sciatica who attended our hospital between July 2013 and October 2015 and underwent lumbar X-ray (anteroposterior and lateral view), lumbar flexion-extension radiographs, computed tomography, and magnetic resonance imaging after admission. Seventy-four patients with central-type lumbar disc herniation but no other complications were randomly selected and divided into the observation and control groups. The observation group comprised 37 patients treated with lumbar fusion using a channel system combined with O3 therapy, whereas the control group comprised 37 patients treated with lumbar fusion alone. The effects of the two therapies were evaluated using visual analog scale, Japanese Orthopaedic Association, and MacNab scores. There was no significant difference in scores between the two groups before surgery (P>0.05). The scores of the observation group after treatment were significantly lower than those before surgery and those of the control group (P<0.05). One patient in the observation group experienced no obvious improvement in symptoms after surgery, and two patients in the control group experienced postoperative recurrence; these three patients subsequently underwent laminectomy combined with planted bone fusion and internal fixation. There was no significant difference in total efficacy rates between the two groups (P>0.05). Lumbar fusion using a channel system combined with O3 therapy for the treatment of L3-L4 central-type lumbar disc herniation is safe and effective. It has the advantages of reduced trauma, fewer complications, and rapid pain relief, and it promotes the recovery of lumbar function. Strict mastery of the surgical indications is key to the success of the procedure; however, it is worth expanding its use in

  2. 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

    2010-01-01

    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

  3. Three-Years Outcome of Microdiscectomy via Paramedian Approach for Lumbar Foraminal or Extraforaminal Disc Herniations in Elderly Patients over 65 Years Old

    PubMed Central

    Yeo, Chang Gi; Kim, Sang Woo; Ko, Sam Kyu; Woo, Byung Kil; Song, Kwang Chul

    2016-01-01

    Objective Lumbar foraminal or extraforaminal disc herniations (FEFDH) have unusual clinical features and higher incidence in elderly patients compared to usual intraspinal canal disc herniations. We evaluated the efficacy of microdiscectomy via paramedian approach for lumbar FEFDH in elderly patients over the age of 65. Methods Retrospective study was performed in 68 patients over the age of 65 (23 male and 45 female patients; 71.46±3.87 years) who underwent microdiscectomy via paramedian approach for unilateral lumbar FEFDH causing sciatica. The radiological factors including degree of slippage, presence of instability, disc height, and degree of disc degeneration; pain and functional status by the means of visual analogue scale score, Oswestry Disability Index score, and Macnab classification were analyzed preoperatively and during the postoperative follow-up period of 3 years to evaluate the efficacy of the surgical treatment. Results Pain and functional status improved according to short- and long-term follow-up evaluations after surgery. Radiological changes following surgery, which can be understood as structural deteriorations and deformations, did not represent patient condition. Nine patients underwent additional surgery due to sustained or recurring leg pain of aggravation of back pain, and fusion surgery was required for 3 patients. Degree of preoperative slippage was the only statistically significant factor related to additional surgery (p<0.05). Conclusion Microdiscectomy via paramedian approach for FEFDH may be a good surgical alternative in elderly patients. Radiological changes after surgery did not show a concordance with patients' actual functional status. The excessive preoperative slippage tended to lead to unfavorable result after surgery and was associated with additional surgery. PMID:27799988

  4. Hyperexcitability in Spinal WDR Neurons following Experimental Disc Herniation Is Associated with Upregulation of Fractalkine and Its Receptor in Nucleus Pulposus and the Dorsal Root Ganglion

    PubMed Central

    Moen, Aurora; Haugen, Fred; Gjerstad, Johannes

    2016-01-01

    Introduction. Lumbar radicular pain following intervertebral disc herniation may be associated with a local inflammatory response induced by nucleus pulposus (NP) cells. Methods. In anaesthetized Lewis rats, extracellular single unit recordings of wide dynamic range (WDR) neurons in the dorsal horn and qPCR were used to explore the effect of NP application onto the dorsal nerve roots (L3–L5). Results. A clear increase in C-fiber response was observed following NP conditioning. In the NP tissue, the expression of interleukin-1β (IL-1β), colony stimulating factor 1 (Csf1), fractalkine (CX3CL1), and the fractalkine receptor CX3CR1 was increased. Minocycline, an inhibitor of microglial activation, inhibited the increase in neuronal activity and attenuated the increase in IL-1β, Csf1, CX3L1, and CX3CR1 expression in NP tissue. In addition, the results demonstrated an increase in the expression of TNF, CX3CL1, and CX3CR1 in the dorsal root ganglions (DRGs). Conclusion. Hyperexcitability in the pain pathways and the local inflammation after disc herniation may involve upregulation of CX3CL1 signaling in both the NP and the DRG. PMID:28116212

  5. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali

    PubMed Central

    Mahadewa Tjokorda, G. B.; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome. PMID:27695567

  6. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali.

    PubMed

    Mahadewa Tjokorda, G B; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome.

  7. Comparing clinical outcomes of repeat discectomy versus fusion for recurrent disc herniation utilizing the N(2)QOD.

    PubMed

    Guan, Jian; Ravindra, Vijay M; Schmidt, Meic H; Dailey, Andrew T; Hood, Robert S; Bisson, Erica F

    2017-01-01

    OBJECTIVE Recurrent lumbar disc herniation (RLDH) is a significant cause of morbidity in patients undergoing lumbar discectomy and has been reported to occur in up to 18% of cases. While repeat discectomy is often successful in treating these patients, concern over repeat RLDH may lead surgeons to advocate instrumented fusion even in the absence of instability. The authors' goal was to compare clinical outcomes for patients undergoing repeat discectomy versus instrumented fusion for RLDH. METHODS The authors used the National Neurosurgery Quality and Outcomes Database (N(2)QOD) to assess outcomes of patients who underwent repeat discectomy versus instrumented fusion at a single institution from 2012 to 2015. Primary outcomes included Oswestry Disability Index (ODI) score, visual analog scale (VAS) score, and quality-adjusted life year (QALY) measures. Secondary outcomes included hospital length of stay, discharge status, and hospital charges. RESULTS The authors identified 25 repeat discectomy and 12 instrumented fusion patients with 3- and 12-month follow-up records. The groups had similar ODI and VAS scores and QALY measurements at 3 and 12 months. Patients in the instrumented fusion group had significantly longer hospitalizations (3.7 days vs 1.0 days, p < 0.001) and operative times (229.6 minutes vs 82.7 minutes, p < 0.001). They were also more likely to be female (p = 0.020) and to be discharged to inpatient rehabilitation instead of home (p = 0.036). Hospital charges for the instrumented fusion group were also significantly higher ($54,458.29 vs $11,567.05, p < 0.001). Rates of reoperation were higher in the repeat discectomy group (12% vs 0%), but the difference was not statistically significant (p = 0.211). CONCLUSIONS Repeat discectomy and instrumented fusion result in similar clinical outcomes at short-term follow-up. Patients undergoing repeat discectomy had significantly shorter operative times and length of stay, and they incurred dramatically lower

  8. Endplate degeneration may be the origination of the vacuum phenomenon in intervertebral discs.

    PubMed

    Li, Fang-Cai; Zhang, Ning; Chen, Wei-Shan; Chen, Qi-Xin

    2010-08-01

    The intravertebral vacuum phenomenon (VP) is usually associated with degenerative disc disease, which could be related to the low back pain. Various theories related to the pathogenesis of VP have been proposed, but these theories have not been critically examined and remain hypothetical. In this article, we review the possible role of endplate degeneration in the pathogenesis of VP, and discuss several pathways possibly linked to them. Due to the endplate calcification and activated cytokines, the transport pathway of the nutrition for the intervertebral disc was blocked, resulting in the metabolic unbalance and decrease of the synthesis of matrix structural proteins. It could promote the matrix decomposition, causing the decrease of the quantity of matrix and the changes of stress distribution in intervertebral disc. As a result, the structure of intervertebral discs became increasingly unstable. While compression happened, the intravertebral cleft could occur and be gradually filled with gas, which may cause low back pain and aggravate the intervertebral discs degeneration. As outlined above, we hypothesize that endplate degeneration might be the origination of the vacuum phenomenon.

  9. Herniated Lumbar Disc

    MedlinePlus

    ... Manipulation may provide short-term relief from nonspecific low back pain, but should be avoided in most cases of ... your main symptom is leg pain (rather than low back pain), you can expect good results from surgery. Before ...

  10. Herniated Cervical Disc

    MedlinePlus

    ... resume your normal daily activities. A thorough postoperative rehabilitation program is advisable to help you resume the activities of daily living. Most patients will benefit from a postoperative exercise program or supervised physical therapy after surgery. You should ask your doctor about ...

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

    PubMed

    Broughton, Henare Renata

    2009-01-01

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

  12. The Effects of Stretching with Lumbar Traction on VAS and Oswestry Scales of Patients with Lumbar 4–5 Herniated Intervertebral Disc

    PubMed Central

    Yang, Hae-sun; Yoo, Won-gyu

    2014-01-01

    [Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry scale scores of lumbar 4–5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4–5 HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4–5 HIVD patients during 4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4–5 HIVD patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for lumbar 4–5 HIVD patients. PMID:25140094

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

    PubMed

    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

    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.

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

    PubMed Central

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

    2016-01-01

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

  15. The Strategy and Early Clinical Outcome of Percutaneous Full-Endoscopic Interlaminar or Extraforaminal Approach for Treatment of Lumbar Disc Herniation

    PubMed Central

    Ao, Jun; Cao, Guangru; Qin, Jianpu; Cai, Yuqiang

    2016-01-01

    Objective is to analyze the surgical strategy, safety, and clinical results of percutaneous full-endoscopic discectomy through interlaminar or extraforaminal puncture technique for LDH. Preoperative CT and MRI were analyzed, which were based on the main location of the herniated disc and its relationship with compressed nerve root. Sixty-two patients satisfied the inclusion criteria during the period from August 2012 to March 2014. We use percutaneous full-endoscopic discectomy through different puncture technique to remove the protrusive NP for LDH. Sixty patients completed the full-endoscopic operation successfully. Their removed disc tissue volume ranged from 1.5 mL to 3.8 mL each time. Postoperative ODI and VAS of low back and sciatica pain were significantly decreased in each time point compared to preoperative ones. No nerve root injury, infection, and other complications occurred. The other two patients were shifted to open surgery. No secondary surgery was required and 91.6% of excellent-to-good ratio was achieved on the basis of Macnab criteria at postoperative 12 months. Acquired benefits are fewer complications, rapid recovery, complete NP removal, effective nerve root decompression, and satisfactory cosmetic effect as well. This is a safe, effective, and rational minimally invasive spine-surgical technology with excellent clinical outcome. PMID:27648445

  16. Herniated Disk

    MedlinePlus

    ... to pain if the back is stressed. A herniated disk is a disk that ruptures. This allows the ... or back pain. Your doctor will diagnose a herniated disk with a physical exam and, sometimes, imaging tests. ...

  17. CASE-REPORT Association between an ACAN gene variable number tandem repeat polymorphism and lumbar disc herniation: a case control study.

    PubMed

    Casa, N L L; Casa Junior, A J; Melo, A V; Teodoro, L S; Nascimento, G R; Sousa, A F; Flausino, T C; Brito, D; Bergamini, R; Minasi, L B; da Cruz, A D; Vieira, T C; Curado, M P

    2016-12-19

    We investigated the association between an aggrecan gene (ACAN) polymorphism and lumbar disc herniation (LDH). This was a case-control study with quinquennial age and gender groups. The study comprised 119 men and women aged between 20 and 60 from Goiânia (Brazil). Of these, 39 were allocated to the case group (Ca) and 80 to the control group (Ct). We gathered sociodemographic and clinical data, and peripheral blood samples. DNA was isolated for genotyping the ACAN variable number tandem repeat (VNTR) via conventional polymerase chain reaction (PCR). Data were statistically analyzed using the chi-square test, multiple comparison analysis, the Student t-test, and odds ratios, with a level of significance set at 5% (P ≤ 0.05). The groups were homogenous in terms of sociodemographic, anthropometric, and life style variables. The allele score for the ACAN VNTR was significantly lower in volunteers with LDH; the A22 allele was significantly more prevalent in this same group; the Ca group presented greater frequency of short alleles A13-A25, whereas the Ct group presented a higher frequency of long alleles. However, this difference was not statistically significant. In both groups, the most common alleles were A28, A27, and A29, and the A26/A26 genotype was significantly more common in the Ca group. The results showed an association between short alleles and LDH among the investigated adults (Ca), corroborating the hypothesis that aggrecan with shorter repeat lengths can lead to a reduction in the physiological proteoglycan function of intervertebral disc hydration and, consequently, increased individual susceptibility to LDH.

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

    PubMed Central

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

    2013-01-01

    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. PMID:23351495

  19. Inhibition of cystathionine β-synthetase suppresses sodium channel activities of dorsal root ganglion neurons of rats with lumbar disc herniation

    PubMed Central

    Yan, Jun; Hu, Shufen; Zou, Kang; Xu, Min; Wang, Qianliang; Miao, Xiuhua; Yu, Shan Ping; Xu, Guang-Yin

    2016-01-01

    The pathogenesis of pain in lumbar disc herniation (LDH) remains poorly understood. We have recently demonstrated that voltage-gated sodium channels (VGSCs) in dorsal root ganglion (DRG) neurons were sensitized in a rat model of LDH. However, the detailed molecular mechanism for sensitization of VGSCs remains largely unknown. This study was designed to examine roles of the endogenous hydrogen sulfide synthesizing enzyme cystathionine β-synthetase (CBS) in sensitization of VGSCs in a previously validated rat model of LDH. Here we showed that inhibition of CBS activity by O-(Carboxymethyl) hydroxylamine hemihydrochloride (AOAA) significantly attenuated pain hypersensitivity in LDH rats. Administration of AOAA also reduced neuronal hyperexcitability, suppressed the sodium current density, and right-shifted the V1/2 of the inactivation curve, of hindpaw innervating DRG neurons, which is retrogradely labeled by DiI. In vitro incubation of AOAA did not alter the excitability of acutely isolated DRG neurons. Furthermore, CBS was colocalized with NaV1.7 and NaV1.8 in hindpaw-innervating DRG neurons. Treatment of AOAA markedly suppressed expression of NaV1.7 and NaV1.8 in DRGs of LDH rats. These data suggest that targeting the CBS-H2S signaling at the DRG level might represent a novel therapeutic strategy for chronic pain relief in patients with LDH. PMID:27905525

  20. Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up

    PubMed Central

    Kim, Kyoung-Tae; Cho, Dae-Chul; Sung, Joo-Kyung; Kim, Young-Baeg; Kim, Du Hwan

    2017-01-01

    Objective To compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria. Methods Thirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2–7 range of motion (ROM), FSU, and the adjacent segment were also checked. Results The clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were 8.6±2.3 and 8.4±2.0, and lower level motion values were 8.4±2.2 and 8.3±1.9. Preoperative and postoperative FSU heights were 37.0±2.1 and 37.1±1.8. In the group B, upper level adjacent segment motion values were 8.1±2.6 and 8.2±2.8, and lower level motion values were 6.5±3.3 and 6.3±3.1. FSU heights were 37.1±2.0 and 36.2±1.8. The postoperative FSU motion and height changes were significant (p<0.05). The patient’s satisfaction rates for surgery were 88.2% in group A and 88.8% in group B. Conclusion TDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient’s biomechanical characteristics and economic status should be understood and treated using the optimal procedure. PMID:28061490

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

    PubMed Central

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

    2015-01-01

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

  2. Sensitization of P2X3 receptors by cystathionine β-synthetase mediates persistent pain hypersensitivity in a rat model of lumbar disc herniation.

    PubMed

    Wang, Qianliang; Zhu, Hongyan; Zou, Kang; Yuan, Bo; Zhou, You-Lang; Jiang, Xinghong; Yan, Jun; Xu, Guang-Yin

    2015-03-20

    Lumbar disc herniation (LDH) is a major cause of discogenic low back pain and sciatica, but the underlying mechanisms remain largely unknown. Hydrogen sulfide (H2S) is becoming recognized for its involvement in a wide variety of processes including inflammation and nociception. The present study was designed to investigate the roles of the H2S signaling pathway in the regulation of expression and function of purinergic receptors (P2XRs) in dorsal root ganglion (DRG) neurons from rats with LDH. LDH was induced by implantation of autologous nucleus pulposus (NP), harvested from rat tail, in lumbar 5 and 6 spinal nerve roots. Implantation of autologous NP induced persistent pain hypersensitivity, which was partially reversed by an intrathecal injection of A317491, a potent inhibitor of P2X3Rs and P2X2/3Rs. The NP induced persistent pain hypersensitivity was associated with the increased expression of P2X3Rs, but not P2X1Rs and P2X2Rs, receptors in L5-6 DRGs. NP implantation also produced a 2-fold increase in ATP-induced intracellular calcium signals in DRG neurons when compared to those of controls (P < 0.05). Interestingly, NP implantation significantly enhanced expression of the endogenous hydrogen sulfide producing enzyme, cystathionine-β-synthetase (CBS). Systematic administration of O-(Carboxymethyl) hydroxylamine hemihydrochloride (AOAA), an inhibitor of CBS, suppressed the upregulation of P2X3R expression and the potentiation of ATP-induced intracellular calcium signals in DRG neurons (P < 0.05). Intrathecal injection of AOAA markedly attenuated NP induced- persistent pain hypersensitivity. Our results suggest that sensitization of P2X3Rs, which is likely mediated by CBS-H2S signaling in primary sensory neurons, contributes to discogenic pain. Targeting CBS/H2S-P2X3R signaling may represent a potential treatment for neuropathic pain caused by LDH.

  3. The effect of low back pain on the daily activities of patients with lumbar disc herniation: a Turkish military hospital experience.

    PubMed

    Kose, Gulsah; Hatipoglu, Sevgi

    2012-04-01

    This study was performed to assess disability on daily living activities, which developed secondary to low back pain, in patients with lumbar disc herniation and treated either conservatively or surgically. The study was performed between November 2008 and June 2009. Visual analogue scale (VAS) was used to measure the intensity of pain, and the Oswestry Disability Index (ODI) was used to assess the disability of the patients on daily living activities. Of the 112 patients, 55 were women and 57 were men. The mean age was 39.68 years for the conservative treatment group and 46.46 years the for surgical treatment group. In the pretreatment period, the patients who were selected for surgical treatment had higher VAS score and ODI than did the patients who were selected for conservative treatment. The disability areas that were reported in the pretreatment period were walking, sleeping, standing, and traveling for the surgical treatment group and self-care, sitting, and social life areas for the conservative treatment group. When the ODI and VAS score of the patients were statistically compared at the third month of posttreatment period, the scores were significantly low in the surgical treatment group. The disability areas that were reported at the third month of posttreatment period were weight lifting, self-care, and walking for the surgical treatment group and social life, sleeping, sitting, and standing for the conservative treatment group. This study found that patients with low back pain experience physical disabilities due to pain. Their daily living activities are affected by these disabilities and the intensity of pain affects the level of disability. Knowledge of the disability areas caused by low back pain plays an important role in the determination of nursing care and content of the education which will be offered to the patients. The use of scale on the patient's care is important to form a common language in nursing and to obtain evidence-based data

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

    Objectives This study aimed to assess the efficacy and safety of an integrative complementary and alternative medicine (CAM) approach in the management of lumbar herniated disc (LHD) with sciatic pain and investigate pain relapse, use of medical care and surgery rates in patients who actively chose non-surgical CAM treatment for LHD. Study design/Setting This prospective observational study was undertaken at a Korean medicine hospital outpatient setting in Korea. Participants A total of 128 consecutive patients with LHD with a numeric rating scale for leg pain of ≥5 completed 6 months of CAM treatment after recruitment from November 2006, and 73/128 participants (57%) attended follow-up 3 years later. Interventions 6 months of CAM treatment (herbal medicine, acupuncture, bee venom pharmacopuncture, and Chuna manipulation). Primary outcome measures Visual analogue scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI), and Short Form (SF)-36 Health Survey. Secondary outcome measures Neurological impairment (muscular weakness, sensory loss, Straight Leg Raise test), MRIs, recurrence of low back pain and/or radiating pain, and use of medical care. Results 92 patients could be assessed for surgical state, of whom 4 replied that they had received surgery. 73 patients attended the 3-year follow-up. The baseline VAS of back pain (4.37±2.70) decreased after treatment (0.90±1.01; p<0.001) and was maintained at 3 years (1.12±1.64; p=0.19). The baseline VAS of leg pain (7.57±1.40) also decreased on treatment (0.82±1.18; p<0.001) and was sustained at 3 years (0.99±1.58; p=0.34). ODI scores declined from 40.74±16.15 to 9.84±9.67 (p<0.001), then decreased further to 6.30±7.19 (p<0.01). SF-36 scores increased from 34.96±13.30 to 69.20±14.96 (p<0.001), reaching 76.19±14.45 (p<0.001) at 3 years. 37 patients reported recurrence of pain and most chose CAM treatment for management of relapse symptoms. Conclusions Although the absence of a

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

    PubMed Central

    Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej

    2014-01-01

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

  7. Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response?

    PubMed Central

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-01-01

    Abstract Epidural steroid injection (ESI) is known to be an effective treatment for neck or radicular pain due to herniated intervertebral disc (HIVD) and spinal stenosis (SS). Although repeat ESI has generally been indicated to provide more pain relief in partial responders after single ESI, there has been little evidence supporting the usefulness of this procedure. The purpose of this study, therefore, was to determine whether repeat ESI at a prescribed interval of 2 to 3 weeks after the first injection would provide greater clinical benefit in patients with partial pain reduction than intermittent ESI performed only when pain was aggravated. One hundred eighty-four patients who underwent transforaminal ESI (TFESI) for treatment of axial neck and radicular arm pain due to HIVD or SS and could be followed up for 1 year were enrolled. We divided the patients into 2 groups. Group A (N = 108) comprised partial responders (numeric rating scale (NRS) ≥ 3 after the first injection) who underwent repeat injection at a prescribed interval of 2 to 3 weeks after the first injection. Group B (N = 76) comprised partial responders who did not receive repeat injection at the prescribed interval, but received intermittent injections only for aggravation of pain. Various clinical data were assessed, including total number of injections during 1 year, NRS duration of <3 during 1 year (NRS < 3 duration), and time interval until pain was increased to require additional injections after repeat injection in Group A, or after first injection in Group B (time to reinjection). Groups A and B were compared in terms of total population, HIVD, and SS. In the whole population, HIVD subgroup, and SS subgroup, patients in Group A required significantly fewer injections to obtain satisfactory pain relief during the 1-year follow-up period. Group A showed a significantly longer time to reinjection and longer NRS < 3 than Group B did. Repeat TFESI conducted at 2- to 3-week

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

    PubMed Central

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

    2016-01-01

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

  9. Lipoxin A4 attenuates radicular pain possibly by inhibiting spinal ERK, JNK and NF-κB/p65 and cytokine signals, but not p38, in a rat model of non-compressive lumbar disc herniation.

    PubMed

    Miao, G-S; Liu, Z-H; Wei, S-X; Luo, J-G; Fu, Z-J; Sun, T

    2015-08-06

    Inflammatory response induced by protrused nucleus pulposus (NP) has been shown to play a crucial role in the process of radicular pain. Lipoxins represent a unique class of lipid mediators that have anti-inflammatory and pro-resolving action. The present study was undertaken to investigate if intrathecal lipoxin A4 (LXA4) could alleviate mechanical allodynia in the rat models of application of NP to the L5 dorsal root ganglion (DRG). Non-compressive models of application of NP to L5 DRG were established and intrathecal catheterization for drug administration was performed in rats. Daily intrathecal injection of vehicle or LXA4 (10ng or 100ng) was performed for three successive days post-operation. Mechanical thresholds were tested and the ipsilateral lumbar (L4-L6) segment of spinal dorsal horns were removed for the determination of tumor necrosis factor-α (TNF-α), IL-1β, transforming growth factor-β1 (TGF-β1) and IL-10 expression and NF-κB/p65, extracellular signal-regulated kinase (ERK), C-Jun N-terminal kinase (JNK) and P38 expression. Application of NP to DRG in rats induced mechanical allodynia, increased the expression of pro-inflammatory factors (TNF-α and IL-1β), NF-κB/p65, the phosphorylated-ERK (p-ERK), -JNK (p-JNK) and -P38 (p-p38) and decreased the expression of anti-inflammatory cytokines (TGF-β1 and IL-10) in the ipsilateral lumbar (L4-L6) segment of spinal dorsal horns. Intrathecal injection of LXA4 alleviated the development of neuropathic pain, inhibited the upregulation of pro-inflammatory cytokines (TNF-α and IL-1β), upregulated the expression of anti-inflammatory cytokines (TGF-β1 and IL-10) and attenuated the activation of NF-κB/p65, p-ERK, p-JNK, but not p-p38, in a dose-dependent manner. In this study, we have demonstrated that LXA4 potently alleviate radicular pain in a rat model of non-compressive lumbar disc herniation. The anti-inflammatory and pro-resolution properties of LXA4 have shown a great promise for the management

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

    SciTech Connect

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

    2012-10-15

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

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

    PubMed Central

    Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej

    2013-01-01

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

  12. Bay11-7082 attenuates neuropathic pain via inhibition of nuclear factor-kappa B and nucleotide-binding domain-like receptor protein 3 inflammasome activation in dorsal root ganglions in a rat model of lumbar disc herniation

    PubMed Central

    Zhang, Ailiang; Wang, Kun; Ding, Lianghua; Bao, Xinnan; Wang, Xuan; Qiu, Xubin; Liu, Jinbo

    2017-01-01

    Lumbar disc herniation (LDH) is an important cause of radiculopathy, but the underlying mechanisms are incompletely understood. Many studies suggested that local inflammation, rather than mechanical compression, results in radiculopathy induced by LDH. On the molecular and cellular level, nuclear factor-kappa B (NF-κB) and nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome have been implicated in the regulation of neuroinflammation formation and progression. In this study, the autologous nucleus pulposus (NP) was implanted in the left L5 dorsal root ganglion (DRG) to mimic LDH in rats. We investigated the expression of NF-κB and the components of NLRP3 inflammasome in the DRG neurons in rats. Western blotting and immunofluorescence for the related molecules, including NLRP3, apoptosis-associated speck-like protein containing caspase-1 activator domain (ASC), caspase-1, interleukin (IL)-1β, IL-18, IκBα, p-IκBα, p65, p-p65, and calcitonin gene-related peptide (CGRP) were examined. In the NP-treated group, the activations of NLRP3, ASC, caspase-1, IL-1β, IL-18, p-IκBα, and p-p65 in DRG neurons in rats were elevated at 1 day after surgery, and the peak occurred at 7 days. Treatment with Bay11-7082, an inhibitor of the actions of IKK-β, was able to inhibit expression and activation of the molecules (NLRP3, ASC, caspase-1, IL-1β, IL-18, p-IκBα, and p-p65) and relieve the pain in rats. Our study shows that NF-κB and NLRP3 inflammasome are involved in the maintenance of NP-induced pain, and that Bay11-7082 could alleviate mechanical allodynia and thermal hyperalgesia by inhibiting NF-κB and NLRP3 inflammasome activation. PMID:28243141

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

    PubMed

    Volchegorskiĭ, I A; Mester, K M

    2010-01-01

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

  14. [Spinal and extra-spinal tumors mimicking discal herniation].

    PubMed

    Tamir, E; Mirovsky, Y; Robinson, D; Halperin, N

    1999-12-15

    Low back pain radiating to a limb is usually caused by lumbar disc herniation. Tumors of the spinal cord or near the sciatic or femoral plexus can cause neural compression and clinical signs similar to those of disc herniation. Such tumors are usually misdiagnosed as discal herniation and appropriate treatment is delayed. We present 4 men who had tumors causing low back pain radiating to the leg: a 70-year-old with metastatic squamous cell carcinoma of the lung, a 20-year-old with aneurysmal bone cyst of the vertebral column, a 52-year-old with retroperitoneal sarcoma and a 32-year-old who also had retroperitoneal sarcoma. Diagnosis and treatment were delayed because the clinical symptoms were ascribed to lumbar disc herniation. The latter 2 patients had CT-scans showing lumbar disc herniation, but similar findings are common among asymptomatic individuals. The differential diagnosis of low back pain radiating to the leg should include tumor when there is a history of cancer, pain not relieved by conservative treatment nor by lying down, pain is increased at night, pain accompanied by weight loss, and when physical examination demonstrates injury to more than 1 nerve root. In these circumstances work-up should include EMG, radioisotope scan and CT of the pelvis.

  15. Remote cerebellar hemorrhage as an early and potentially lethal complication of a discal lumbar herniation surgery.

    PubMed

    Royon, V; Rabehenoina, C; Tourrel, F; Compère, V; Dureuil, B

    2014-01-01

    Remote cerebellar hemorrhage (RCH) is an infrequent but serious complication after lumbar herniation surgery. Little is known about this complication but excessive cerebrospinal fluid (CSF) leakage is thought to be a leading cause of RCH. We describe the case of a patient suffering from a life-threatening RCH, which occurred a few hours after lumbar disc herniation surgery.

  16. [Polish nomenclature of lumbar disc disease].

    PubMed

    Radło, Paweł; Smetkowski, Andrzej; Tesiorowski, Maciej

    2014-01-01

    Lumbar disc herniation is one of the most common damage of musculoskeletal system. The incidence of pain of lumbosacral spine is estimated approximately on 60-90% in general population, whereas the incidence of disc herniation in patients experiencing low back pain is about 91%. Despite the high incidence and uncomplicated pathogenesis of disc disease there is a problem with the nomenclature. In the vast majority of cases, the naming confusion stems from ignorance of the etiology of low back pain. Different terminologies: morphological, topographical, Radiological and Clinical are used interchangeably. In addition, diagnosis is presented in a variety of languages: Polish, English and Latin. Moreover, the medical and traditional language are used alternately. The authors found in Polish literature more, than 20 terms to describe lumbar disc herniation. All of these terms in the meaning of the authors are used to determine one pathology--mechanical damage to the intervertebral disc and moving the disc material beyond the anatomical area.

  17. Apparent diffusion coefficient in normal and abnormal pattern of intervertebral lumbar discs: initial experience☆

    PubMed Central

    Niu, Gang; Yu, Xuewen; Yang, Jian; Wang, Rong; Zhang, Shaojuan; Guo, Youmin

    2011-01-01

    The aim of the present study was to compare the relationship of morphologically defined non-bulging/herniated, bulging and herniated intervertebral lumbar discs with quantitative apparent diffusion coefficient (ADC). Thirty-two healthy volunteers and 28 patients with back pain or sciatica were examined by MRI. All intervertebral lumbar discs from L1 to S1 were classified according to morphological abnormality and degenerated grades. The ADC values of nucleus pulposus (NP) were measured and recorded. The significant differences about mean ADC values of NP were found between non-bulging/herniated discs and bulging discs as well as herniated discs (P < 0.05), whereas there were no significant differences in ADC values between bulging and herniated discs (P > 0.05). Moreover, statistically significant relationship was found in the mean ADC values of NP between “non-bulging/herniated and non-degenerated discs” and “non-bulging/herniated degenerated discs” as well as herniated discs (P < 0.05). Linear regression analysis between ADC value and disc level revealed an inverse correlation (r = -0.18). The ADC map of the NP is a potentially useful tool for the quantitative assessment of componential and molecular alterations accompanied with lumbar disc abnormalities. PMID:23554690

  18. Lumbar discal herniation in the elderly: long-term results of chymopapain chemonucleolysis.

    PubMed

    Benoist, M; Parent, H; Nizard, M; Lassale, B; Deburge, A

    1993-10-01

    Very few reports in the literature have dealt with lumbar disc herniation in the elderly and its treatment by chymopapain chemonucleolysis. Between September 1981 and May 1991, 42 patients aged between 60 and 80 years were treated by chemonucleolysis for lumbar disc herniation. The clinical symptoms and signs, similar to those observed in younger patients, were well correlated with a clear picture of discal herniation on the CT scan without any associated stenosis. At the last follow-up (mean 4.5 years) satisfactory results were obtained in 78% of the patients. No complication were observed. It is concluded that in the rare cases of discal herniation in the elderly, chymopapain chemonucleolysis should be considered as a safe and efficacious alternative to surgery.

  19. Surgical experience of gas-containing disk herniation.

    PubMed

    Choi, Kyung-Chul; Kim, Jin-Sung; Lee, Sang-Ho

    2010-01-01

    Disk herniation with gas or gas-containing disk herniation (GCDH) is rare, although epidural gas is associated with the vacuum phenomenon. The clinical, radiologic, and surgical findings were retrospectively analyzed of 18 patients with GCDH. The demographic, clinical, and radiologic findings including computed tomography and magnetic resonance imaging, as well as operative methods were examined. The mean age was 64.4 years (range 51-84 years). All patients presented with acute radiculopathy or exacerbation of chronic pain associated with GCDH of the lumbar spine. All lumbar GCDHs were related to the vacuum phenomenon. Ruptured disks predominantly compressed the nerve root with gas in 17 cases, except in one with only compressed nerve root by gas without disk herniation. All patients had confirmed GCDH at surgery. All patients underwent removal of GCDH and five with another level of spinal stenosis or disk herniation underwent selective decompression. The six patients with instability underwent fusion. Visual analogue scale score of radicular pain was improved from 7.4 ± 0.9 before surgery to 3.2 ± 0.7 at the 3-month follow-up examination. No recurrence occurred after surgery. GCDH can occur as a space-occupying lesion in epidural space as well as a cause of radiculopathy. GCDH may indicate the source of clinical symptoms in the degenerative spine, especially combined with spinal stenosis or multiple spinal disk herniations.

  20. Herniated disk repair (image)

    MedlinePlus

    ... is one of the most common causes of lower back pain. The mainstay of treatment for herniated disks is an initial period of rest with pain and anti-inflammatory medications followed by physical therapy. If pain and symptoms persist, surgery to remove ...

  1. Cervical disc hernia operations through posterior laminoforaminotomy

    PubMed Central

    Yolas, Coskun; Ozdemir, Nuriye Guzin; Okay, Hilmi Onder; Kanat, Ayhan; Senol, Mehmet; Atci, Ibrahim Burak; Yilmaz, Hakan; Coban, Mustafa Kemal; Yuksel, Mehmet Onur; Kahraman, Umit

    2016-01-01

    Objective: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. Results: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. Conclusion: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis. PMID:27217655

  2. Cervical Deuk Laser Disc Repair®: A novel, full-endoscopic surgical technique for the treatment of symptomatic cervical disc disease

    PubMed Central

    Deukmedjian, Ara J.; Cianciabella, Augusto; Cutright, Jason; Deukmedjian, Arias

    2012-01-01

    Background: Cervical Deuk Laser Disc Repair® is a novel full-endoscopic, anterior cervical, trans-discal, motion preserving, laser assisted, nonfusion, outpatient surgical procedure to safely treat symptomatic cervical disc diseases including herniation, spondylosis, stenosis, and annular tears. Here we describe a new endoscopic approach to cervical disc disease that allows direct visualization of the posterior longitudinal ligament, posterior vertebral endplates, annulus, neuroforamina, and herniated disc fragments. All patients treated with Deuk Laser Disc Repair were also candidates for anterior cervical discectomy and fusion (ACDF). Methods: A total of 142 consecutive adult patients with symptomatic cervical disc disease underwent Deuk Laser Disc Repair during a 4-year period. This novel procedure incorporates a full-endoscopic selective partial decompressive discectomy, foraminoplasty, and posterior annular debridement. Postoperative complications and average volume of herniated disc fragments removed are reported. Results: All patients were successfully treated with cervical Deuk Laser Disc Repair. There were no postoperative complications. Average volume of herniated disc material removed was 0.09 ml. Conclusions: Potential benefits of Deuk Laser Disc Repair for symptomatic cervical disc disease include lower cost, smaller incision, nonfusion, preservation of segmental motion, outpatient, faster recovery, less postoperative analgesic use, fewer complications, no hardware failure, no pseudoarthrosis, no postoperative dysphagia, and no increased risk of adjacent segment disease as seen with fusion. PMID:23230523

  3. Upper lumbar disk herniations.

    PubMed

    Cedoz, M E; Larbre, J P; Lequin, C; Fischer, G; Llorca, G

    1996-06-01

    Specific features of upper lumbar disk herniations are reviewed based on data from the literature and from a retrospective study of 24 cases treated surgically between 1982 and 1994 (seven at L1-L2 and 17 at L2-L3). Clinical manifestations are polymorphic, misleading (abdominogenital pain suggestive of a visceral or psychogenic condition, meralgia paresthetica, isolated sciatica; femoral neuralgia is uncommon) and sometimes severe (five cases of cauda equina syndrome in our study group). The diagnostic usefulness of imaging studies (radiography, myelography, computed tomography, magnetic resonance imaging) and results of surgery are discussed. The risk of misdiagnosis and the encouraging results of surgery are emphasized.

  4. Hybrid cervical disc arthroplasty.

    PubMed

    Tu, Tsung-Hsi; Wu, Jau-Ching; Cheng, Henrich; Mummaneni, Praveen V

    2017-01-01

    For patients with multilevel cervical stenosis at nonadjacent segments, one of the traditional approaches has included a multilevel fusion of the abnormal segments as well as the intervening normal segment. In this video we demonstrate an alternative treatment plan with tailored use of a combination of anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) with an intervening skipped level. The authors present the case of a 72-year-old woman with myeloradiculopathy and a large disc herniation with facet joint degeneration at C3-4 and bulging disc at C5-6. After nonoperative treatment failed, she underwent a single-level ACDF at C3-4 and single-level arthroplasty at C5-6, which successfully relieved her symptoms. No intervention was performed at the normal intervening C4-5 segment. By using ACDF combined with arthroplasty, the authors have avoided a 3-level fusion for this patient and maintained the range of motion of 2 disc levels. The video can be found here: https://youtu.be/OrxcPUBvqLk .

  5. Decellularized allogeneic intervertebral disc: natural biomaterials for regenerating disc degeneration

    PubMed Central

    Hu, Zhijun; Chen, Kai; Shan, Zhi; Chen, Shuai; Wang, Jiying; Mo, Jian; Ma, Jianjun; Xu, Wenbing; Qin, An; Fan, Shunwu

    2016-01-01

    Intervertebral disc degeneration is associated with back pain and disc herniation. This study established a modified protocol for intervertebral disc (IVD) decellularization and prepared its extracellular matrix (ECM). By culturing mesenchymal stem cells (MSCs)(3, 7, 14 and 21 days) and human degenerative IVD cells (7 days) in the ECM, implanting it subcutaneously in rabbit and injecting ECM microparticles into degenerative disc, the biological safety and efficacy of decellularized IVD was evaluated both in vitro and in vivo. Here, we demonstrated that cellular components can be removed completely after decellularization and maximally retain the structure and biomechanics of native IVD. We revealed that allogeneic ECM did not evoke any apparent inflammatory reaction in vivo and no cytotoxicity was found in vitro. Moreover, IVD ECM can induce differentiation of MSCs into IVD-like cells in vitro. Furthermore, allogeneic ECM microparticles are effective on the treatment of rabbit disc degeneration in vivo. In conclusion, our study developed an optimized method for IVD decellularization and we proved decellularized IVD is safe and effective for the treatment of degenerated disc diseases. PMID:26933821

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

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

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

  7. Lumbar Disc Degenerative Disease: Disc Degeneration Symptoms and Magnetic Resonance Image Findings

    PubMed Central

    Saleem, Shafaq; Rehmani, Muhammad Asim Khan; Raees, Aisha; Alvi, Arsalan Ahmad; Ashraf, Junaid

    2013-01-01

    Study Design Cross sectional and observational. Purpose To evaluate the different aspects of lumbar disc degenerative disc disease and relate them with magnetic resonance image (MRI) findings and symptoms. Overview of Literature Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. It may present as disc herniation, lumbar spinal stenosis, facet joint arthropathy or any combination. Presenting symptoms of lumbar disc degeneration are lower back pain and sciatica which may be aggravated by standing, walking, bending, straining and coughing. Methods This study was conducted from January 2012 to June 2012. Study was conducted on the diagnosed patients of lumbar disc degeneration. Diagnostic criteria were based upon abnormal findings in MRI. Patients with prior back surgery, spine fractures, sacroiliac arthritis, metabolic bone disease, spinal infection, rheumatoid arthritis, active malignancy, and pregnancy were excluded. Results During the targeted months, 163 patients of lumbar disc degeneration with mean age of 43.92±11.76 years, came into Neurosurgery department. Disc degeneration was most commonly present at the level of L4/L5 105 (64.4%).Commonest types of disc degeneration were disc herniation 109 (66.9%) and lumbar spinal stenosis 37 (22.7%). Spondylolisthesis was commonly present at L5/S1 10 (6.1%) and associated mostly with lumbar spinal stenosis 7 (18.9%). Conclusions Results reported the frequent occurrence of lumbar disc degenerative disease in advance age. Research efforts should endeavor to reduce risk factors and improve the quality of life. PMID:24353850

  8. [Lumbar disc protrusion in childhood. Description of a case].

    PubMed

    Lins, E; Basedow, H

    1976-02-01

    This is a case of lumbar disc protrusion in a 14 year old girl, with typical symptomatology. Special attention should be called to the rarity of this case. The clinical and myelographic diagnosis showed a lumbar herniation L 4/L5. Treatment was performed by lumbar hemilaminectomie. The post operative controll showed remission of the clinical findings.

  9. Percutaneous diode laser disc nucleoplasty

    NASA Astrophysics Data System (ADS)

    Menchetti, P. P.; Longo, Leonardo

    2004-09-01

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

  10. [Traumatic recurrence of idiopathic spinal cord herniation].

    PubMed

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

    2013-01-01

    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.

  11. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  12. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  13. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  14. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  15. 46 CFR 64.61 - Rupture disc.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  16. 1980 Volvo award in basic science. Proteoglycans in experimental intervertebral disc degeneration.

    PubMed

    Lipson, S J; Muir, H

    1981-01-01

    An animal model of intervertebral disc degeneration induced surgically by ventral nuclear herniation in the rabbit produces morphologic changes of disc degeneration. Histologic characteristics and proteoglycan changes have been studied at various times after herniation. After injury, there was metaplasia into fibrocartilage originating from the cells along the margins of the annular wound, with proliferation of cells changing almost the entire disc space into fibrocartilage. A vertebral osteophyte occurred through an endochondral ossification sequence. Aggregating proteoglycans had two periods of repletion in the early course of degeneration. The water content of the disc was rapidly but only transiently restored in the first two days after herniation, whilst the changes in the total proteoglycan content of the disc paralleled these changes. Hyaluronic acid content decreased rapidly after herniation, but the size of the proteoglycan monomers did not change with degeneration. It is suggested that loss of confined fluid mechanics signals an abortive repair attempt rather than that of biochemical changes in proteoglycans initiate disc degeneration.

  17. Spontaneous secretion of interleukin 1 receptor antagonist (IL-1ra) by cells isolated from herniated lumbar discal tissue after discectomy.

    PubMed

    Koch, H; Reinecke, J A; Meijer, H; Wehling, P

    1998-09-01

    In the study presented, cells of a herniated lumbar disc were cultivated in vitro and analysed for interleukin 1beta (IL-1beta) and interleukin 1 receptor antagonist (IL-1Ra) production. The objective of this study was the detection of IL-1beta and IL-1Ra secreted by herniated lumbar discal cells after discectomy. The involvement of cytokines in the degeneration of intervertebral discs and in the pathophysiology of radiculopathy is established. Antagonizing proteins, e.g. IL-1Ra are thought to have considerable therapeutic potential. In the present study, a 51-year-old male with massive sequestrated lumbar disc herniation at L5/S1 was treated by microsurgical discectomy. Discal cells were isolated, cultures and culture supernatants immunochemically analysed for IL-1beta and IL-1Ra secretion. Spontaneous secretion of IL-1Ra was found. IL-1beta was not detected. Our findings might contradict recent studies on the role of IL-1beta and IL-1Ra. A possible therapeutic role of exogenous IL-1Ra in disc degeneration needs further research.

  18. Incidence of trocar site herniation following robotic gynecologic surgery

    PubMed Central

    Clark, Leslie H.; Soliman, Pamela T.; Odetto, Diego; Munsell, Mark F.; Schmeler, Kathleen M.; Fleming, Nicole; Westin, Shannon N.; Nick, Alpa M.; Ramirez, Pedro T.

    2014-01-01

    Objective Trocar site herniation is a recognized complication of minimally invasive surgery, but published data on trocar site herniation after robotic surgery are scarce. We sought to determine the incidence of trocar site herniation in women undergoing robotic surgery for gynecologic disease. Methods A retrospective review of robotic surgeries performed from January 1, 2006, through December 31, 2012, was conducted. Postoperative trocar site herniations were identified, along with time to presentation, location of herniation, and management. Patients were excluded if surgery was converted to laparotomy or traditional laparoscopy. The Wilcoxon rank-sum test was used to compare patients with and without herniation with respect to continuous variables, and Fisher's exact test was used to compare these 2 groups with respect to categorical variables. Results The study included 500 patients, 3 of whom experienced herniation at a single trocar site. The patients with and without herniation did not differ with respect to age, body mass index, smoking status, medical comorbidities, operating time, or estimated blood loss. All 3 herniations occurred at 12-mm trocar sites. Two herniations occurred at assistant port sites, and 1 occurred at the umbilical camera port site. The median time to herniation was 21 days (range, 8-38 days). One patient required immediate surgical intervention; the other 2 patients had conservative management. Conclusions Trocar site herniation is a rare complication following robotic surgery. The most important risk factor for trocar site herniation appears to be larger trocar size, as all herniations occurred at 12-mm port sites. PMID:23988416

  19. Effects of muscle extension strength exercise on trunk muscle strength and stability of patients with lumbar herniated nucleus pulposus

    PubMed Central

    Jeon, Kyoungkyu; Kim, Taeyoung; Lee, Sang-Ho

    2016-01-01

    [Purpose] The purpose of this study was to provide the data for constructing an integrated exercise program to help restore muscle strength and stability through extension strength exercise in adult females with lumbar disc herniation. [Subjects and Methods] An 8-week exercise program for lumbar muscle extension strength and stabilization was performed by 26 females older than 20 with lumbar disc herniation findings. [Results] Significant differences were found in lumbar extension muscle strength at every angle of lumbar flexion after participation in the 8-week stabilization exercise program; but there was no significant difference in the weight distribution index. [Conclusion] An integrated exercise program aiming to strengthen lumbar spine muscles, reduce pain and stabilize the trunk can help to maintain muscle strength and balance. In addition, improvement in extension strength is expected to be helpful in daily life by securing the range of joint motion and improving the strength and stability. PMID:27313342

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

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

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

  1. Cell transplantation in lumbar spine disc degeneration disease.

    PubMed

    Hohaus, C; Ganey, T M; Minkus, Y; Meisel, H J

    2008-12-01

    Low back pain is an extremely common symptom, affecting nearly three-quarters of the population sometime in their life. Given that disc herniation is thought to be an extension of progressive disc degeneration that attends the normal aging process, seeking an effective therapy that staves off disc degeneration has been considered a logical attempt to reduce back pain. The most apparent cellular and biochemical changes attributable to degeneration include a decrease in cell density in the disc that is accompanied by a reduction in synthesis of cartilage-specific extracellular matrix components. With this in mind, one therapeutic strategy would be to replace, regenerate, or augment the intervertebral disc cell population, with a goal of correcting matrix insufficiencies and restoring normal segment biomechanics. Biological restoration through the use of autologous disc chondrocyte transplantation offers a potential to achieve functional integration of disc metabolism and mechanics. We designed an animal study using the dog as our model to investigate this hypothesis by transplantation of autologous disc-derived chondrocytes into degenerated intervertebral discs. As a result we demonstrated that disc cells remained viable after transplantation; transplanted disc cells produced an extracellular matrix that contained components similar to normal intervertebral disc tissue; a statistically significant correlation between transplanting cells and retention of disc height could displayed. Following these results the Euro Disc Randomized Trial was initiated to embrace a representative patient group with persistent symptoms that had not responded to conservative treatment where an indication for surgical treatment was given. In the interim analyses we evaluated that patients who received autologous disc cell transplantation had greater pain reduction at 2 years compared with patients who did not receive cells following their discectomy surgery and discs in patients that

  2. [Dorsal extrusion of intervertebral disc as a cause of cauda equina syndrome].

    PubMed

    Jusić, Aldin; Skomorac, Rasim; Beculić, Hakija

    2011-01-01

    We have presented a case of rare dorsally sequestrated lumbar disc herniation manifesting as cauda equina syndrome. The patient was admitted to the Neurological Department of Canton Hospital Zenica due to urinary retention and weakness in both lower extremities. Magnetic resonance imaging showed a compressing mass located in the dorsal extradural space at the L2-L3 level. An extruded intervertebral disc was found intraoperatively. The decompression was followed by good recovery.

  3. Thoracoabdominal herniation – but not as you know it

    PubMed Central

    Noble, F; King, A

    2014-01-01

    Thoracoabdominal hernias are uncommon following blunt trauma. If diaphragmatic rupture does occur, the abdominal viscera can herniate into the thorax through the diaphragm. We report a rare case of thoracoabdominal herniation in which the bowel herniated through the lateral abdominal wall, migrating cranially and entering the thorax through an intercostal defect. This case highlights the need for early and definitive surgical repair. PMID:24992399

  4. Trans-mediastinal herniation of bulla: Semilunar sign

    PubMed Central

    Singh, Sheetu; Singh, Nishtha; Singh, Virendra

    2015-01-01

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

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

    PubMed

    Wenger, Markus; Markwalder, Thomas-Marc

    2016-04-01

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

  6. Role of Cytokines in Intervertebral Disc Degeneration: Pain and Disc-content

    PubMed Central

    Risbud, Makarand V.; Shapiro, Irving. M

    2014-01-01

    Degeneration of the intervertebral disc is the major contributor to back/neck and radicular pain. It is characterized by an elevation in levels of the inflammatory cytokines tumor necrosis factor (TNF)-α, interleukin (IL)-1 α/β, IL-6 and IL-17 secreted by the disc cells themselves; these cytokines promote matrix degradation, chemokine production and changes in cell phenotype. The resulting imbalance between catabolic and anabolic responses leads to degeneration, as well as herniation and radicular pain. Release of chemokines from degenerating discs promote infiltration and activation of T and B cells, macrophages, neutrophils, and mast cells further amplifying the inflammatory cascade. Immunocyte migration into the disc is accompanied by the appearance of microvasculature and nerve fibers arising from the dorsal root ganglion (DRG). In this inflammatory milieu, neurogenic factors in particular nerve growth factor (NGF) and brain-derive neurotrophic factor (BDNF) generated by disc and immune cells induce expression of pain associated cation channels in DRGs. Depolarization of these channels is likely to promote discogenic and radicular pain and reinforce the cytokine-mediated degenerative cascade. Taken together, the enhanced understanding of the contribution of cytokines and immune cells to catabolic and nociceptive processes provide new targets for treating symptomatic disc disease. PMID:24166242

  7. Traumatic Lung Herniation following Skateboard Fall

    PubMed Central

    Kiffin, Chauniqua; Carrillo, Eddy H.

    2016-01-01

    Lung herniation (LH) is a rare clinical entity involving the protrusion of lung outside the thoracic cage. It has a variety of etiologies and clinical presentations, making diagnosis difficult. We present a case of a 20-year-old male who reported pleuritic pain after falling from a skateboard. Evaluation through computed tomography (CT) scanning of the chest revealed an anterior lung hernia associated with rib fractures. This case emphasizes the need for clinicians to include lung herniation in the differential diagnosis of patients with trauma and inexplicable or persistent pulmonary issues. PMID:27872645

  8. Non-reclosing pressure relief device for vacuum systems

    DOEpatents

    Swansiger, William A.

    1994-01-01

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

  9. Non-reclosing pressure relief device for vacuum systems

    DOEpatents

    Swansiger, W.A.

    1994-02-08

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

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

    PubMed Central

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

    2013-01-01

    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%. PMID:23776754

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

    SciTech Connect

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

    2010-10-15

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

  12. Propionibacterium acnes, Coagulase-Negative Staphylococcus, and the “Biofilm-like” Intervertebral Disc

    PubMed Central

    Coscia, Michael F.; Denys, Gerald A.; Wack, Matthew F.

    2016-01-01

    Study Design. Patients scheduled for spinal surgery were screened prospectively for a microbial presence associated with intervertebral disc specimens. Inclusion was limited to patients requiring surgery for any of five conditions: study patients with cervical spine intervertebral herniation (IVH), lumbar spine IVH, lumbar spine discogenic pain, and control patients with idiopathic scoliosis/Scheurermann's kyphosis or trauma/neuromuscular deformity. Exclusion criteria included ongoing systemic infection, abnormal pre-operative white cell counts, documented or suspected spinal infection, or previous surgery to the involved disc. Objective. The aim of this study was to test for an association between the presence of a bacterial entity in operated discs and a diagnosis of pathologic disc disease. Summary of Background Data. An association has been described between microbial colonization and progressive intervertebral disc degeneration in 36 herniation patients undergoing microdiscectomies. A total of 19 patients had positive cultures on long-term incubation, with Propionibacterium acnes present in 84% of discs. Materials and Methods. Discs were harvested during surgery, using strict sterile technique. Each disc was divided, with half the sample sealed in a sterile, commercially prepared anaerobic culture transport container, and half fixed in formalin. Live specimens were cultured for bacteria at a university-affiliated laboratory in a blinded fashion. Fixed pathologic specimens were gram-stained and read by a board-certified pathologist. Results. A total of 169 intervertebral discs from 87 patients were evaluated (46 males, 41 females). Positive cultures were noted in 76 of 169 discs (45%), with 34 discs positive for P. acnes and 30 discs positive for Staphylococcus. No pathologic evidence was seen of microorganisms, acute or chronic inflammation, or infection. Pooling the IVH and discogenic pain patients and contrasting them with control patients showed a

  13. Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting

    PubMed Central

    Espinosa, Jose

    2016-01-01

    Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option. PMID:27446619

  14. Advancing the cellular and molecular therapy for intervertebral disc disease.

    PubMed

    Sakai, Daisuke; Grad, Sibylle

    2015-04-01

    The healthy intervertebral disc (IVD) fulfils the essential function of load absorption, while maintaining multi-axial flexibility of the spine. The interrelated tissues of the IVD, the annulus fibrosus, the nucleus pulposus, and the cartilaginous endplate, are characterised by their specific niche, implying avascularity, hypoxia, acidic environment, low nutrition, and low cellularity. Anabolic and catabolic factors balance a slow physiological turnover of extracellular matrix synthesis and breakdown. Deviations in mechanical load, nutrient supply, cellular activity, matrix composition and metabolism may initiate a cascade ultimately leading to tissue dehydration, fibrosis, nerve and vessel ingrowth, disc height loss and disc herniation. Spinal instability, inflammation and neural sensitisation are sources of back pain, a worldwide leading burden that is challenging to cure. In this review, advances in cell and molecular therapy, including mobilisation and activation of endogenous progenitor cells, progenitor cell homing, and targeted delivery of cells, genes, or bioactive factors are discussed.

  15. Paraplegia by acute cervical disc protrusion after lumbar spine surgery.

    PubMed

    Chen, Sheng-Huan; Hui, Yu-Ling; Yu, Chong-Ming; Niu, Chi-Chien; Lui, Ping-Wing

    2005-04-01

    Non-traumatic paraplegia caused by herniation of the cervical intervertebral disc is an uncommon postoperative complication. A patient with claudication and radiculopathy was scheduled for lumbar laminectomy due to spinal stenosis. Postoperatively, numbness below T6 was found in his both legs of the patient. MRI showed a protruded intervertebral disc between C6 and C7. Despite urgent disectomy, the patient's lower extremities remained paralyzed without significant improvement for 3 months. Loss of muscle support during general anesthesia, excessive neck extension during endotracheal intubation and positioning, as well as bucking and agitation are believed as triggering factors for the protrusion of the cervical disc. We suggest that a complete history taking and physical examination be accomplished in patients scheduled for lumbar spine surgery in order to exclude coexisting cervical spine disorders. In addition, skillful endotracheal intubation and careful neck positioning are mandatory for patients receiving surgery in the prone position.

  16. [Cardiac herniation and torsion after transpericardial pneumonectomy].

    PubMed

    Schummer, W; Hottenrott, A; Nissel, C

    2016-07-05

    This article presents the case of a 43 year old woman with right-sided lung cancer. She underwent transpericardial pneumonectomy. After an uneventfull surgery, the patient was transferred to the intensive care unit for postoperative monitoring. She was hemodynamically stable and had already been extubated in the OR.On postoperative chest X‑ray a mediastinal shift to the operated side as well as a herniation of the heart into the right chest cavity was detected. While the patient remained hemodynamically stable a computed tomography of the chest was performed which confirmed the diagnosis of cardiac herniation and torsion. The lady underwent rethoracotomy the following day where the heart was repositioned and the pericardial defect was closed. She made an uneventfull recovery.Five years after the pneumonectomy she remains well and is without relapse of lung cancer.Mechanism for cardiac herniation and torsion, the clinical presentation and the typical radiologic signs are discussed. However, the clue to early diagnosis is a high index of clinical suspicion.It is highlighted that a hemodynamically unstable patient under these circumstances demands urgent rethoracotomy.

  17. Redundant disc

    NASA Technical Reports Server (NTRS)

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

    1978-01-01

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

  18. Spontaneous lumbar intervertebral disc protrusion in cats: literature review and case presentations.

    PubMed

    Kathmann, I; Cizinauskas, S; Rytz, U; Lang, J; Jaggy, A

    2000-12-01

    Reports on intervertebral disc disease in cats are rare in the veterinary literature. It has been postulated that intervertebral disc protrusion is a frequent finding during necropsy in cats, without having any clinical relevance (King and Smith 1958, King & Smith 1960a, King & Smith 1960b). However, a total of six cases with disc protrusions and clinically significant neurological deficits have been reported over the past decade. (Heavner 1971, Seim & Nafe 1981, Gilmore 1983, Littlewood et al 1984, Sparkes & Skerry 1990, Bagley et al 1995). As in dogs, there are also two types of intervertebral disc disease in cats: Hansen's type I (extrusion), and type II (herniation). Cervical spinal cord involvement was more commonly recognised in cats than the lumbar or the thoraco lumbar area. Cats over 15 years were mainly affected (King & Smith 1958, King & Smith 1960a, King & Smith 1960b). We describe two cats with lumbar intervertebral disc protrusions. Emphasis is placed on differential diagnoses, treatment and follow-up.

  19. VACUUM TRAP

    DOEpatents

    Gordon, H.S.

    1959-09-15

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

  20. Should anyone perform percutaneous endoscopic laser diskectomy and percutaneous lumbar disc decompressions?

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: Increasingly, pain management specialists (P-S) (e.g., anesthesiologists, radiologists, or physiatrists), who are not spinal surgeons, are performing percutaneous endoscopic laser diskectomy (PELD), percutaneous lumbar disc decompression (PLDD), and target percutaneous laser disc decompression (T-PLDD) in patients with minimal/mild disc herniations. Here, theoretically, the laser vaporizes/shrinks a small portion of disc tissue that lowers intradiscal pressure/volume, and thereby provides “symptomatic relief” (e.g., low back pain/radiculopathy). Nevertheless, the vast majority of these patients experience spontaneous relief of their complaints over several months without any intervention. Methods: A literature review revealed that P-S specialists are performing PELD/PLDD/T-PLDD to address minimal/mild disc herniations. However, multiple well-designed studies confirmed that PELD/PLDD/T-PLDD were ineffective for managing acute/chronic pain in these patients. Results: Several randomized clinical trials documented the lack of clinical efficacy of PELD/PLDD/T-PLLD procedures over microdiskectomy. PELD/PLDD/T-PLDD correlated with only 60–70% success rates with higher reoperation rates (e.g., up to 38%) vs. 90% success rates for routine microdiskectomy (e.g., with faster recovery and only 16% reoperation rates). Nevertheless, without surgical training, P-S are performing these procedures and are, therefore, unable to adddress perioperative/postoperative PELD/PLDD/T-PLDD surgical complications. Conclusions: Pain management specialists, who are not trained spinal surgeons, should not perform PELD/PLDD/T-PLDD surgery to treat minimal/mild disc herniations. Not only do most of these discs resolve spontaneously over several months but also they are largely ineffective. Furthermore, there is no evidence to support the superiority of PELD/PLDD/T-PLDD procedures over microdiskectomy even if performed by spinal specialists. PMID:28144489

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

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

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

  2. Vacuum Technology

    SciTech Connect

    Biltoft, P J

    2004-10-15

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

  3. Vacuum Virtues

    ERIC Educational Resources Information Center

    Rathey, Allen

    2007-01-01

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

  4. Vacuum mechatronics

    NASA Technical Reports Server (NTRS)

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

    1989-01-01

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

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

    PubMed Central

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

    2010-01-01

    Existing studies on micro-endoscopic lumbar discectomy report similar outcomes to those of open and microdiscectomy and conflicting results on complications. We designed a randomised controlled trial to investigate the hypothesis of different outcomes and complications obtainable with the three techniques. 240 patients aged 18–65 years affected by posterior lumbar disc herniation and symptoms lasting over 6 weeks of conservative management were randomised to micro-endoscopic (group 1), micro (group 2) or open (group 3) discectomy. Exclusion criteria were less than 6 weeks of pain duration, cauda equina compromise, foraminal or extra-foraminal herniations, spinal stenosis, malignancy, previous spinal surgery, spinal deformity, concurrent infection and rheumatic disease. Surgery and follow-up were made at a single Institution. A biomedical researcher independently collected and reviewed the data. ODI, back and leg VAS and SF-36 were the outcome measures used preoperatively, postoperatively and at 6-, 12- and 24-month follow-up. 212/240 (91%) patients completed the 24-month follow-up period. VAS back and leg, ODI and SF36 scores showed clinically and statistically significant improvements within groups without significant difference among groups throughout follow-up. Dural tears, root injuries and recurrent herniations were significantly more common in group 1. Wound infections were similar in group 2 and 3, but did not affect patients in group 1. Overall costs were significantly higher in group 1 and lower in group 3. In conclusion, outcome measures are equivalent 2 years following lumbar discectomy with micro-endoscopy, microscopy or open technique, but severe complications are more likely and costs higher with micro-endoscopy. PMID:20127495

  6. Gravitational vacuum

    NASA Astrophysics Data System (ADS)

    Grigoryan, L. S.; Saakyan, G. S.

    1984-09-01

    The existence of a special gravitational vacuum is considered in this paper. A phenomenological method differing from the traditional Einsteinian formalization is utilized. Vacuum, metric and matter form a complex determined by field equations and at great distances from gravitational masses vacuum effects are small but could be large in powerful fields. Singularities and black holes justify the approach as well as the Ambartsmyan theory concerning the existence of supermassive and superdense prestallar bodies that then disintegrate. A theory for these superdense bodies is developed involving gravitational field equations that describe the vacuum by an energy momentum tensor and define the field and mass distribution. Computations based on the theory for gravitational radii with incompressible liquid models adequately reflecting real conditions indicate that a gravitational vacuum could have considerable effects on superdense stars and could have radical effects for very large masses.

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

    PubMed Central

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

    2006-01-01

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

  8. The pathogenesis of retinal detachment with morning glory disc and optic pit.

    PubMed

    Irvine, A R; Crawford, J B; Sullivan, J H

    1986-01-01

    A child with nonrhegmatogenous retinal detachment associated with morning glory disc underwent first a vitrectomy and then, some months later, an optic nerve sheath fenestration. The latter procedure led to retinal reattachment. It also produced a biopsy specimen that confirmed the perineural herniation of poorly differentiated retinal tissue in this condition, similar to that in congenital pit of the optic nerve. It demonstrated continuity of the vitreous cavity with the perineural space, both histologically and by the fact that gas injected through the pars plana into the vitreous cavity bubbled out the window in the optic nerve sheath. The authors suggest that morning glory disc and optic pit share similar anatomic features, differing more in degree than in kind, and that the porous nature of the poorly differentiated tissue herniated around the optic nerve into the subarachnoid space in these conditions makes several sources of subretinal fluid possible.

  9. Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

    PubMed Central

    Ruzicka, Filip; Schmitz, Jonathan E.; James, Garth A.; Machackova, Tana; Jancalek, Radim; Smrcka, Martin; Lipina, Radim; Ahmed, Fahad S.; Alamin, Todd F.; Anand, Neel; Baird, John C.; Bhatia, Nitin; Demir-Deviren, Sibel; Eastlack, Robert K.; Fisher, Steve; Garfin, Steven R.; Gogia, Jaspaul S.; Gokaslan, Ziya L.; Kuo, Calvin C.; Lee, Yu-Po; Mavrommatis, Konstantinos; Michu, Elleni; Noskova, Hana; Raz, Assaf; Sana, Jiri; Shamie, A. Nick; Stewart, Philip S.; Stonemetz, Jerry L.; Wang, Jeffrey C.; Witham, Timothy F.; Coscia, Michael F.; Birkenmaier, Christof; Fischetti, Vincent A.; Slaby, Ondrej

    2017-01-01

    Background In previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of ~25% of patients undergoing microdiscectomy, suggesting a possible link between chronic bacterial infection and disc degeneration. However, given the prominence of P. acnes as a skin commensal, such analyses often struggled to exclude the alternate possibility that these organisms represent perioperative microbiologic contamination. This investigation seeks to validate P. acnes prevalence in resected disc cultures, while providing microscopic evidence of P. acnes biofilm in the intervertebral discs. Methods Specimens from 368 patients undergoing microdiscectomy for disc herniation were divided into several fragments, one being homogenized, subjected to quantitative anaerobic culture, and assessed for bacterial growth, and a second fragment frozen for additional analyses. Colonies were identified by MALDI-TOF mass spectrometry and P. acnes phylotyping was conducted by multiplex PCR. For a sub-set of specimens, bacteria localization within the disc was assessed by microscopy using confocal laser scanning and FISH. Results Bacteria were cultured from 162 discs (44%), including 119 cases (32.3%) with P. acnes. In 89 cases, P. acnes was cultured exclusively; in 30 cases, it was isolated in combination with other bacteria (primarily coagulase-negative Staphylococcus spp.) Among positive specimens, the median P. acnes bacterial burden was 350 CFU/g (12 - ~20,000 CFU/g). Thirty-eight P. acnes isolates were subjected to molecular sub-typing, identifying 4 of 6 defined phylogroups: IA1, IB, IC, and II. Eight culture-positive specimens were evaluated by fluorescence microscopy and revealed P. acnes in situ. Notably, these bacteria demonstrated a biofilm distribution within the disc matrix. P. acnes bacteria were more prevalent in males than females (39% vs. 23%, p = 0.0013). Conclusions This study confirms that P. acnes is prevalent in herniated disc tissue. Moreover, it

  10. Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography.

    PubMed

    Schultz, Randall; Steven, Andrew; Wessell, Aaron; Fischbein, Nancy; Sansur, Charles A; Gandhi, Dheeraj; Ibrahimi, David; Raghavan, Prashant

    2017-03-24

    OBJECTIVE Dorsal arachnoid webs (DAWs) and spinal cord herniation (SCH) are uncommon abnormalities affecting the thoracic spinal cord that can result in syringomyelia and significant neurological morbidity if left untreated. Differentiating these 2 entities on the basis of clinical presentation and radiological findings remains challenging but is of vital importance in planning a surgical approach. The authors examined the differences between DAWs and idiopathic SCH on MRI and CT myelography to improve diagnostic confidence prior to surgery. METHODS Review of the picture archiving and communication system (PACS) database between 2005 and 2015 identified 6 patients with DAW and 5 with SCH. Clinical data including demographic information, presenting symptoms and neurological signs, and surgical reports were collected from the electronic medical records. Ten of the 11 patients underwent MRI. CT myelography was performed in 3 patients with DAW and in 1 patient with SCH. Imaging studies were analyzed by 2 board-certified neuroradiologists for the following features: 1) location of the deformity; 2) presence or absence of cord signal abnormality or syringomyelia; 3) visible arachnoid web; 4) presence of a dural defect; 5) nature of dorsal cord indentation (abrupt "scalpel sign" vs "C"-shaped); 6) focal ventral cord kink; 7) presence of the nuclear trail sign (endplate irregularity, sclerosis, and/or disc-space calcification that could suggest a migratory path of a herniated disc); and 8) visualization of a complete plane of CSF ventral to the deformity. RESULTS The scalpel sign was positive in all patients with DAW. The dorsal indentation was C-shaped in 5 of 6 patients with SCH. The ventral subarachnoid space was preserved in all patients with DAW and interrupted in cases of SCH. In no patient was a web or a dural defect identified. CONCLUSIONS DAW and SCH can be reliably distinguished on imaging by scrutinizing the nature of the dorsal indentation and the integrity of

  11. Volvulus of the liver with intrathoracic herniation

    PubMed Central

    Thomson, PM; Bohra, A

    2014-01-01

    Introduction We present a rare case of a liver volvulus, stomach and transverse colon herniating through the diaphragm. This scenario has not been reported previously. We discuss the presentation and management of this interesting case. Case history A 65-year-old woman with a history of sarcoidosis and recurrent pericardial effusions, treated previously with a subxiphoid pericardial oval window fenestration, presented with acute upper abdominal pain radiating to the chest. High contrast computed tomography showed a volvulus of the liver with consequent venous congestion, and herniation of the liver, stomach and transverse colon through an anterior diaphragmatic defect. With liver perfusion threatened, an urgent laparoscopic repair was performed. The stomach and transverse colon were reduced, and the twisted left lobe of the liver was unrotated and reduced into the abdominal cavity. A double-sided synthetic mesh was used to repair the defect. The patient made an uneventful recovery. Conclusions This is a novel complication of a patient presenting with abdominal pain with a previous history of pericardial window fenestration. A laparoscopic reduction and repair can be performed safely with excellent postoperative results. PMID:25245721

  12. Vacuum aperture isolator for retroreflection from laser-irradiated target

    DOEpatents

    Benjamin, Robert F.; Mitchell, Kenneth B.

    1980-01-01

    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.

  13. Growth factor expression in degenerated intervertebral disc tissue. An immunohistochemical analysis of transforming growth factor beta, fibroblast growth factor and platelet-derived growth factor.

    PubMed

    Tolonen, Jukka; Grönblad, Mats; Vanharanta, Heikki; Virri, Johanna; Guyer, Richard D; Rytömaa, Tapio; Karaharju, Erkki O

    2006-05-01

    Degenerated intervertebral disc has lost its normal architecture, and there are changes both in the nuclear and annular parts of the disc. Changes in cell shape, especially in the annulus fibrosus, have been reported. During degeneration the cells become more rounded, chondrocyte-like, whereas in the normal condition annular cells are more spindle shaped. These chondrocyte-like cells, often forming clusters, affect extracellular matrix turnover. In previous studies transforming growth factor beta (TGFbeta) -1 and -2, basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) have been highlighted in herniated intervertebral disc tissue. In the present study the same growth factors are analysed immunohistochemically in degenerated intervertebral disc tissue. Disc material was obtained from 16 discs operated for painful degenerative disc disease. Discs were classified according to the Dallas Discogram Description. Different disc regions were analysed in parallel. As normal control disc tissue material from eight organ donors was used. Polyclonal antibodies against different growth factors and TGFbeta receptor type II were used, and the immunoreaction was detected by the avidin biotin complex method. All studied degenerated discs showed immunoreactivity for TGFbeta receptor type II and bFGF. Fifteen of 16 discs were immunopositive for TGFbeta-1 and -2, respectively, and none showed immunoreaction for PDGF. Immunopositivity was located in blood vessels and in disc cells. In the nucleus pulposus the immunoreaction was located almost exclusively in chondrocyte-like disc cells, whereas in the annular region this reaction was either in chondrocyte-like disc cells, often forming clusters, or in fibroblast-like disc cells. Chondrocyte-like disc cells were especially prevalent in the posterior disrupted area. In the anterior area of the annulus fibrosus the distribution was more even between these two cell types. bFGF was expressed in the anterior annulus

  14. Transforaminal Approach in Thoracal Disc Pathologies: Transforaminal Microdiscectomy Technique

    PubMed Central

    Dalbayrak, Sedat; Öztürk, Kadir; Yılmaz, Mesut; Gökdağ, Mahmut; Ayten, Murat

    2014-01-01

    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. PMID:24839557

  15. Turbine disc sealing assembly

    DOEpatents

    Diakunchak, Ihor S.

    2013-03-05

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

  16. Recognition of lumbar disk herniation with NMR

    SciTech Connect

    Chafetz, N.I.; Genant, H.K.; Moon, K.L.; Helms, C.A.; Morris, J.M.

    1983-12-01

    Fifteen nuclear magnetic resonance (NMR) studies of 14 patients with herniated lumbar intervertebral disks were performed on the UCSF NMR imager. Computed tomographic (CT) scans done on a GE CT/T 8800 or comparable scanner were available at the time of NMR scan interpretation. Of the 16 posterior disk ruptures seen at CT, 12 were recognized on NMR. Diminished nucleus pulposus signal intensity was present in all ruptured disks. In one patient, NMR scans before and after chymopapain injection showed retraction of the protruding part of the disk and loss of signal intensity after chemonucleolysis. Postoperative fibrosis demonstrated by CT in one patient and at surgery in another showed intermediate to high signal intensity on NMR, easily distinguishing it from nearby thecal sac and disk. While CT remains the method of choice for evaluation of the patient with suspected lumbar disk rupture, the results of this study suggest that NMR may play a role in evaluating this common clinical problem.

  17. Anterior discectomy without fusion for treatment of cervical lateral soft disc extrusion: a follow-up of 120 cases.

    PubMed

    Grisoli, F; Graziani, N; Fabrizi, A P; Peragut, J C; Vincentelli, F; Diaz-Vasquez, P

    1989-06-01

    One hundred and twenty patients with soft lateral disc herniation underwent surgery by anterior microsurgical discectomy and routine ablation of the posterior longitudinal ligament between 1976 and 1986. The study excluded patients with hard discs and soft disc extrusion with medullary symptoms. In our series 76.6% of patients were men. In 64% of the patients no causative factor was found. All of the patients presented with cervicobrachialgia; 53% also had a motor deficit. In 91.7% a single disc was involved. The last 40 cases were evaluated by computed tomography alone. In 51.5% an extruded disc was found. No permanent postoperative complication was encountered. All patients returned to their previous activities. Fifty patients underwent follow-up radiological evaluation at 1 and 5 years after the intervention and vertebral fusion was observed in 70% of these.

  18. 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

    Mern, Demissew S.; Beierfuß, Anja; Fontana, Johann; Thomé, Claudius; Hegewald, Aldemar A.

    2014-01-01

    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

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

    PubMed

    Sontas, B Hasan; Toydemir, F T Seval; Erdogan, Ozge; Sennazli, Gülbin; Ekici, Hayri

    2013-09-01

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

  20. Herniated gyrus rectus causing idiopathic compression of the optic chiasm.

    PubMed

    Smith, Jacob; Jack, Megan M; Peterson, Jeremy C; Chamoun, Roukoz B

    2017-02-01

    Anomalies in the frontal lobe can interfere with visual function by compression of the optic chiasm and nerve. The gyrus rectus is located at the anterior cranial fossa floor superior to the intracranial optic nerves and chiasm. Compression of these structures by the gyrus rectus is often caused by neoplastic or dysplastic growth in the area. We report a rare case of a herniated gyrus rectus impinged on the optic chiasm and nerve without a clear pathological cause for the herniation.

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

    PubMed Central

    Sontas, B. Hasan; Toydemir, F.T. Seval; Erdogan, Özge; Şennazli, Gülbin; Ekici, Hayri

    2013-01-01

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

  2. Emergency Neurological Life Support: Intracranial Hypertension and Herniation

    PubMed Central

    Shoykhet, Michael; Cadena, Rhonda

    2016-01-01

    Sustained intracranial hypertension and acute brain herniation are “brain codes,” signifying catastrophic neurological events that require immediate recognition and treatment to prevent irreversible injury and death. As in cardiac arrest, a brain code mandates the organized implementation of a stepwise management algorithm. The goal of this emergency neurological life support protocol is to implement an evidence-based, standardized approach to the evaluation and management of patients with intracranial hypertension and/or herniation. PMID:26438459

  3. Disc protrusion in the child. Particular features and comparison with neoplasms.

    PubMed

    Martínez-Lage, J F; Martínez Robledo, A; López, F; Poza, M

    1997-04-01

    Lumbar intervertebral disc herniation, although common in adults, is infrequent in the young, and especially in patients under 17 years old. In this work we review clinical data pertaining to two pediatric groups of patients whose main complaint was low back pain and/or sciatica, trying to identify factors that might contribute to their earlier referral and to the differential diagnosis of protruded disc and spinal neoplasm in this population. Group A comprises 17 youngsters diagnosed as having lumbar herniated nucleus pulposus and group B, 16 children with neoplasms of the lower thoracic and lumbosacral regions. Both groups were similar in sex distribution and symptoms of pain and numbness. However, there was a striking difference in age at presentation. No patient in group A was younger than 11 years, while most of those in group B were in their first decade of life (P = 0.018). The classic clinical onset in the children with herniated discs started with low back pain and sciatica, as in the children with neoplasms, although in subgroup B leg pain tended to be bilateral. The usual examination findings in both groups were spinal rigidity and sensory loss, but motor weakness and impaired reflexes were found to be more frequent in the group with spinal growths (P = 0.02). Children with lumbosacral neoplasms also tended to present with atypical symptoms (acute onset, intracranial hypertension, subarachnoid hemorrhage and abdominal pain), while this was the exception in the group with herniated discs. Plain radiographs of the pediatric spine showed that X-ray examination is still a good tool for diagnosing spinal growths compared with their scant utility in disc herniations (P = 0.001). During the survey we were impressed by the children's apparent good tolerance to pain, which is probably due to the lack of the emotional component of pain in adults and explains their delayed referral for neurosurgical consultation. However, all modalities of treatment seemed to be

  4. Intervertebral Disc Swelling Demonstrated by 3D and Water Content Magnetic Resonance Analyses after a 3-Day Dry Immersion Simulating Microgravity

    PubMed Central

    Treffel, Loïc; Mkhitaryan, Karen; Gellee, Stéphane; Gauquelin-Koch, Guillemette; Gharib, Claude; Blanc, Stéphane; Millet, Catherine

    2016-01-01

    Background: Vertebral deconditioning is commonly experienced after space flight and simulation studies. Disc herniation is quadrupled after space flight. Purpose: The main hypothesis formulated by the authors is that microgravity results in intervertebral disc (IVD) swelling. Study Design: The aim of the study was to identify the morphological changes of the spine and their clinical consequences after simulated microgravity by 3-day dry immersion (DI). The experimental protocol was performed on 12 male volunteers using magnetic resonance imaging and spectroscopy before and after DI. Methods: All the experiment was financially supported by CNES (Centre national d'études spatiales i.e., French Space Agency). Results: We observed an increase in spine height of 1.5 ± 0.4 cm and a decrease in curvature, particularly for the lumbar region with a decrease of −4 ± 2.5°. We found a significant increase in IVD volume of +8 ± 9% at T12-L1 and +11 ± 9% at L5-S1. This phenomenon is likely associated with the increase in disc intervertebral water content (IWC), 17 ± 27%. During the 3 days in DI, 92% of the subjects developed back pain in the lumbar region below the diaphragmatic muscle. This clinical observation may be linked to the morphological changes of the spine. Conclusions: The morphological changes observed and, specifically, the disc swelling caused by increased IWC may contribute to understanding disc herniation after microgravity exposure. Our results confirmed the efficiency of the 3-day DI model to reproduce quickly the effects of microgravity on spine morphology. Our findings raise the question of the subject selection in spatial studies, especially studies about spine morphology and reconditioning programs after space flight. These results may contribute to a better understanding of the mechanisms underlying disc herniation and may serve as the basis to develop countermeasures for astronauts and to prevent IVD herniation and back pain on Earth. PMID

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

    PubMed

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

    2016-03-01

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

  6. Herniation of the cervical disk in plastic surgeons.

    PubMed

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

    2012-12-01

    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.

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

    NASA Astrophysics Data System (ADS)

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

    2010-05-01

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

  8. Predictive Score Card in Lumbar Disc Herniation: Is It Reflective of Patient Surgical Success after Discectomy?

    PubMed

    Azimi, Parisa; Benzel, Edward C; Montazeri, Ali

    2016-01-01

    Does the Finneson-Cooper score reflect the true value of predicting surgical success before discectomy? The aim of this study was to identify reliable predictors for surgical success two year after surgery for patients with LDH. Prospective analysis of 154 patients with LDH who underwent single-level lumbar discectomy was performed. Pre- and post-surgical success was assessed by the Oswestry Disability Index (ODI) over a 2-year period. The Finneson-Cooper score also was used for evaluation of the clinical results. Using the ODI, surgical success was defined as a 30% (or more) improvement on the ODI score from the baseline. The ODI was considered the gold standard in this study. Finally, the sensitivity, specificity, and positive and negative predictive power of the Finneson-Cooper score in predicting surgical success were calculated. The mean age of the patients was 49.6 (SD = 9.3) years and 47.4% were male. Significant improvement from the pre- to post-operative ODI scores was observed (P < 0.001). Post-surgical success was 76.0% (n = 117). The patients' rating on surgical success assessments by the ODI discriminated well between sub-groups of patients who differed with respect to the Finneson-Cooper score. Regarding patients' surgical success, the sensitivity, specificity, and accuracy of the Finneson-Cooper ratings correlated with success rate. The findings indicated that the Finneson-Cooper score was reflective of surgical success before discectomy.

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

    PubMed

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

    2012-02-01

    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.

  10. Holographic optical disc

    NASA Astrophysics Data System (ADS)

    Zhou, Gan; An, Xin; Pu, Allen; Psaltis, Demetri; Mok, Fai H.

    1999-11-01

    The holographic disc is a high capacity, disk-based data storage device that can provide the performance for next generation mass data storage needs. With a projected capacity approaching 1 terabit on a single 12 cm platter, the holographic disc has the potential to become a highly efficient storage hardware for data warehousing applications. The high readout rate of holographic disc makes it especially suitable for generating multiple, high bandwidth data streams such as required for network server computers. Multimedia applications such as interactive video and HDTV can also potentially benefit from the high capacity and fast data access of holographic memory.

  11. Lumbar Herniation of Kidney following Iliac Crest Bone Harvest

    PubMed Central

    2016-01-01

    The iliac crest is a popular source for autogenous bone harvesting, but the process is rife with complications. This case report presents a patient that experienced incisional lumbar herniation of her kidney following an iliac crest bone harvesting procedure. A discussion is included on the underappreciated complications of this procedure and recommendations for improving outcomes with more thorough evaluation and documentation. PMID:28042490

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

    PubMed Central

    Kim, Hyeong-Suk; Park, Jung-Soo

    2012-01-01

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

  13. Stepwise illustration of teeth-fixation semi-constrained cervical disc arthroplasty.

    PubMed

    Chang, Chih-Chang; Wu, Jau-Ching; Chang, Peng-Yuan; Yeh, Mei-Yin; Kuo, Yi-Hsuan; Fay, Li-Yu; Tu, Tsung-Hsi; Huang, Wen-Cheng; Cheng, Henrich

    2017-01-01

    There are many kinds of artificial discs available for cervical disc arthroplasty (CDA), with various designs of fixation and articulation mechanisms. Each of these designs has different features and theoretically fits most optimally in selected types of patients. However, there has been insufficient literature to guide individualized selection among these CDA devices. Since CDA aims to restore the joint function rather than arthrodesis, tailor-made size, shape, and mechanical properties should be taken into account for each candidate's target disc. Despite several large-scale prospective randomized control trials that have demonstrated the effectiveness and durability of CDA for up to 8 years, none of them involved more than one kind of artificial disc. In this video the authors present detailed steps and technical aspects of the newly introduced ProDisc-C Vivo (DePuy Synthes Spine), which has the same ball-and-socket design for controlled, predictable motion as the ProDisc-C. The newly derived teeth fixation provides high primary stability and multilevel capability by avoidance of previous keel-related limitations and complications (e.g., split vertebral fracture). Please note that the ProDisc-C Vivo is currently not available on the US market. The authors present the case of a 53-year-old woman who had symptoms of both radiculopathy and myelopathy caused by a large, calcified disc herniation at C4-5. There was no improvement after 4 months of medical treatment and rehabilitation. A single-level CDA was successfully performed with the ProDisc-C Vivo, and her symptoms were completely ameliorated afterward. The follow-up images demonstrated preservation of motion at the indexed level. The video can be found here: https://youtu.be/4DSES1xgvQU .

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

    PubMed Central

    Wenger, Markus; Markwalder, Thomas-Marc

    2010-01-01

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

  15. Risk Factors for Postoperative Pain Intensity in Patients Undergoing Lumbar Disc Surgery: A Systematic Review

    PubMed Central

    Löbner, Margrit; Stein, Janine; Konnopka, Alexander; Meisel, Hans J.; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; König, Hans-Helmut; Riedel-Heller, Steffi G.

    2017-01-01

    Objectives Pain relief has been shown to be the most frequently reported goal by patients undergoing lumbar disc surgery. There is a lack of systematic research investigating the course of postsurgical pain intensity and factors associated with postsurgical pain. This systematic review focuses on pain, the most prevalent symptom of a herniated disc as the primary outcome parameter. The aims of this review were (1) to examine how pain intensity changes over time in patients undergoing surgery for a lumbar herniated disc and (2) to identify socio-demographic, medical, occupational and psychological factors associated with pain intensity. Methods Selection criteria were developed and search terms defined. The initial literature search was conducted in April 2015 and involved the following databases: Web of Science, Pubmed, PsycInfo and Pubpsych. The course of pain intensity and associated factors were analysed over the short-term (≤ 3 months after surgery), medium-term (> 3 months and < 12 months after surgery) and long-term (≥ 12 months after surgery). Results From 371 abstracts, 85 full-text articles were reviewed, of which 21 studies were included. Visual analogue scales indicated that surgery helped the majority of patients experience significantly less pain. Recovery from disc surgery mainly occurred within the short-term period and later changes of pain intensity were minor. Postsurgical back and leg pain was predominantly associated with depression and disability. Preliminary positive evidence was found for somatization and mental well-being. Conclusions Patients scheduled for lumbar disc surgery should be selected carefully and need to be treated in a multimodal setting including psychological support. PMID:28107402

  16. Structure and mechanical function of the inter-lamellar matrix of the annulus fibrosus in the disc.

    PubMed

    Tavakoli, Javad; Elliott, Dawn M; Costi, John J

    2016-08-01

    The inter-lamellar matrix (ILM) has an average thickness of less than 30 µm and lies between adjacent lamellae in the annulus fibrosus (AF). The microstructure and composition of the ILM have been studied in various anatomic regions of the disc; however, their contribution to AF mechanical properties and structural integrity is unknown. It was suggested that the ILM components, mainly elastic fibers and cross-bridges, play a role in providing mechanical integrity of the AF. Therefore, the manner in which they respond to different loadings and stabilize adjacent lamellae structure will influence AF tear formation and subsequent herniation. This review paper summarizes the composition, microstructure, and potential role of the ILM in the progression of disc herniation, clarifies the micromechanical properties of the ILM, and proposes critical areas for future studies. There are a number of unknown characteristics of the ILM, such as its mechanical role, impact on AF integrity, and ultrastructure of elastic fibers at the ILM-lamella boundary. Determining these characteristics will provide important information for tissue engineering, repair strategies, and the development of more-physiological computational models to study the initiation and propagation of AF tears that lead to herniation and degeneration. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1307-1315, 2016.

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

    PubMed

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

    2015-10-01

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

  18. The origin of thick discs

    NASA Astrophysics Data System (ADS)

    Comerón, Sébastien

    2015-03-01

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

  19. Germanium detector vacuum encapsulation

    NASA Technical Reports Server (NTRS)

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

    1991-01-01

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

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

    PubMed Central

    Ranu, H S

    1993-01-01

    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. PMID:8447694

  1. Accuracy of survey radiographic diagnosis of intervertebral disc protrusion in dogs.

    PubMed

    Lamb, C R; Nicholls, A; Targett, M; Mannion, P

    2002-01-01

    To assess the diagnostic accuracy of survey radiography for canine thoracolumbar intervertebral disc protrusion, survey radiographs (lateral and ventrodorsal) of 64 dogs with surgically-confirmed thoracolumbar intervertebral disc protrusion, 51 dogs with negative myelograms and 29 dogs with various spinal conditions other than disc protrusion were reviewed by three independent observers who were unaware of any clinical information. There were marked differences in observer performance for diagnosis of intervertebral disc protrusion, although there were no significant differences in intraobserver diagnostic accuracy for small vs. large dogs. Accuracy of observers for determining sites of intervertebral disc protrusion using survey radiography was in the range 51-61%. All observers had low accuracy for identification of second sites of intervertebral disc protrusion. The most useful radiographic sign, narrowed intervertebral space, had only moderate sensitivity (range 64-69%) and moderate predictive value (range 63-71%) for intervertebral disc protrusion. Vacuum phenomenon was an infrequent but accurate sign of intervertebral disc protrusion. Recognition of multiple radiographic signs of intervertebral disc protrusion at one site was associated with increased accuracy of diagnosis. No observer was accurate enough to justify attempting targeted surgical treatment of intervertebral disc protrusion without myelography.

  2. Herniation of a Pulmonary Emphysematous Bulla to Contralateral Hemithorax

    PubMed Central

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

    2011-01-01

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

  3. [Pathobiomechanical impairments of the vertebral column in intervertebral disk protrusion and herniation].

    PubMed

    Novosel'tsev, S V; Malinovskiĭ, E L; Smirnov, V V; Savvova, M v; Lebedeva, V V

    2011-01-01

    Magnetic resonance imaging of patients with intervertebral disk herniation was used to study the stages of degenerative and dystrophic processes in the spinal structures in the presence of intervertebral disk protrusion and herniation. Differences were found in the pathobiomechanical mechanisms in the spinal motor segments of herniation and protrusion in the area of their localization and in the adjacent spinal motor segments. Among the symptoms traditionally analyzed, joint facet joint arthritis and arthrosoarthritis classified as spondyloarthritis by radiodiagnosis were examined for their impact on the rate of herniation and protrusion.

  4. Brain Herniation into Giant Arachnoid Granulation: An Unusual Case

    PubMed Central

    Santos, Gonçalo Roque

    2017-01-01

    Arachnoid granulations are structures filled with cerebrospinal fluid (CSF) that extend into the venous sinuses through openings in the dura mater and allow the drainage of CSF from subarachnoid space into venous system. Usually they are asymptomatic but can be symptomatic when large enough to cause sinus occlusion. We report a rare case of a brain herniation into a giant arachnoid granulation in an asymptomatic elderly male patient, which was discovered incidentally. PMID:28392955

  5. Fourth ventricular entrapment caused by rostrocaudal herniation following shunt malfunction.

    PubMed

    Montgomery, C T; Winfield, J A

    1993-01-01

    The subacute development of isolated fourth ventricle (IFV) is a recognized complication following shunting of the lateral ventricles for congenital and acquired hydrocephalus. We present an unusual case of acute IFV in a clinical setting which has not previously been described. Subsequent to rostrocaudal herniation caused by an obstructed frontally placed ventricular catheter, IFV developed in our patient 24 h following shunt revision, necessitating placement of an additional fourth ventricle shunt system. No signs of intraventricular hemorrhage or cerebrospinal fluid (CSF) infection were detected at the time of shunt revision and there was no documentation of similar events in the perinatal history. Dependent upon the actual underlying etiology of this child's hydrocephalus, we hypothesize that two mechanisms may have accounted for this unusual and precipitous development of IFV. Following rostrocaudal herniation and caudal shift of the brainstem, progressive edema in the pons developed. If communicating hydrocephalus was the primary etiology, then midbrain edema occluded the aqueduct of Sylvius, preventing retrograde flow of CSF to the shunt. A distinctly different mechanism for acute IFV must be invoked if aqueductal stenosis was the preexisting cause for congenital hydrocephalus. Following herniation, brainstem displacement and edema resulted in obliteration of the lateral pontine and ambient cisterns, preventing the normal rostral migration of CSF around and over the mesencephalon. Cerebellar tonsillar herniation with impaction of the tonsils into the foramen magnum may have also contributed to obstruction of fourth ventricular outflow in both settings. This unusual case of acute onset IFV is presented in detail. The underlying etiologies and clinical settings in which IFV may develop is reviewed as well.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. The Galactic stellar disc

    NASA Astrophysics Data System (ADS)

    Feltzing, S.; Bensby, T.

    2008-12-01

    The study of the Milky Way stellar discs in the context of galaxy formation is discussed. In particular, we explore the properties of the Milky Way disc using a new sample of about 550 dwarf stars for which we have recently obtained elemental abundances and ages based on high-resolution spectroscopy. For all the stars we also have full kinematic information as well as information about their stellar orbits. We confirm results from previous studies that the thin and the thick discs have distinct abundance patterns. But we also explore a larger range of orbital parameters than what has been possible in our previous studies. Several new results are presented. We find that stars that reach high above the Galactic plane and have eccentric orbits show remarkably tight abundance trends. This implies that these stars formed out of well-mixed gas that had been homogenized over large volumes. We find some evidence that suggest that the event that most likely caused the heating of this stellar population happened a few billion years ago. Through a simple, kinematic exploration of stars with super-solar [Fe/H], we show that the solar neighbourhood contains metal-rich, high velocity stars that are very likely associated with the thick disc. Additionally, the HR1614 moving group and the Hercules and Arcturus stellar streams are discussed and it is concluded that, probably, a large fraction of the groups and streams so far identified in the disc are the result of evolution and interactions within the stellar disc rather than being dissolved stellar clusters or engulfed dwarf galaxies. This paper includes data gathered with the 6.5 m Magellan Telescopes located at Las Campanas Observatory, Chile. Also based on observations collected at the Nordic Optical Telescope on La Palma, Spain, and at the European Southern Observatories on La Silla and Paranal, Chile, Proposals no. 65.L-0019(B), 67.B-0108(B), 69.B-0277.

  7. Paradoxical Herniation in the Postcraniectomy Syndrome: Report and Literature Update

    PubMed Central

    Ramos-Zúñiga, Rodrigo; Mares-Pais, Roberto; Gutiérrez-Avila, Oscar; Saldaña-Koppel, Daniel A.

    2016-01-01

    Introduction The decompressive craniectomy is a surgical strategy widely used with specific criteria to control the refractory intracranial pressure (ICP). However, it is important to warn about the presence of a postcraniectomy syndrome and analyze the risk-benefit on a long term. Case Report A 72-year-old male patient diagnosed with a subarachnoid hemorrhage secondary to the rupture of an anterior circulation aneurysm that develops vasospasm, secondary ischemia, and edema with signs of herniation that required a decompressive craniectomy on a first step. Afterwards, the aneurysm was approached and he consequently developed hydrocephaly. A ventriculoperitoneal shunt is installed, contralateral to the craniectomy, and progressive sinking of the skin flap, there is neurological deterioration and paradoxical herniation. Its association with the clinical deterioration by bronchoaspiration did not allow the cranioplasty to resolve the ICP decompensation. Conclusions The paradoxical herniation as part of the postcraniectomy syndrome is an increasingly common condition identified in adult patients with cortical atrophy, and who have also been treated with ventricular shunt systems. Timely cranioplasty represents the ideal therapeutic plan once the compromise from the mass effect has resolved to avoid complications derived from the decompressive craniectomy per se. PMID:26929899

  8. Three-point disc amplitudes in the RNS formalism

    NASA Astrophysics Data System (ADS)

    Becker, Katrin; Becker, Melanie; Robbins, Daniel; Su, Ning

    2016-06-01

    We calculate all tree level string theory vacuum to Dp-brane disc amplitudes involving an arbitrary RR-state and two NS-NS vertex operators. This computation was earlier performed by K. Becker, Guo, and Robbins for the simplest case of a RR-state of type C (p - 3). Here we use the aid of a computer to calculate all possible three-point amplitudes involving a RR-vertex operator of type C (p + 1 + 2 k).

  9. How do accretion discs break?

    NASA Astrophysics Data System (ADS)

    Dogan, Suzan

    2016-07-01

    Accretion discs are common in binary systems, and they are often found to be misaligned with respect to the binary orbit. The gravitational torque from a companion induces nodal precession in misaligned disc orbits. In this study, we first calculate whether this precession is strong enough to overcome the internal disc torques communicating angular momentum. We compare the disc precession torque with the disc viscous torque to determine whether the disc should warp or break. For typical parameters precession wins: the disc breaks into distinct planes that precess effectively independently. To check our analytical findings, we perform 3D hydrodynamical numerical simulations using the PHANTOM smoothed particle hydrodynamics code, and confirm that disc breaking is widespread and enhances accretion on to the central object. For some inclinations, the disc goes through strong Kozai cycles. Disc breaking promotes markedly enhanced and variable accretion and potentially produces high-energy particles or radiation through shocks. This would have significant implications for all binary systems: e.g. accretion outbursts in X-ray binaries and fuelling supermassive black hole (SMBH) binaries. The behaviour we have discussed in this work is relevant to a variety of astrophysical systems, for example X-ray binaries, where the disc plane may be tilted by radiation warping, SMBH binaries, where accretion of misaligned gas can create effectively random inclinations and protostellar binaries, where a disc may be misaligned by a variety of effects such as binary capture/exchange, accretion after binary formation.

  10. Revival of the Jumping Disc

    ERIC Educational Resources Information Center

    Ucke, C.; Schlichting, H-J.

    2009-01-01

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

  11. The Teddy Bears' Disc.

    ERIC Educational Resources Information Center

    Laurillard, Diana

    1985-01-01

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

  12. Preoperative sport improves the outcome of lumbar disc surgery: a prospective monocentric cohort study.

    PubMed

    Tschugg, Anja; Lener, Sara; Hartmann, Sebastian; Wildauer, Matthias; Löscher, Wolfgang N; Neururer, Sabrina; Thomé, Claudius

    2017-01-13

    A lumbar disc herniation resulting in surgery may be an incisive event in a patient's everyday life. The patient's recovery after sequestrectomy may be influenced by several factors. There is evidence that regular physical activity can lower pain perception and improve the outcome after surgery. For this purpose, we hypothesized that patients performing regular sports prior to lumbar disc surgery might have less pain perception and disability thereafter. Fifty-two participants with a single lumbar disc herniation confirmed on MRI treated by a lumbar sequestrectomy were included in the trial. They were categorized into two groups based on their self-reported level of physical activity prior to surgery: group NS, no regular physical activity and group S, with regular physical activity. Further evaluation included a detailed medical history, a physical examination, and various questionnaires: Visual Analog Scale (VAS), Beck-Depression-Inventory (BDI), Oswestry Disability Index (ODI), Core Outcome Measure Index (COMI), and the EuroQoL-5Dimension (EQ- 5D). Surgery had an excellent overall improvement of pain and disability (p < 0.005). The ODI, COMI, and EQ-5D differed 6 months after intervention (p < 0.05) favoring the sports group. Leg and back pain on VAS was also significantly less in group B than in group A, 12 months after surgery (p < 0.05). Preoperative regular physical activity is an important influencing factor for the overall satisfaction and disability after lumbar disc surgery. The importance of sports may have been underestimated for surgical outcomes.

  13. Surgical treatments for lumbar disc disease in adolescent patients; chemonucleolysis / microsurgical discectomy/ PLIF with cages.

    PubMed

    Kuh, Sung-Uk; Kim, Young-Soo; Cho, Young-Eun; Yoon, Young-Sul; Jin, Byung-Ho; Kim, Keun-Su; Chin, Dong-Kyu

    2005-02-28

    The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1-4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications.

  14. Vacuum-assisted delivery

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000514.htm Vacuum-assisted delivery To use the sharing features on ... the baby through the birth canal. When is Vacuum-assisted Delivery Needed? Even after your cervix is ...

  15. Radiation hard vacuum switch

    DOEpatents

    Boettcher, Gordon E.

    1990-03-06

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

  16. Radiation hard vacuum switch

    DOEpatents

    Boettcher, Gordon E.

    1990-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2015-01-01

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

  18. The Classical Vacuum.

    ERIC Educational Resources Information Center

    Boyer, Timothy H.

    1985-01-01

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

  19. Vacuum tribological behaviour of self lubricant quasicrystalline composite coatings

    NASA Astrophysics Data System (ADS)

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

    2003-09-01

    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.

  20. Biomechanics of Disc Degeneration

    PubMed Central

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

    2012-01-01

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

  1. Mechanotransduction in intervertebral discs

    PubMed Central

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

    2014-01-01

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

  2. Effect of Interlaminar Epidural Steroid Injection in Acute and Subacute Pain Due to Lumbar Disk Herniation: A Randomized Comparison of 2 Different Protocols

    PubMed Central

    Gelalis, I.D; Arnaoutoglou, E; Pakos, E.E; Politis, A.N; Rapti, M; Xenakis, T.A; Papadopoulos, G

    2009-01-01

    In order to assess the efficacy of epidural steroid injections (ESI) in acute and subacute pain due to lumbar spine disk herniation, we conducted a randomized trial, comparing 2 different protocols. Fourty patients with radicular pain due to L4-L5 and L5-S1 disc herniation were assigned to receive either 3 consecutive ESI every 24 hours through a spinal catheter (group A) or 3 consecutive ESI every 10 days with an epidural needle (group B). All patients had improved Oswestry Disabilty Index (ODI) and the Visual Analog Scale (VAS) for pain scores at 1 month of follow-up compared to baseline, while no significant differences were observed between the 2 groups. The scores for group B were statistically significant lower at 2 months of follow-up compared to those of group A. The improvement in the scores of group B was continuous since the mean scores at 2 months of follow up were lower compared to the respective scores at 1 month. Protocol B (3 consecutive ESI every 10 days) was found more effective in the treatment of subacute pain compared to Protocol A (3 consecutive ESI every 24 hours) with statistically significant differences in the ODI and VAS scores at 2 months of follow-up. PMID:20111695

  3. Lumbar Scoliosis Combined Lumbar Spinal Stenosis and Herniation Diagnosed Patient Was Treated with “U” Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    Zhang, Shaobo; Lian, Qingquan; Yan, Haibo; Lin, Xianfa

    2017-01-01

    The objective was to report a case of a 63-year-old man with a history of low back pain (LBP) and left leg pain for 2 years, and the symptom became more serious in the past 5 months. The patient was diagnosed with lumbar scoliosis combined with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH) at the level of L4-5 that was confirmed using Computerized Topography and Magnetic Resonance Imaging. The surgical team preformed a novel technique, “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD), which led to substantial, long-term success in reduction of pain intensity and disability. After removing the osteophyte mass posterior to the thecal sac at L4-5, the working channel direction was changed to the gap between posterior longitudinal ligament and thecal sac, and we also removed the herniation and osteophyte at L3-4 with “U” route PELD. The patient's symptoms were improved immediately after the surgical intervention; low back pain intensity decreased from preoperative 9 to postoperative 2 on a visual analog scale (VAS) recorded at 1 month postoperatively. The success of the intervention suggests that “U” route PELD may be a feasible alternative to treat lumbar scoliosis with LSS and LDH patients. PMID:28203471

  4. Total disc replacement.

    PubMed

    Vital, J-M; Boissière, L

    2014-02-01

    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.

  5. Mechanics of Actuated Disc Cutting

    NASA Astrophysics Data System (ADS)

    Dehkhoda, Sevda; Detournay, Emmanuel

    2017-02-01

    This paper investigates the mechanics of an actuated disc cutter with the objective of determining the average forces acting on the disc as a function of the parameters characterizing its motion. The specific problem considered is that of a disc cutter revolving off-centrically at constant angular velocity around a secondary axis rigidly attached to a cartridge, which is moving at constant velocity and undercutting rock at a constant depth. This model represents an idealization of a technology that has been implemented in a number of hard rock mechanical excavators with the goal of reducing the average thrust force to be provided by the excavation equipment. By assuming perfect conformance of the rock with the actuated disc as well as a prescribed motion of the disc (perfectly rigid machine), the evolution of the contact surface between the disc and the rock during one actuation of the disc can be computed. Coupled with simple cutter/rock interaction models that embody either a ductile or a brittle mode of fragmentation, these kinematical considerations lead to an estimate of the average force on the cartridge and of the partitioning of the energy imparted by the disc to the rock between the actuation mechanism of the disc and the translation of the cartridge on which the actuated disc is attached.

  6. Polarimetric microlensing of circumstellar discs

    NASA Astrophysics Data System (ADS)

    Sajadian, Sedighe; Rahvar, Sohrab

    2015-12-01

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

  7. A rare case of femoral herniation of female internal genitalia

    PubMed Central

    Ambedkar, Vivek; Singh, Abhilash; Bain, Jayanta; Singh, Lal Mani

    2015-01-01

    We report a rare case with herniation of the uterus, fallopian tube, and ovary in a femoral hernia. A female patient was admitted with complain of the painful lump in the left groin. Clinical examination indicated strangulated femoral hernia, which necessitated an emergency surgery. During surgical procedure, the uterine tube, left fallopian tube and left ovary, were observed as the contents of the hernia. The contents were reduced back into the pelvic cavity, and the hernia was repaired. The patient made good recovery postsurgery. PMID:26283851

  8. Mammoth orbitofrontal neurofibromatosis with herniating meningo-encephalocele.

    PubMed

    Dhanraj, Prema; Paul, Kingsly; Lamba, Shashank; Shetty, Rahul

    2010-01-01

    We are presenting a mammoth orbito-frontal neurofibroma with a herniating meningo-encephalocele in a 23 year old African male. The tumour measured 87cm x 54cm and occupied the right orbito-temporo-facial region and had destroyed the right orbit. A pre operative embolization of the feeding vessels was followed by a one stage near total excision of the tumour and repair of the meningo-encephalocele in hypotensive anaesthesia. The excised tumour weighed 8 Kg and, to the best of our knowledge, is the largest orbito-facial neurofibroma reported in literature.

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

    PubMed Central

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

    2015-01-01

    Objectives: Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc. Methods: In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed. Results: There were 27 male and 23 female with followup mean follow up of 115 months (range 105–130 months) with a mean age was 52 years (range 26–74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3–4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions. Conclusions: Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective. PMID:25767571

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

    PubMed

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

    2016-02-01

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

  11. Indian Vacuum Society: The Indian Vacuum Society

    NASA Astrophysics Data System (ADS)

    Saha, T. K.

    2008-03-01

    The Indian Vacuum Society (IVS) was established in 1970. It has over 800 members including many from Industry and R & D Institutions spread throughout India. The society has an active chapter at Kolkata. The society was formed with the main aim to promote, encourage and develop the growth of Vacuum Science, Techniques and Applications in India. In order to achieve this aim it has conducted a number of short term courses at graduate and technician levels on vacuum science and technology on topics ranging from low vacuum to ultrahigh vacuum So far it has conducted 39 such courses at different parts of the country and imparted training to more than 1200 persons in the field. Some of these courses were in-plant training courses conducted on the premises of the establishment and designed to take care of the special needs of the establishment. IVS also regularly conducts national and international seminars and symposia on vacuum science and technology with special emphasis on some theme related to applications of vacuum. A large number of delegates from all over India take part in the deliberations of such seminars and symposia and present their work. IVS also arranges technical visits to different industries and research institutes. The society also helped in the UNESCO sponsored post-graduate level courses in vacuum science, technology and applications conducted by Mumbai University. The society has also designed a certificate and diploma course for graduate level students studying vacuum science and technology and has submitted a syllabus to the academic council of the University of Mumbai for their approval, we hope that some colleges affiliated to the university will start this course from the coming academic year. IVS extended its support in standardizing many of the vacuum instruments and played a vital role in helping to set up a Regional Testing Centre along with BARC. As part of the development of vacuum education, the society arranges the participation of

  12. Narrowing of lumbar spinal canal predicts chronic low back pain more accurately than intervertebral disc degeneration: a magnetic resonance imaging study in young Finnish male conscripts.

    PubMed

    Visuri, Tuomo; Ulaska, Jaana; Eskelin, Marja; Pulkkinen, Pekka

    2005-11-01

    The objective of this magnetic resonance imaging study was to evaluate the role of degenerative changes, developmental spinal stenosis, and compression of spinal nerve roots in chronic low back (CLBP) and radicular pain in Finnish conscripts. The degree of degeneration, protrusion, and herniation of the intervertebral discs and stenosis of the nerve root canals was evaluated, and the midsagittal diameter and cross-sectional area of the lumbar vertebrae canal were measured in 108 conscripts with CLBP and 90 asymptomatic controls. The midsagittal diameters at L1-L4 levels were significantly smaller in the patients with CLBP than in the controls. Moreover, degeneration of the L4/5 disc and protrusion or herniation of the L5/S1 disc and stenosis of the nerve root canals at level L5/S1 were more frequent among the CLBP patients. Multifactorial analysis of the magnetic resonance imaging findings provided a total explanatory rate of only 33%. Narrowing of the vertebral canal in the anteroposterior direction was more likely to produce CLBP and radiating pain than intervertebral disc degeneration or narrowing of the intervertebral nerve root canals.

  13. Rethinking Black Hole Accretion Discs

    NASA Astrophysics Data System (ADS)

    Salvesen, Greg

    Accretion discs are staples of astrophysics. Tapping into the gravitational potential energy of the accreting material, these discs are highly efficient machines that produce copious radiation and extreme outflows. While interesting in their own right, accretion discs also act as tools to study black holes and directly influence the properties of the Universe. Black hole X-ray binaries are fantastic natural laboratories for studying accretion disc physics and black hole phenomena. Among many of the curious behaviors exhibited by these systems are black hole state transitions -- complicated cycles of dramatic brightening and dimming. Using X-ray observations with high temporal cadence, we show that the evolution of the accretion disc spectrum during black hole state transitions can be described by a variable disc atmospheric structure without invoking a radially truncated disc geometry. The accretion disc spectrum can be a powerful diagnostic for measuring black hole spin if the effects of the disc atmosphere on the emergent spectrum are well-understood; however, properties of the disc atmosphere are largely unconstrained. Using statistical methods, we decompose this black hole spin measurement technique and show that modest uncertainties regarding the disc atmosphere can lead to erroneous spin measurements. The vertical structure of the disc is difficult to constrain due to our ignorance of the contribution to hydrostatic balance by magnetic fields, which are fundamental to the accretion process. Observations of black hole X-ray binaries and the accretion environments near supermassive black holes provide mounting evidence for strong magnetization. Performing numerical simulations of accretion discs in the shearing box approximation, we impose a net vertical magnetic flux that allows us to effectively control the level of disc magnetization. We study how dynamo activity and the properties of turbulence driven by the magnetorotational instability depend on the

  14. Heat distribution in disc brake

    NASA Astrophysics Data System (ADS)

    Klimenda, Frantisek; Soukup, Josef; Kampo, Jan

    2016-06-01

    This article is deals by the thermal analysis of the disc brake with floating caliper. The issue is solved by numerically. The half 2D model is used for solution in program ADINA 8.8. Two brake discs without the ventilation are solved. One disc is made from cast iron and the second is made from stainless steel. Both materials are an isotropic. By acting the pressure force on the brake pads will be pressing the pads to the brake disc. Speed will be reduced (slowing down). On the contact surface generates the heat, which the disc and pads heats. In the next part of article is comparison the maximum temperature at the time of braking. The temperatures of both materials for brake disc (gray cast iron, stainless steel) are compares. The heat flux during braking for the both materials is shown.

  15. Enclosed rotary disc air pulser

    DOEpatents

    Olson, A. L.; Batcheller, Tom A.; Rindfleisch, J. A.; Morgan, John M.

    1989-01-01

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

  16. Management of massive calcified transdural thoracic disk herniation.

    PubMed

    Al-Barbarawi, Mohammed; Sekhon, Lali H S

    2003-11-01

    Thoracic disk herniation is a not uncommon pathology faced by the spinal surgeon. The management of massive intradural thoracic disk herniation with ventral cord compression is problematic both in terms of obtaining adequate decompression and ensuring no subsequent leakage of cerebrospinal fluid. A 54-year-old woman presented with a 10 year history of back pain and left leg pain. Over the past 6 months she experienced a progressive spastic paraparesis in both legs with recent urinary incontinence. A left anterolateral thoracotomy for excision of T8/9 thoracic disk protrusion was affected. A transdural decompression was performed with resection of the calcified dura and performance of a Gore-Tex duraplasty and pleuroplasty. A free muscle graft was placed in the intervening space and the chest drains were placed on non-suction. A spinal drain was maintained for 5 days. She made an excellent neurological recovery. Avoidance of cerebrospinal leakage is paramount when performing transthoracic approaches as negative intrapleural pressure can lead to persistence of leakage. This report documents a safe and reliable way to deal with massive intradural thoracic disk rupture with avoidance of subsequent spinal fluid leak.

  17. Spinal Epidural Varices, a great Mimic of Intervertebral Disc Prolapse - A Case Series

    PubMed Central

    V, Raghavendra; Haridas, Papanaik; Kumar, Anand; K, Ajith

    2014-01-01

    Introduction: Epidural venous plexus enlargement, presenting with low back pain and radiculopathy, is an uncommon cause of nerve roots impingement. This condition commonly mimics a herniated nucleus pulposus radiologically. The radiological diagnosis is often missed and the diagnosis is made during the surgery. We are hereby presenting 2 such cases of epidural varices mimicking intervertebral disc prolapse with lumbar radiculopathy. Case Report: Case 1: 43 yr old female presented with acute exacerbation of low back ache and significant right L5–S1 radiculopathy without neurological deficit. MRI reported as L5-S1 disc prolapse. Intra-operatively engorged dilated epidural vein seen compressing S1 nerve root. Associated Disc bulge removed and Coagulative ablation of the dilated epidural vein was performed Case 2: 45 year old male manual labourer presented with backache with left sided sciatica since 8 months, increased in severity since past 1month associated with sensory blunting in L5 and S1 dermatomes. Neurologic examination revealed normal muscle power in his lower extremities. Sensations was blunted in L5 and S1 dermatomes. MRI was reported as L5-S1 disc prolapsed compressing left S1 nerve root. Decompression of the L5–S1 intervertebral space was performed through a left –sidelaminotomy. Large, engorged serpentine epidural veins was found in the axilla of S1 nerve root, compressing it. Coagulative ablation of the dilated epidural vein was performed. Retrospectively, features of epidural varices were noted in the preoperative magnetic resonance imaging scans. Both patients had significant improvement in radiculopathy immediate postoperatively, and sensory symptoms resolved over the next 6 weeks in second case. At recent follow up, both patients had significant relief of symptoms and no recurrent radicular symptoms. Conclusion: An abnormal dilated epidural venous plexus that mimics a herniated lumbar disc is a rare entity. This pathology should be always kept

  18. Vacuum pump aids ejectors

    SciTech Connect

    Nelson, R.E.

    1982-12-01

    The steam ejector/vacuum pump hybrid system has been operating satisfactorily since the summer of 1981. This system has essentially been as troublefree as the all-ejector system and, of course, has provided a substantial cost savings. Construction is currently under way to convert the vacuum system of another crude still which is equipped with steam ejectors and barometric condensers to the hybrid system of steam ejectors, surface condensers, and vacuum pumps. This current project is even more financially attractive because it allows a dirty water cooling tower which serves the barometric condensers to be shut down. Providing a vacuum for crude distillation vacuum towers with this hybrid system is by no means the only application of this technique. Any vacuum system consisting of all steam ejectors would be a candidate for this hybrid system and the resulting savings in energy.

  19. Maintaining vacuum furnaces

    SciTech Connect

    Kowalewski, J.

    2000-04-01

    A preventive maintenance program is essential for safe and consistent vacuum furnace operation. The program should be developed in cooperation with safety, maintenance, and furnace operators, implemented as soon as the furnace is commissioned, and adhered to throughout the life of the furnace. This article serves as an introduction to the topic of vacuum furnace preventive maintenance. Basic information about installing a new vacuum furnace also is provided.

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  1. Sizes of protoplanetary discs after star-disc encounters

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

    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

  2. Vacuum probe surface sampler

    NASA Technical Reports Server (NTRS)

    Zahlava, B. A. (Inventor)

    1973-01-01

    A vacuum probe surface sampler is described for rapidly sampling relatively large surface areas which possess relatively light loading densities of micro-organism, drug particles or the like. A vacuum head with a hollow handle connected to a suitable vacuum source is frictionally attached to a cone assembly terminating in a flared tip adapted to be passed over the surface to be sampled. A fine mesh screen carried by the vacuum head provides support for a membrane filter which collects the microorganisms or other particles. The head assembly is easily removed from the cone assembly without contacting the cone assembly with human hands.

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

    PubMed

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

    2014-01-01

    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.

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

    PubMed

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

    2013-10-01

    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.

  5. A Study on Dispersion and Rate of Fat Infiltration in the Lumbar Spine of Patients with Herniated Nucleus Polpusus

    PubMed Central

    Kong, Bong-jun; Lim, Jong-soo; Kim, Kyung

    2014-01-01

    [Purpose] This study investigated the relationship between herniated nucleus pulposus (HNP) and fat infiltration of muscles around the spine by measuring body mass index (BMI) and fat infiltration of the muscles around the spine. [Subjects and Methods] Subjects were 82 people, both men and women they were divided into two groups, a normal group and a patient group who were suffering from serious HNP between L4 and L5. Of the anthropometric measurement, and fat infiltration muscles by measuring the cross-sectional area from the center of the disc to the muscle around the spine and the cross-sectional area of fat infiltration. [Results] Fat infiltration rate of each lumbar layer in the normal group was different L34–L45 and L45–L5S1, but not between L23–L34. Fat infiltration in the muscle between the normal group and patients with HNP was different in the layers and the difference was greatest in the L5–S1 layer. [Conclusion] We performed correlation analysis of BMI and the total fat infiltration rate in each group to find the relationship between obesity and fat infiltration in the lumbar spine. Fat infiltration increased, and normal people or patients with chronic back pain are considered to be exposed to other diseases as fat infiltration in the lumbar spine increases. PMID:24567672

  6. Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

    PubMed Central

    Frati, Alessandro; Palmieri, Mauro; Vangelista, Tommaso; Caruso, Riccardo; Salvati, Maurizio; Raco, Antonino

    2017-01-01

    Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots. PMID:28163949

  7. Imaginal disc regeneration takes flight.

    PubMed

    Hariharan, Iswar K; Serras, Florenci

    2017-04-01

    Drosophila imaginal discs, the larval precursors of adult structures such as the wing and leg, are capable of regenerating after damage. During the course of regeneration, discs can sometimes generate structures that are appropriate for a different type of disc, a phenomenon termed transdetermination. Until recently, these phenomena were studied by physically fragmenting discs and then transplanting them into the abdomens of adult female flies. This field has experienced a renaissance following the development of genetic ablation systems that can damage precisely defined regions of the disc without the need for surgery. Together with more traditional approaches, these newer methods have generated many novel insights into wound healing, the mechanisms that drive regenerative growth, plasticity during regeneration and systemic effects of tissue damage and regeneration.

  8. Working in a Vacuum

    ERIC Educational Resources Information Center

    Rathey, Allen

    2005-01-01

    In this article, the author discusses several myths about vacuum cleaners and offers tips on evaluating and purchasing this essential maintenance tool. These myths are: (1) Amps mean performance; (2) Everyone needs high-efficiency particulate air (HEPA): (3) Picking up a "bowling ball" shows cleaning power; (4) All vacuum bags are the same; (5)…

  9. Intraoral micro-identification discs.

    PubMed

    Hansen, R W

    1991-12-01

    Intraoral micro-identification discs have recently been utilized to provide a more permanent method of personal identification. A wafer of plastic or metal with a surface area of 2.5 to 5 mm2 and carrying identifying numbers and/or letters (indicia) is bonded to the buccal enamel surface of the posterior teeth. Personal identification can occur after the I.D. disc is identified and the indicia is read. Reading of photoreduced indicia requires the aid of a microscope subsequent to the removal of the microdisc. In situ reading of disc indicia is possible using low power handheld magnifiers if the size of the indicia approximates 0.3 mm. Computerization is an integral part of non-custom alpha/numeric type designs, but a custom disc carries a name, address, and other specific information unique to the manufacturer. The use of a computer improves access to the database and it decreases the amount of data placed on the disc. Microdisc bases may be fabricated using a mylar type plastic or they may be manufactured from a stainless steel blank. Plastic discs are constructed with an internal sandwich containing the photo-reduced indicia. Metal discs are marked with a photochemical etch or engraved with a computer driven YAG laser. Attachment of the disc to the enamel surface is accomplished by conventional etching and bonding techniques and are typically bonded to the buccal surface of the maxillary first permanent molar or the second primary molar. Clear composite bonding material covers the disc so that salivary contamination does not result in degradation of the indicia. Orthodontic style discs with a mesh back carry laser written information that may be cemented with conventional orthodontic bonding cement. Standardization of the indicia and overall design is considered to be an important aspect of patient and professional acceptance.

  10. ELETTRA vacuum system

    NASA Astrophysics Data System (ADS)

    Bernardini, M.

    1991-08-01

    A status report of the vacuum system of ELETTRA, the 2 GeV, 400 mA light source under construction in Trieste, will be described. The Vacuum project, presented at ``Synchrotron Radiation Vacuum Workshop'' at Riken (Japan 22-24 March 1990) and more recently at EVC-2, the European Vacuum Conference at Trieste (Italy 21-26 May 1990), is now in the phase of testing a prototype sector, which is 1/24 of the ring circumference. Details and some technological aspects of the fabrication will be reviewed together with the vacuum performances. Results of laboratory experiments on components, standard or not, allowed us to finalize the main choices in light of the general philosophy of the project and will be properly summarized.

  11. Microfabricated triggered vacuum switch

    DOEpatents

    Roesler, Alexander W.; Schare, Joshua M.; Bunch, Kyle

    2010-05-11

    A microfabricated vacuum switch is disclosed which includes a substrate upon which an anode, cathode and trigger electrode are located. A cover is sealed over the substrate under vacuum to complete the vacuum switch. In some embodiments of the present invention, a metal cover can be used in place of the trigger electrode on the substrate. Materials used for the vacuum switch are compatible with high vacuum, relatively high temperature processing. These materials include molybdenum, niobium, copper, tungsten, aluminum and alloys thereof for the anode and cathode. Carbon in the form of graphitic carbon, a diamond-like material, or carbon nanotubes can be used in the trigger electrode. Channels can be optionally formed in the substrate to mitigate against surface breakdown.

  12. Cervical spine annulus vacuum.

    PubMed

    Bohrer, S P; Chen, Y M

    1988-01-01

    Thirty-eight annulus vacuums in 27 patients were analyzed with regard to location, configuration, and associated vertebral abnormalities such as degenerative changes, absent and compressed anterosuperior vertebral body corners, and annulus calcification. It is concluded that most annulus vacuums are a degenerative phenomenon at the attachment of the annulus to bone. These vacuums may be associated with other degenerative changes such as osteophytes and annulus calcification. Vacuums have a strong association with compressed anterosuperior corners. These deformed corners are thought to be early osteophytes and may be related to previous trauma, a vertebra with an absent corner, and/or normal motion. Small annulus vacuums adjacent to vertebral corners with a normal appearance are more likely to result from acute trauma.

  13. A prospective comparison of computed tomography and myelography in the diagnosis of herniated lumbar disks

    SciTech Connect

    Haughton, V.M.; Eldevik, O.P.; Magnaes, B.; Amundsen, P.

    1982-01-01

    Although CT effectively demonstrates normal and herniated intervetebral disks, the value of CT in low back pain has not been adequately evaluated. We compared CT prospectively with myelography in 107 patients referred to Ulleval Hospital Department of Radiology for myelography. Fifty-two patients subsequently had spinal explorations, one patient twice during the stud and two patients at two levels. Forty-six CT and 44 myelographic diagnoses agreed perfectly wth the operative diagnosis at that level. In 30 disk herniations, there were 29 true-positive CT diagnoses and 38 true-positive myelographic diagnoses. False-negative diagnoses of herniated nucleus pulposus were made twice on myelography and once on CT. In 24 other spinal operations, there were eight false-positive CT and nine false-positive myelographic diagnoses of herniated nucleus pulposus. CT demonstrates lumbar disk disease as effectively as myelography.

  14. Classification, diagnostic imaging, and imaging characterization of a lumbar herniated disk.

    PubMed

    Milette, P C

    2000-11-01

    The absence of universal nomenclature standardization with respect to the definition of a disk herniation and its different categories, especially regarding type and location, is still a major problem that will only be overcome when major national or international scientific societies join efforts to support a particular scheme. Meanwhile, it is important to realize that the two models that are currently most used are based on a different [figure: see text] perspective. Trying to straddle the two by opposing, for instance, bulging disk and herniation is doomed to failure because this exercise defies formal logic. MR imaging is currently the most accurate noninvasive imaging modality to diagnose a disk herniation and to determine its exact location. The determination of some pathoanatomic characteristics of herniated disks (type and composition) may require the use of CT, diskography, or CT diskography.

  15. Semimembranosus muscle herniation: a rare case with emphasis on muscle biomechanics.

    PubMed

    Naffaa, Lena; Moukaddam, Hicham; Samim, Mohammad; Lemieux, Aaron; Smitaman, Edward

    2017-03-01

    Muscle herniations are rare and most reported cases involve muscles of the lower leg. We use a case of muscle herniation involving the semimembranosus muscle, presenting as a painful mass in an adolescent male after an unspecified American football injury, to highlight a simple concept of muscle biomechanics as it pertains to muscle hernia(s): decreased traction upon muscle fibers can increase conspicuity of muscle herniation(s)-this allows a better understanding of the apt provocative maneuvers to employ, during dynamic ultrasound or magnetic resonance imaging, in order to maximize diagnostic yield and, thereby, limit patient morbidity related to any muscle herniation. Our patient subsequently underwent successful decompressive fasciotomy and has since returned to his normal daily activities.

  16. Herniation of the temporomandibular joint into the external auditory canal: a complication of otologic surgery.

    PubMed

    Selesnick, S H; Carew, J F; DiBartolomeo, J R

    1995-11-01

    Herniation of the temporomandibular joint into the external auditory canal has been reported as a result of trauma, neoplasia, infection, inflammatory processes, or developmental malformations. This paper reviews the intimate relation of the temporomandibular joint to the temporal bone as well as the literature describing temporomandibular joint herniation into the external auditory canal. Four cases of temporomandibular joint herniation into the external auditory canal resulting from otologic surgery are presented. Their characteristic location, clinical and radiographic findings are described and contrasted to previously reported cases. Despite striking displacement of the temporomandibular joint into the external auditory canal, there were no clinical symptoms referable to this finding. The absence of symptoms distinguished this postoperative etiology of temporomandibular joint herniation from other etiologies mentioned above.

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

    SciTech Connect

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

    1984-03-01

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

  18. [Paradoxical transtentorial herniation, extreme trephined syndrome sign: A case report].

    PubMed

    Narro-Donate, Jose Maria; Huete-Allut, Antonio; Escribano-Mesa, Jose A; Rodríguez-Martínez, Virginia; Contreras-Jiménez, Ascensión; Masegosa-González, Jose

    2015-01-01

    The current increasing use of decompressive craniectomy carries the implicit appearance of complications due to alterations in both intracranial pressure and in the hydrostatic-hemodynamic equilibrium. Paradoxical transtentorial herniation represents a rare manifestation, included in "trephine syndrome", extremely critical but with relatively simple treatment. We present the case of a 56-year-old woman with no interesting medical history, who, after an olfactory groove meningioma surgery, presented a haemorrhage located in the surgical area with an important oedema. The patient required a second emergency surgery without any chance of conserving the cranial vault. During the post-operational period, great neurological deterioration in orthostatic position was noticed, which resolved spontaneously in decubitus. This deficit was resolved with bone replacement afterwards. We discuss possible predisposing factors and aetiologies of this pathology.

  19. Jarcho-Levin Syndrome with Splenic Herniation: A Rare Presentation

    PubMed Central

    Chandra, Namita; Kumar, Sanjay; Raj, Vaibhav; Vishwakarma, Pawan Kumar; Sinha, Sheela; Saha, Ram Prakash

    2016-01-01

    Patient: Female, 5 Final Diagnosis: Jarco-Levine syndrome Symptoms: Respiatory distress Medication: — Clinical Procedure: Supportive management Specialty: Pediatrics and Neonatology Objective: Congenital defects/diseases Background: Jarcho-Levin syndrome, also known as spondylothoracic dysplasia and spondylocostal dysplasia, is characterized by varieties of vertebrae and rib anomalies. Jarcho-Levin syndrome is a clinical-radiological diagnosis with clinical evidence of short neck, short trunk, normal-sized limbs, or increased arm span, and vertebral and rib defects on the skeletal survey. Case report: About 400 cases have been reported in world literature and 18 in our Indian literature. We report the case of a one-day-old female baby with a short trunk, short neck, low hairline, apparently long limbs, protuberant abdomen, mild midfacial dysmorphism, low-set ears, and a high-arched palate. There was one cystic swelling over the lateral side of the left hypochondrium sized about 3×3 centimeters, nonpusatile; the skin over the swelling was normal color and free. Radiological findings showed crowding of ribs with pebble-like appearance of the vertebrae and diastematomyelia of the spinal cord (type 2). We report here the first case of Jarcho-Levin syndrome with splenic herniation. To the best of our knowledge there have been no case reports of Jarcho-Levin syndrome with splenic herniation in the literature. Conclusions: Jarcho-Levin syndrome can be easily diagnosed by clinical-radiological findings in newborns, with short trunk having a high index of suspicion. Prenatal diagnosis using level 2 ultrasonography can make it easier to manage the baby after delivery. Management should be from the basic neonatal care to prevention and immediate treatment of recurrent respiratory infections. Spinal surgical intervention to improve the thoracic volume and hence decrease the pulmonary restriction has been tried. PMID:27739421

  20. Jarcho-Levin Syndrome with Splenic Herniation: A Rare Presentation.

    PubMed

    Chandra, Namita; Kumar, Sanjay; Raj, Vaibhav; Vishwakarma, Pawan Kumar; Sinha, Sheela; Saha, Ram Prakash

    2016-10-14

    BACKGROUND Jarcho-Levin syndrome, also known as spondylothoracic dysplasia and spondylocostal dysplasia, is characterized by varieties of vertebrae and rib anomalies. Jarcho-Levin syndrome is a clinical-radiological diagnosis with clinical evidence of short neck, short trunk, normal-sized limbs, or increased arm span, and vertebral and rib defects on the skeletal survey. CASE REPORT About 400 cases have been reported in world literature and 18 in our Indian literature. We report the case of a one-day-old female baby with a short trunk, short neck, low hairline, apparently long limbs, protuberant abdomen, mild midfacial dysmorphism, low-set ears, and a high-arched palate. There was one cystic swelling over the lateral side of the left hypochondrium sized about 3×3 centimeters, nonpusatile; the skin over the swelling was normal color and free. Radiological findings showed crowding of ribs with pebble-like appearance of the vertebrae and diastematomyelia of the spinal cord (type 2). We report here the first case of Jarcho-Levin syndrome with splenic herniation. To the best of our knowledge there have been no case reports of Jarcho-Levin syndrome with splenic herniation in the literature. CONCLUSIONS Jarcho-Levin syndrome can be easily diagnosed by clinical-radiological findings in newborns, with short trunk having a high index of suspicion. Prenatal diagnosis using level 2 ultrasonography can make it easier to manage the baby after delivery. Management should be from the basic neonatal care to prevention and immediate treatment of recurrent respiratory infections. Spinal surgical intervention to improve the thoracic volume and hence decrease the pulmonary restriction has been tried.

  1. Cervical Total Disc Arthroplasty

    PubMed Central

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

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

  2. Housing protects laser in vacuum

    NASA Technical Reports Server (NTRS)

    Canali, V. G.

    1978-01-01

    Airtight housing encloses laser for easy alinement and operation in high-vacuum chamber. Beam is transmitted through window into vacuum chamber. Flexible line runs through vacuum chamber to outside, maintaining laser enclosure at atmospheric pressure.

  3. Double-disc gate valve

    DOEpatents

    Wheatley, Seth J.

    1979-01-01

    This invention relates to an improvement in a conventional double-disc gate valve having a vertically movable gate assembly including a wedge, spreaders slidably engaged therewtih, a valve disc carried by the spreaders. When the gate assembly is lowered to a selected point in the valve casing, the valve discs are moved transversely outward to close inlet and outlet ports in the casing. The valve includes hold-down means for guiding the disc-and-spreader assemblies as they are moved transversely outward and inward. If such valves are operated at relatively high differential pressures, they sometimes jam during opening. Such jamming has been a problem for many years in gate valves used in gaseous diffusion plants for the separtion of uranium isotopes. The invention is based on the finding that the above-mentioned jamming results when the outlet disc tilts about its horizontal axis in a certain way during opening of the valve. In accordance with the invention, tilting of the outlet disc is maintained at a tolerable value by providing the disc with a rigid downwardly extending member and by providing the casing with a stop for limiting inward arcuate movement of the member to a preselected value during opening of the valve.

  4. End Plate Disproportion and Degenerative Disc Disease: A Case-Control Study

    PubMed Central

    Poureisa, Masoud; Daghighi, Mohammad Hossein; Mesbahi, Sepideh; Hagigi, Amir

    2014-01-01

    Study Design Case-control. Purpose To determine whether a disproportion between two neighboring vertebral end plates is associated with degenerative disc disease. Overview of Literature Recently, it has been suggested that disproportion of the end plates of two adjacent vertebrae may increase the risk of disc herniation. Methods Magnetic resonance (MR) images (n=160) with evidence of grades I-II lumbar degenerative disc disease (modified Pfirrmann's classification) and normal MR images of the lumbar region (n=160) were reviewed. On midsagittal sections, the difference of anteroposterior diameter of upper and lower end plates neighboring a degenerated (in the case group) or normal (in the control group) intervertebral disc was calculated (difference of end plates [DEP]). Results Mean DEP was significantly higher in the case group at the L5-S1 level (2.73±0.23 mm vs. 2.21±0.12 mm, p=0.03). Differences were not statistically significant at L1-L2 (1.31±0.13 mm in the cases vs. 1.28±0.08 mm in the controls, p=0.78), L2-L3 (1.45±0.12 mm in the cases vs. 1.37±0.08 mm in the controls, p=0.58), L3-L4 (1.52±0.13 mm in the cases vs. 1.49±0.10 mm in the controls, p=0.88), and L4-L5 (2.15±0.21 mm in the cases vs. 2.04±0.20 mm in the controls, p=0.31) levels. The difference at the L5-S1 level did not remain significant after adjusting for body mass index (BMI), which was significantly higher in the patients. Conclusions End plate disproportion may be a significant, BMI-dependent risk factor for lumbar degenerative disc disease. PMID:25187856

  5. Thermophoretic vacuum wand

    DOEpatents

    Klebanoff, Leonard Elliott; Rader, Daniel John

    2001-01-01

    A thermophoretic vacuum wand that is particularly suited for transporting articles in a cleanroom environment so that potential particle contaminants in the air do not become adhered to the surface of the article is described. The wand includes a housing having a platen with a front surface with suction port(s) through the platen; a vacuum source for applying a negative pressure to the suction port(s); and heating device for the object. Heating the article when it is held by the vacuum wand affords thermophoretic protection that effectively prevents particles in the air from depositing onto the article.

  6. Thermophoretic vacuum wand

    DOEpatents

    Klebanoff, Leonard Elliott; Rader, Daniel John

    2000-01-01

    A thermophoretic vacuum wand that is particularly suited for transporting articles in a cleanroom environment so that potential particle contaminants in the air do not become adhered to the surface of the article is described. The wand includes a housing having a platen with a front surface with suction port(s) through the platen; a vacuum source for applying a negative pressure to the suction port(s); and heating device for the object. Heating the article when it is held by the vacuum wand affords thermophoretic protection that effectively prevents particles in the air from depositing onto the article.

  7. Medical Information on Optical Disc*

    PubMed Central

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

    1987-01-01

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

  8. Mitral disc-valve variance

    PubMed Central

    Berroya, Renato B.; Escano, Fernando B.

    1972-01-01

    This report deals with a rare complication of disc-valve prosthesis in the mitral area. A significant disc poppet and struts destruction of mitral Beall valve prostheses occurred 20 and 17 months after implantation. The resulting valve incompetence in the first case contributed to the death of the patient. The durability of Teflon prosthetic valves appears to be in question and this type of valve probably will be unacceptable if there is an increasing number of disc-valve variance in the future. Images PMID:5017573

  9. [Major vascular complications following surgery for a herniated lumbar disk].

    PubMed

    Abad, C; Martel, D; Feijóo, J J; Carreira, L

    1993-01-01

    Two cases of arterial injury of the iliac arteries during surgery of the lumbar disc are presented. Both patients were successfully operated, in the first case a primary repair was accomplished, the second patient was treated by means of an ileo-femoral bypass graft. A comment of the pathophysiology, diagnostic and surgical management of this unusual complication is presented.

  10. Design Issues in Video Disc Map Display.

    DTIC Science & Technology

    1984-10-01

    Tables: disc storage capacities under various conditions. Photos: map frames. Constanzo , D.J. (1984a), "The Potential for Video Disc Technology in...discs. Constanzo , D.J. (1984b), "Requirements and Specifications for Cartographic Video Discs", presented as a poster paper at the 1984 Army Science

  11. Enlivening Physics, a Local Video Disc Project.

    ERIC Educational Resources Information Center

    McInerney, M.

    1989-01-01

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

  12. Disc Golf: Teaching a Lifetime Activity

    ERIC Educational Resources Information Center

    Eastham, Susan L.

    2015-01-01

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

  13. Collapse of vacuum bubbles in a vacuum

    SciTech Connect

    Ng, Kin-Wang; Wang, Shang-Yung

    2011-02-15

    We revisit the dynamics of a false vacuum bubble in a background de Sitter spacetime. We find that there exists a large parameter space that allows the bubble to collapse into a black hole or to form a wormhole. This may have interesting implications for the creation of a baby universe in the laboratory, the string landscape where the bubble nucleation takes place among a plenitude of metastable vacua, and the inflationary physics.

  14. Vacuum mechatronics first international workshop

    SciTech Connect

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

    1989-01-01

    This report contains papers on the following topics: proposed epitaxial thin film growth in the ultra-vacuum of space; particle monitoring and control in vacuum processing equipment; electrostatic dust collector for use in vacuum systems; materials evaluation of an electrically noisy vacuum slip ring assembly; an overview of lubrication and associated materials for vacuum service; the usage of lubricants in a vacuum environment; guidelines and practical applications for lubrication in vacuum; recent development in leak detector and calibrator designs; the durability of ballscrews for ultrahigh vacuum; vacuum-compatible robot for self-contained manufacturing systems; the design, fabrication, and assembly of an advanced vacuum robotics system for space payload calibration; design criteria for mechanisms used in space; and concepts and requirements for semiconductor multiprocess integration in vacuum. These papers are indexed separately elsewhere.

  15. The classical vacuum

    NASA Astrophysics Data System (ADS)

    Boyer, T. H.

    1985-08-01

    The history of vacuum concepts is reviewed, noting that no way is known to physically produce a true void. Even at absolute zero, a pattern of electromagnetic wave fluctuations are still present. The fluctuations are called zero-point radiation (ZPR). To be invariant to Lorentz transformation, ZPR has a spectral intensity proportional to the cube of each frequency. ZPR does not change in response to compression and produces a force between objects that is inversely proportional to the 4th power of the separation distance. The ZPR scale value has been measured to be one-half of the Planck constant, and is the measure of the energy of a harmonic oscillator, such as the electron, in a vacuum. Finally, since gravitational accelerations always occur in the physical space, a minimum thermal radiation can also be found for the vacuum, implying that a fixed relationship exists between thermal radiation and the classical vacuum.

  16. Vacuum Camera Cooler

    NASA Technical Reports Server (NTRS)

    Laugen, Geoffrey A.

    2011-01-01

    Acquiring cheap, moving video was impossible in a vacuum environment, due to camera overheating. This overheating is brought on by the lack of cooling media in vacuum. A water-jacketed camera cooler enclosure machined and assembled from copper plate and tube has been developed. The camera cooler (see figure) is cup-shaped and cooled by circulating water or nitrogen gas through copper tubing. The camera, a store-bought "spy type," is not designed to work in a vacuum. With some modifications the unit can be thermally connected when mounted in the cup portion of the camera cooler. The thermal conductivity is provided by copper tape between parts of the camera and the cooled enclosure. During initial testing of the demonstration unit, the camera cooler kept the CPU (central processing unit) of this video camera at operating temperature. This development allowed video recording of an in-progress test, within a vacuum environment.

  17. Eclipse Mapping of Accretion Discs

    NASA Astrophysics Data System (ADS)

    Baptista, R.

    The eclipse mapping method is an inversion technique that makes use of the information contained in eclipse light curves to probe the structure, the spectrum and the time evolution of accretion discs. In this review I present the basics of the method and discuss its different implementations. I summarize the most important results obtained to date and discuss how they have helped to improve our understanding of accretion physics, from testing the theoretical radial brightness temperature distribution and measuring mass accretion rates to showing the evolution of the structure of a dwarf novae disc throughout its outburst cycle, from isolating the spectrum of a disc wind to revealing the geometry of disc spiral shocks. I end with an outline of the future prospects.

  18. Tissue engineering: A live disc

    NASA Astrophysics Data System (ADS)

    Hukins, David W. L.

    2005-12-01

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

  19. TFTR diagnostic vacuum controller

    SciTech Connect

    Olsen, D.; Persons, R.

    1981-01-01

    The TFTR diagnostic vacuum controller (DVC) provides in conjunction with the Central Instrumentation Control and Data Acquisition System (CICADA), control and monitoring for the pumps, valves and gauges associated with each individual diagnostic vacuum system. There will be approximately 50 systems on TFTR. Two standard versions of the controller (A and B) wil be provided in order to meet the requirements of two diagnostic manifold arrangements. All pump and valve sequencing, as well as protection features, will be implemented by the controller.

  20. Disc Golf, a Growing Sport

    PubMed Central

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

    2015-01-01

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

  1. Mohawk promotes the maintenance and regeneration of the outer annulus fibrosus of intervertebral discs

    PubMed Central

    Nakamichi, Ryo; Ito, Yoshiaki; Inui, Masafumi; Onizuka, Naoko; Kayama, Tomohiro; Kataoka, Kensuke; Suzuki, Hidetsugu; Mori, Masaki; Inagawa, Masayo; Ichinose, Shizuko; Lotz, Martin K.; Sakai, Daisuke; Masuda, Koichi; Ozaki, Toshifumi; Asahara, Hiroshi

    2016-01-01

    The main pathogenesis of intervertebral disc (IVD) herniation involves disruption of the annulus fibrosus (AF) caused by ageing or excessive mechanical stress and the resulting prolapse of the nucleus pulposus. Owing to the avascular nature of the IVD and lack of understanding the mechanisms that maintain the IVD, current therapies do not lead to tissue regeneration. Here we show that homeobox protein Mohawk (Mkx) is a key transcription factor that regulates AF development, maintenance and regeneration. Mkx is mainly expressed in the outer AF (OAF) of humans and mice. In Mkx−/− mice, the OAF displays a deficiency of multiple tendon/ligament-related genes, a smaller OAF collagen fibril diameter and a more rapid progression of IVD degeneration compared with the wild type. Mesenchymal stem cells overexpressing Mkx promote functional AF regeneration in a mouse AF defect model, with abundant collagen fibril formation. Our results indicate a therapeutic strategy for AF regeneration. PMID:27527664

  2. Evolution of protoplanetary discs with magnetically driven disc winds

    NASA Astrophysics Data System (ADS)

    Suzuki, Takeru K.; Ogihara, Masahiro; Morbidelli, Alessandro; Crida, Aurélien; Guillot, Tristan

    2016-12-01

    Aims: We investigate the evolution of protoplanetary discs (PPDs) with magnetically driven disc winds and viscous heating. Methods: We considered an initially massive disc with 0.1 M⊙ to track the evolution from the early stage of PPDs. We solved the time evolution of surface density and temperature by taking into account viscous heating and the loss of mass and angular momentum by the disc winds within the framework of a standard α model for accretion discs. Our model parameters, turbulent viscosity, disc wind mass-loss, and disc wind torque, which were adopted from local magnetohydrodynamical simulations and constrained by the global energetics of the gravitational accretion, largely depends on the physical condition of PPDs, particularly on the evolution of the vertical magnetic flux in weakly ionized PPDs. Results: Although there are still uncertainties concerning the evolution of the vertical magnetic flux that remains, the surface densities show a large variety, depending on the combination of these three parameters, some of which are very different from the surface density expected from the standard accretion. When a PPD is in a wind-driven accretion state with the preserved vertical magnetic field, the radial dependence of the surface density can be positive in the inner region <1-10 au. The mass accretion rates are consistent with observations, even in the very low level of magnetohydrodynamical turbulence. Such a positive radial slope of the surface density strongly affects planet formation because it inhibits the inward drift or even causes the outward drift of pebble- to boulder-sized solid bodies, and it also slows down or even reversed the inward type-I migration of protoplanets. Conclusions: The variety of our calculated PPDs should yield a wide variety of exoplanet systems.

  3. ISABELLE vacuum systems

    SciTech Connect

    Halama, H J

    1980-01-01

    The Intersecting Storage Accelerator (ISABELLE) consists of two rings having a circumference of 3.8 km each. In these rings superconducting magnets, held at 4 K, bend and focus the proton beam which is accelerated up to 400 GeV. Due to very different pressure requirements, ISABELLE has two completely independent vacuum systems. One, which operates at 1 x 10/sup -11/ Torr, provides a very clean environment for the circulating proton beam. Here only ion and titanium sublimation pumps are used to provide the vacuum. The other system maintains superconducting magnet vessels at a pressure below 1 x 10/sup -4/ Torr, since at this pressure the gas conduction becomes negligible. In this so-called insulating vacuum system, turbomolecular pumps pump the inadvertent small helium leaks. Other gases are cryocondensed on the cold surfaces of the cryogenic system. The basic element of ISABELLE known as Full Cell containing 45 meters of beam tube, 8 pumping stations, 8 superconducting magnets and complete instrumentation has been constructed, leak checked and tested. All design parameters have been achieved in both vacuum systems. The two vacuum systems are described with particular emphasis on the influence of superconducting magnets in the selection of materials and UHV components.

  4. Transmastoid approach to repair meningoencephalic herniation in the middle ear.

    PubMed

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

    2013-04-01

    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.

  5. Herniation pit mimicking osseous metastasis on 18F-FDG PET/CT in patient with lung cancer.

    PubMed

    Yoo, Su Woong; Song, Ho-Chun; Oh, Jong-Ryool; Kim, Jahae; Kang, Sae-Ryung; Chong, Ari; Byun, Byung Hyun; Hong, Sun-Pyo; Min, Jung-Joon; Bom, Hee-Seung

    2012-07-01

    Herniation pits are small subcortical osseous defects located typically at the proximal anterosuperior quadrant of the femoral neck that are most frequently seen in the young, athletic adult population. We report a case with herniation pit showing focal 18F-FDG uptake on PET/CT images mimicking osseous metastasis in a 69-year-old patient with lung cancer.

  6. Improving Vacuum Cleaners

    NASA Technical Reports Server (NTRS)

    1997-01-01

    Under a Space Act Agreement between the Kirby company and Lewis Research Center, NASA technology was applied to a commercial vacuum cleaner product line. Kirby engineers were interested in advanced operational concepts, such as particle flow behavior and vibration, critical factors to improve vacuum cleaner performance. An evaluation of the company 1994 home care system, the Kirby G4, led to the refinement of the new G5 and future models. Under the cooperative agreement, Kirby had access to Lewis' holography equipment, which added insight into how long a vacuum cleaner fan would perform, as well as advanced computer software that can simulate the flow of air through fans. The collaboration resulted in several successes including fan blade redesign and continuing dialogue on how to improve air-flow traits in various nozzle designs.

  7. Gravitoturbulence in magnetized protostellar discs

    NASA Astrophysics Data System (ADS)

    Riols, A.; Latter, H.

    2016-08-01

    Gravitational instability (GI) features in several aspects of protostellar disc evolution, most notably in angular momentum transport, fragmentation, and the outbursts exemplified by FU Ori and EX Lupi systems. The outer regions of protostellar discs may also be coupled to magnetic fields, which could then modify the development of GI. To understand the basic elements of their interaction, we perform local 2D ideal and resistive magnetohydrodynamics simulations with an imposed toroidal field. In the regime of moderate plasma beta, we find that the system supports a hot gravitoturbulent state, characterized by considerable magnetic energy and stress and a surprisingly large Toomre parameter Q ≳ 10. This result has potential implications for disc structure, vertical thickness, ionization, etc. Our simulations also reveal the existence of long-lived and dense `magnetic islands' or plasmoids. Lastly, we find that the presence of a magnetic field has little impact on the fragmentation criterion of the disc. Though our focus is on protostellar discs, some of our results may be relevant for the outer radii of AGN.

  8. Superoleophobicity under vacuum

    NASA Astrophysics Data System (ADS)

    Liu, Xinjie; Wang, Xiaolong; Liang, Yongmin; Bell, Steven E. J.; Liu, Weimin; Zhou, Feng

    2011-05-01

    By using superoleophobic alumina and low vapor pressure oils we have been able to study wetting behavior at high vacuum. Here, we show that a superoleophobic state can exist for some probe liquids, even under high vacuum. However, with other liquids the surfaces are only superoloephobic because air is trapped beneath the droplet and the contact angle decreases dramatically (150°-120°) if this air is removed. These observations open up the possibility of designing materials which fully exploit the potential of physically trapped air to achieve extreme oleophobicity and/or hydrophobicity.

  9. Electrostatic Levitator Vacuum Chamber

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Optical ports ring the Electrostatic Levitator (ESL) vacuum chamber to admit light from the heating laser (beam passes through the window at left), positioning lasers (one port is at center), and lamps to allow diagnostic instruments to view the sample. The ESL uses static electricity to suspend an object (about 2-3 mm in diameter) inside a vacuum chamber while a laser heats the sample until it melts. This lets scientists record a wide range of physical properties without the sample contacting the container or any instruments, conditions that would alter the readings. The Electrostatic Levitator is one of several tools used in NASA's microgravity materials science program.

  10. K-130 Cyclotron vacuum system

    NASA Astrophysics Data System (ADS)

    Yadav, R. C.; Bhattacharya, S.; Bhole, R. B.; Roy, Anindya; Pal, Sarbajit; Mallik, C.; Bhandari, R. K.

    2012-11-01

    The vacuum system for K-130 cyclotron has been operational since 1977. It consists of two sub-systems, main vacuum system and beam line vacuum system. The main vacuum system is designed to achieve and maintain vacuum of about 1 × 10-6 mbar inside the 23 m3 volume of acceleration chamber comprising the Resonator tank and the Dee tank. The beam line vacuum system is required for transporting the extracted beam with minimum loss. These vacuum systems consist of diffusion pumps backed by mechanical pumps like roots and rotary pumps. The large vacuum pumps and valves of the cyclotron vacuum system were operational for more than twenty five years. In recent times, problems of frequent failures and maintenance were occurring due to aging and lack of appropriate spares. Hence, modernisation of the vacuum systems was taken up in order to ensure a stable high voltage for radio frequency system and the extraction system. This is required for efficient acceleration and transportation of high intensity ion beam. The vacuum systems have been upgraded by replacing several pumps, valves, gauges and freon units. The relay based control system for main vacuum system has also been replaced by PLC based state of the art control system. The upgraded control system enables inclusion of additional operational logics and safety interlocks into the system. The paper presents the details of the vacuum system and describes the modifications carried out for improving the performance and reliability of the vacuum system.

  11. Relatively uniform and accelerated degradation of pure iron coated with micro-patterned Au disc arrays.

    PubMed

    Cheng, J; Huang, T; Zheng, Y F

    2015-03-01

    Pure iron has been proven to be a potential biodegradable metal, but its degradation rate was too slow. To accelerate its biodegradation, micro-patterned Au disc films were deposited on the surface of pure iron by vacuum sputtering. The influence of Au disc films on the degradation of pure iron matrix in vitro was investigated in the present study. Electrochemical measurement results indicated that the corrosion current density of pure iron coated with micro-patterned Au disc films in Hank's solution was 4 times larger than that of the uncoated one, while the difference between the influences of micro-patterned Au discs with different diameters on the corrosion rate of pure iron was insignificant. Immersion test indicated that the corrosion depth for pure iron coated with Au disc films was about three times as that of bare pure iron. Both electrochemical test and immersion test revealed that the corrosion of pure iron matrix coated with Au disc array became more uniform.

  12. Inguinal Herniation Containing Bladder, Causing Contralateral Allograft Hydroureteronephrosis-A Case Report and Literature Review.

    PubMed

    du Toit, T; Kaestner, L; Muller, E; Kahn, D

    2017-02-01

    We report the first documented case of an inguinal hernia containing bladder, resulting in contralateral allograft hydroureteronephrosis. A 39-year-old male patient presented with allograft dysfunction, a contralateral inguinoscrotal hernia, and marked hydroureteronephrosis on ultrasound (US). Percutaneous nephrostogram and a retrograde cystogram suggested bladder herniation with incorporation of the contralateral ureteroneocystostomy into the hernia. Paraperitoneal bladder herniation was confirmed at surgery and hernioplasty was performed. Six-week follow-up revealed normal renal function with no sign of hernia recurrence. Despite occurring rarely, transplant ureter or bladder herniation should be considered in the differential diagnosis of hydroureteronephrosis. This case illustrates that the contralateral position of hernia to allograft does not necessarily preclude the hernia as the source of ureteric obstruction.

  13. Conservative management of recurrent lumbar disk herniation with epidural fibrosis: a case report

    PubMed Central

    Welk, Aaron B.; Werdehausen, Destiny N.; Kettner, Norman W.

    2012-01-01

    Objective A retrospective case report of a 24-year-old man with recurrent lumbar disk herniation and epidural fibrosis is presented. Recurrent lumbar disk herniation and epidural fibrosis are common complications following lumbar diskectomy. Clinical Features A 24-year-old patient had a history of lumbar diskectomy and new onset of low back pain and radiculopathy. Magnetic resonance imaging revealed recurrent herniation at L5/S1, left nerve root displacement, and epidural fibrosis. Intervention and Outcomes The patient received a course of chiropractic care including lumbar spinal manipulation and rehabilitation exercises with documented subjective and objective functional and symptomatic improvement. Conclusion This case report describes chiropractic management including spinal manipulative therapy and rehabilitation exercises and subsequent objective and subjective functional and symptomatic improvement. PMID:23843756

  14. Atomic gas in debris discs

    NASA Astrophysics Data System (ADS)

    Hales, Antonio S.; Barlow, M. J.; Crawford, I. A.; Casassus, S.

    2017-04-01

    We have conducted a search for optical circumstellar absorption lines in the spectra of 16 debris disc host stars. None of the stars in our sample showed signs of emission line activity in either Hα, Ca II or Na I, confirming their more evolved nature. Four stars were found to exhibit narrow absorption features near the cores of the photospheric Ca II and Na I D lines (when Na I D data were available). We analyse the characteristics of these spectral features to determine whether they are of circumstellar or interstellar origins. The strongest evidence for circumstellar gas is seen in the spectrum of HD 110058, which is known to host a debris disc observed close to edge-on. This is consistent with a recent ALMA detection of molecular gas in this debris disc, which shows many similarities to the β Pictoris system.

  15. Coevolution of binaries and circumbinary gaseous discs

    NASA Astrophysics Data System (ADS)

    Fleming, David P.; Quinn, Thomas R.

    2017-01-01

    The recent discoveries of circumbinary planets by Kepler raise questions for contemporary planet formation models. Understanding how these planets form requires characterizing their formation environment, the circumbinary protoplanetary disc and how the disc and binary interact and change as a result. The central binary excites resonances in the surrounding protoplanetary disc which drive evolution in both the binary orbital elements and in the disc. To probe how these interactions impact binary eccentricity and disc structure evolution, N-body smooth particle hydrodynamics simulations of gaseous protoplanetary discs surrounding binaries based on Kepler 38 were run for 104 binary periods for several initial binary eccentricities. We find that nearly circular binaries weakly couple to the disc via a parametric instability and excite disc eccentricity growth. Eccentric binaries strongly couple to the disc causing eccentricity growth for both the disc and binary. Discs around sufficiently eccentric binaries which strongly couple to the disc develop an m = 1 spiral wave launched from the 1:3 eccentric outer Lindblad resonance which corresponds to an alignment of gas particle longitude of periastrons. All systems display binary semimajor axis decay due to dissipation from the viscous disc.

  16. VACUUM SEALING MEANS FOR LOW VACUUM PRESSURES

    DOEpatents

    Milleron, N.

    1962-06-12

    S>A vacuum seal is designed in which the surface tension of a thin layer of liquid metal of low vapor pressure cooperates with adjacent surfaces to preclude passages of gases across pressure differentials as low as 10/sup -8/ mm Hg. Mating contiguous surfaces composed of copper, brass, stainless steel, nickel, molybdenum, tungsten, tantalum, glass, quartz, and/or synthetic mica are disposed to provide a maximum tolerance, D, expressed by 2 gamma /P/sub 1/, where gamma is the coefflcient of the surface tension of the metal sealant selected in dynes/cm/sub 2/. Means for heating the surfaces remotely is provided where temperatures drop below about 250 deg C. A sealant consisting of an alloy of gallium, indium, and tin, among other combinations tabulated, is disposed therebetween after treating the surfaces to improve wettability, as by ultrasonic vibrations, the surfaces and sealants being selected according to the anticipated experimental conditions of use. (AEC)

  17. Gas injected vacuum switch

    DOEpatents

    Hardin, K. Dan

    1977-01-01

    The disclosure relates to a gas injected vacuum switch comprising a housing having an interior chamber, a conduit for evacuating the interior chamber, within the chamber an anode and a cathode spaced from the anode, and a detonator for injecting electrically conductive gas into the chamber between the anode and the cathode to provide a current path therebetween.

  18. Sorption vacuum trap

    NASA Technical Reports Server (NTRS)

    Barrington, A. E.; Caruso, A. J.

    1970-01-01

    Modified sorption trap for use in high vacuum systems contains provisions for online regeneration of sorbent material. Trap is so constructed that it has a number of encapsulated resistance heaters and a valving and pumping device for removing gases from heated sorbing material. Excessive downtime is eliminated with this trap.

  19. Vacuum Kundt waves

    NASA Astrophysics Data System (ADS)

    McNutt, David; Milson, Robert; Coley, Alan

    2013-03-01

    We discuss the invariant classification of vacuum Kundt waves using the Cartan-Karlhede algorithm and determine the upper bound on the number of iterations of the Karlhede algorithm to classify the vacuum Kundt waves (Collins (1991 Class. Quantum Grav. 8 1859-69), Machado Ramos (1996 Class. Quantum Grav. 13 1589)). By choosing a particular coordinate system we partially construct the canonical coframe used in the classification to study the functional dependence of the invariants arising at each iteration of the algorithm. We provide a new upper bound, q ⩽ 4, and show that this bound is sharp by analyzing the subclass of Kundt waves with invariant count beginning with (0, 1,…) to show that the class with invariant count (0, 1, 3, 4, 4) exists. This class of vacuum Kundt waves is shown to be unique as the only set of metrics requiring the fourth covariant derivatives of the curvature. We conclude with an invariant classification of the vacuum Kundt waves using a suite of invariants.

  20. Spontaneous reduction of small bowel herniation through the foramen of Winslow: importance of a timely approach

    PubMed Central

    Cho, Hyung-Gyo

    2017-01-01

    We present the case of young female patient presenting with acute onset abdominal pain. Abdominopelvic CT revealed herniation through the foramen of Winslow. The patient was transferred to our hospital and underwent laparoscopic exploration. Though spontaneous reduction was detected, segmental resection of the impacted small bowel was inevitable due to ischemic change. Our case suggests that reducing the time until surgery is very important to lower the probability of bowel resection in case of small bowel herniation through the foramen of Winslow. PMID:28203560

  1. Demonstrations with a Vacuum: Old Demonstrations for New Vacuum Pumps.

    ERIC Educational Resources Information Center

    Greenslade, Thomas B., Jr.

    1989-01-01

    Explains mechanisms of 19th-century vacuum pumps. Describes demonstrations using the pump including guinea and feather tube, aurora tube, electric egg, Gassiots cascade, air mill, bell in vacuum, density and buoyancy of air, fountain in vacuum, mercury shower, palm and bladder glasses, Bacchus demonstration, pneumatic man-lifter, and Magdeburg…

  2. Tritium handling in vacuum systems

    SciTech Connect

    Gill, J.T.; Coffin, D.O.

    1986-10-01

    This report provides a course in Tritium handling in vacuum systems. Topics presented are: Properties of Tritium; Tritium compatibility of materials; Tritium-compatible vacuum equipment; and Tritium waste treatment.

  3. Furnace brazing under partial vacuum

    NASA Technical Reports Server (NTRS)

    Mckown, R. D.

    1979-01-01

    Brazing furnace utilizing partial-vacuum technique reduces tooling requirements and produces better bond. Benefit in that partial vacuum helps to dissociate metal oxides that inhibit metal flow and eliminates heavy tooling required to hold parts together during brazing.

  4. Gas bearing operates in vacuum

    NASA Technical Reports Server (NTRS)

    Perkins, G. S.

    1975-01-01

    Bearing has restrictions to reduce air leaks and is connected to external pumpout facility which removes exhausted air. Token amount of air which is lost to vacuum is easily removed by conventional vacuum pump.

  5. Photoevaporating transitional discs and molecular cloud cores

    NASA Astrophysics Data System (ADS)

    Li, Min; Sui, Ning

    2017-04-01

    We investigate the evolution of photoevaporating protoplanetary discs including mass influx from molecular cloud cores. We examine the influence of cloud core properties on the formation and evolution of transitional discs. We use one-dimensional thin disc assumption and calculate the evolution of the protoplanetary disc. The effects of X-ray photoevaporation are also included. Our calculations suggest that most discs should experience the transitional disc phase within 10 Myr. The formation time of a gap and its initial location are functions of the properties of the cloud cores. In some circumstances, discs can open two gaps by photoevaporation alone. The two gaps form when the gas in the disc can expand to large radius and if the mass at large radius is sufficiently small. The surface density profile of the disc determines whether the two gaps can form. Since the structure of a disc is determined by the properties of a molecular cloud core, the core properties determine the formation of two gaps in the disc. We further find that even when the photoevaporation rate is reduced to 10 per cent of the standard value, two gaps can still form in the disc. The only difference is that the formation time is delayed.

  6. A radiation hard vacuum switch

    DOEpatents

    Boettcher, G.E.

    1988-07-19

    A vacuum switch with an isolated trigger probe which is not directly connected to the switching electrodes. The vacuum switch within the plasmatron is triggered by plasma expansion initiated by the trigger probe which travels through an opening to reach the vacuum switch elements. The plasma arc created is directed by the opening to the space between the anode and cathode of the vacuum switch to cause conduction. 3 figs.

  7. Electromagnetic Levitation of a Disc

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  8. Surge-damping vacuum valve

    DOEpatents

    Bullock, Jack C.; Kelly, Benjamin E.

    1980-01-01

    A valve having a mechanism for damping out flow surges in a vacuum system which utilizes a slotted spring-loaded disk positioned adjacent the valve's vacuum port. Under flow surge conditions, the differential pressure forces the disk into sealing engagement with the vacuum port, thereby restricting the flow path to the slots in the disk damping out the flow surge.

  9. Portable vacuum object handling device

    DOEpatents

    Anderson, Gordon H.

    1983-08-09

    The disclosure relates to a portable device adapted to handle objects which are not to be touched by hand. A piston and bore wall form a vacuum chamber communicating with an adaptor sealably engageable with an object to be lifted. The piston is manually moved and set to establish vacuum. A valve is manually actuatable to apply the vacuum to lift the object.

  10. Bakeout Chamber Within Vacuum Chamber

    NASA Technical Reports Server (NTRS)

    Taylor, Daniel M.; Soules, David M.; Barengoltz, Jack B.

    1995-01-01

    Vacuum-bakeout apparatus for decontaminating and measuring outgassing from pieces of equipment constructed by mounting bakeout chamber within conventional vacuum chamber. Upgrade cost effective: fabrication and installation of bakeout chamber simple, installation performed quickly and without major changes in older vacuum chamber, and provides quantitative data on outgassing from pieces of equipment placed in bakeout chamber.

  11. Increased Risk for Adhesive Capsulitis of the Shoulder following Cervical Disc Surgery

    PubMed Central

    Kang, Jiunn-Horng; Lin, Herng-Ching; Tsai, Ming-Chieh; Chung, Shiu-Dong

    2016-01-01

    Shoulder problems are common in patients with a cervical herniated intervertebral disc (HIVD). This study aimed to explore the incidence and risk of shoulder capsulitis/tendonitis following cervical HIVD surgery. We used data from the Taiwan “Longitudinal Health Insurance Database”. We identified all patients who were hospitalized with a diagnosis of displacement of a cervical HIVD and who underwent cervical surgery (n = 1625). We selected 8125 patients who received cervical HIVD conservative therapy only as the comparison group matched with study patients. We individually tracked these sampled patients for 6 months to identify all patients who received a diagnosis of shoulder tendonitis/capsulitis. We found that incidence rates of shoulder tendonitis/capsulitis during the 6-month follow-up period were 3.69 (95% CI: 2.49~5.27) per 100 person-years for the study group and 2.33 (95% CI: 1.89~2.86) per 100 person-years for the comparison group. Cox proportional hazard regressions showed that the adjusted hazard ratio for shoulder tendonitis/capsulitis among patients who underwent cervical disc surgery was 1.66 (95% CI = 1.09~2.53) when compared to comparison group. We concluded that patients who underwent surgery for a cervical HIVD had a significantly higher risk of developing shoulder capsulitis/tendonitis in 6 months follow-up compared to patients who received cervical HIVD conservative therapy only. PMID:27231090

  12. Localized strain measurements of the intervertebral disc annulus during biaxial tensile testing.

    PubMed

    Karakolis, Thomas; Callaghan, Jack P

    2015-01-01

    Both inter-lamellar and intra-lamellar failures of the annulus have been described as potential modes of disc herniation. Attempts to characterize initial lamellar failure of the annulus have involved tensile testing of small tissue samples. The purpose of this study was to evaluate a method of measuring local surface strains through image analysis of a tensile test conducted on an isolated sample of annular tissue in order to enhance future studies of intervertebral disc failure. An annulus tissue sample was biaxial strained to 10%. High-resolution images captured the tissue surface throughout testing. Three test conditions were evaluated: submerged, non-submerged and marker. Surface strains were calculated for the two non-marker conditions based on motion of virtual tracking points. Tracking algorithm parameters (grid resolution and template size) were varied to determine the effect on estimated strains. Accuracy of point tracking was assessed through a comparison of the non-marker conditions to a condition involving markers placed on tissue surface. Grid resolution had a larger effect on local strain than template size. Average local strain error ranged from 3% to 9.25% and 0.1% to 2.0%, for the non-submerged and submerged conditions, respectively. Local strain estimation has a relatively high potential for error. Submerging the tissue provided superior strain estimates.

  13. Vacuum tool manipulator

    SciTech Connect

    Zollinger, W.T.

    1992-12-31

    This invention is comprised of an apparatus for manipulating a vacuum hose in a reactor vessel comprising a housing with two opposing openings, an arm carried by the housing and deployable from a stowed position essentially completely within the housing to an extended position where the arm extends through the two openings in a generally horizontal position. The arm preferably has a two-fingered gripping device for gripping the vacuum hose but may carry a different end effector such as a grinding wheel. The fingers are opened and closed by one air cylinder. A second air cylinder extends the device. A third air cylinder within the housing pivotally pulls the opposing end of the arm into the housing via a pivoting member pivotally connected between the third air cylinder shaft and the arm.

  14. Edison's vacuum technology patents

    NASA Astrophysics Data System (ADS)

    Waits, Robert K.

    2003-07-01

    During 1879 Thomas Edison's Menlo Park, New Jersey laboratory developed the means to evacuate glass lamp globes to less than a mTorr in 20 min and in mid-1880 began production of carbon-filament incandescent lamps. Among Edison's nearly 1100 U.S. patents are five for vacuum pump improvements, and at least eight others that are vacuum-related; all applied for between 1880 and 1886. Inspired by an 1878 article by De La Rue and Müller [Philos. Trans. R. Soc. London, Ser. A 169, 155 (1878)] on studies of glow discharges, Edison devised a combination pump using the Geissler pump as a rough pump and the Sprengel pump for continuous exhaustion. Edison's patents described means to control the mercury flow and automate the delivery of the mercury to banks of up to a hundred pumps. Other patents described various means to remove residual gases during lamp processing.

  15. Vacuum tool manipulator

    DOEpatents

    Zollinger, W.T.

    1993-11-23

    Apparatus for manipulating a vacuum hose in a reactor vessel comprises a housing with two opposing openings, an arm carried by the housing and deployable from a stowed position essentially completely within the housing to an extended position where the arm extends through the two openings in a generally horizontal position. The arm preferably has a two-fingered gripping device for gripping the vacuum hose but may carry a different end effector such as a grinding wheel. The fingers are opened and closed by one air cylinder. A second air cylinder extends the device. A third air cylinder within the housing pivotally pulls the opposing end of the arm into the housing via a pivoting member pivotally connected between the third air cylinder shaft and the arm. 6 figures.

  16. Compact vacuum insulation

    DOEpatents

    Benson, David K.; Potter, Thomas F.

    1993-01-01

    An ultra-thin compact vacuum insulation panel is comprised of two hard, but bendable metal wall sheets closely spaced apart from each other and welded around the edges to enclose a vacuum chamber. Glass or ceramic spacers hold the wall sheets apart. The spacers can be discrete spherical beads or monolithic sheets of glass or ceramic webs with nodules protruding therefrom to form essentially "point" or "line" contacts with the metal wall sheets. In the case of monolithic spacers that form "line" contacts, two such spacers with the line contacts running perpendicular to each other form effectively "point" contacts at the intersections. Corrugations accommodate bending and expansion, tubular insulated pipes and conduits, and preferred applications are also included.

  17. Compact vacuum insulation embodiments

    DOEpatents

    Benson, David K.; Potter, Thomas F.

    1992-01-01

    An ultra-thin compact vacuum insulation panel is comprised of two hard, but bendable metal wall sheets closely spaced apart from each other and welded around the edges to enclose a vacuum chamber. Glass or ceramic spacers hold the wall sheets apart. The spacers can be discrete spherical beads or monolithic sheets of glass or ceramic webs with nodules protruding therefrom to form essentially "point" or "line" contacts with the metal wall sheets. In the case of monolithic spacers that form "line" contacts, two such spacers with the line contacts running perpendicular to each other form effectively "point" contacts at the intersections. Corrugations accommodate bending and expansion, tubular insulated pipes and conduits, and preferred applications are also included.

  18. Compact vacuum insulation embodiments

    DOEpatents

    Benson, D.K.; Potter, T.F.

    1992-04-28

    An ultra-thin compact vacuum insulation panel is comprised of two hard, but bendable metal wall sheets closely spaced apart from each other and welded around the edges to enclose a vacuum chamber. Glass or ceramic spacers hold the wall sheets apart. The spacers can be discrete spherical beads or monolithic sheets of glass or ceramic webs with nodules protruding therefrom to form essentially point' or line' contacts with the metal wall sheets. In the case of monolithic spacers that form line' contacts, two such spacers with the line contacts running perpendicular to each other form effectively point' contacts at the intersections. Corrugations accommodate bending and expansion, tubular insulated pipes and conduits, and preferred applications are also included. 26 figs.

  19. Compact vacuum insulation

    DOEpatents

    Benson, D.K.; Potter, T.F.

    1993-01-05

    An ultra-thin compact vacuum insulation panel is comprised of two hard, but bendable metal wall sheets closely spaced apart from each other and welded around the edges to enclose a vacuum chamber. Glass or ceramic spacers hold the wall sheets apart. The spacers can be discrete spherical beads or monolithic sheets of glass or ceramic webs with nodules protruding therefrom to form essentially point'' or line'' contacts with the metal wall sheets. In the case of monolithic spacers that form line'' contacts, two such spacers with the line contacts running perpendicular to each other form effectively point'' contacts at the intersections. Corrugations accommodate bending and expansion, tubular insulated pipes and conduits, and preferred applications are also included.

  20. Vacuum tool manipulator

    DOEpatents

    Zollinger, William T.

    1993-01-01

    Apparatus for manipulating a vacuum hose in a reactor vessel comprises a housing with two opposing openings, an arm carried by the housing and deployable from a stowed position essentially completely within the housing to an extended position where the arm extends through the two openings in a generally horizontal position. The arm preferably has a two-fingered gripping device for gripping the vacuum hose but may carry a different end effector such as a grinding wheel. The fingers are opened and closed by one air cylinder. A second air cylinder extends the device. A third air cylinder within the housing pivotally pulls the opposing end of the arm into the housing via a pivoting member pivotally connected between the third air cylinder shaft and the arm.

  1. Integrated structure vacuum tube

    NASA Technical Reports Server (NTRS)

    Dimeff, J.; Kerwin, W. J. (Inventor)

    1976-01-01

    High efficiency, multi-dimensional thin film vacuum tubes suitable for use in high temperature, high radiation environments are described. The tubes are fabricated by placing thin film electrode members in selected arrays on facing interior wall surfaces of an alumina substrate envelope. Cathode members are formed using thin films of triple carbonate. The photoresist used in photolithography aids in activation of the cathodes by carbonizing and reacting with the reduced carbonates when heated in vacuum during forming. The finely powdered triple carbonate is mixed with the photoresist used to delineate the cathode locations in the conventional solid state photolithographic manner. Anode and grid members are formed using thin films of refractory metal. Electron flow in the tubes is between grid elements from cathode to anode as in a conventional three-dimensional tube.

  2. An automated vacuum system

    SciTech Connect

    Atkins, W.H. ); Vaughn, G.D. ); Bridgman, C. )

    1991-01-01

    Software tools available with the Ground Test Accelerator (GTA) control system provide the capability to express a control problem as a finite state machine. System states and transitions are expressed in terms of accelerator parameters and actions are taken based on state transitions. This is particularly useful for sequencing operations which are modal in nature or are unwieldy when implemented with conventional programming. State diagrams are automatically translated into code which is executed by the control system. These tools have been applied to the vacuum system for the GTA accelerator to implement automatic sequencing of operations. With a single request, the operator may initiate a complete pump-down sequence. He can monitor the progress and is notified if an anomaly occurs requiring intervention. The operator is not required to have detailed knowledge of the vacuum system and is protected from taking inappropriate actions. 1 ref., 6 figs.

  3. Peripheral Disc Margin Shape and Internal Disc Derangement: Imaging Correlation in Significantly Painful Discs Identified at Provocation Lumbar Discography

    PubMed Central

    Bartynski, W.S.; Rothfus, W.E.

    2012-01-01

    Summary Annular margin shape is used to characterize lumbar disc abnormality on CT/MR imaging studies. Abnormal discs also have internal derangement including annular degeneration and radial defects. The purpose of this study was to evaluate potential correlation between disc-margin shape and annular internal derangement on post-discogram CT in significantly painful discs encountered at provocation lumbar discography (PLD). Significantly painful discs were encountered at 126 levels in 86 patients (47 male, 39 female) studied by PLD where no prior surgery had been performed and response to intradiscal lidocaine after provocation resulted in either substantial/total relief or no improvement after lidocaine administration. Post-discogram CT and discogram imaging was evaluated for disc-margin characteristics (bulge/protrusion), features of disc internal derangement (radial annular defect [RD: radial tear/fissure/annular gap], annular degeneration) and presence/absence of discographic contrast leakage. In discs with focal protrusion, 50 of 63 (79%) demonstrated Grade 3 RD with 13 (21%) demonstrating severe degenerative change only. In discs with generalized-bulge-only, 48 of 63 (76%) demonstrated degenerative change only (primarily Dallas Grade 3) with 15 of 63 (24%) demonstrating a RD (Dallas Grade 3). Differences were highly statistically significant (p<0.001). Pain elimination with intra-discal lidocaine correlated with discographic contrast leakage (p<0.001). Disc-margin shape correlates with features of internal derangement in significantly painful discs encountered at PLD. Discs with focal protrusion typically demonstrate RD while generalized bulging discs typically demonstrated degenerative changes only (p<0.001). Disc-margin shape may provide an important imaging clue to the cause of chronic discogenic low back pain. PMID:22681741

  4. Vacuum: From Art to Exact Science.

    ERIC Educational Resources Information Center

    Lafferty, James M.

    1981-01-01

    Reviews the history of vacuum technology. Includes vacuum pump developments (mechanical, ion, and cyrogenic pumps), measurement techniques, the development of the American Vacuum Society, and electronics in vacuum technology. (JN)

  5. [Optic disc granuloma secondary to sarcoidosis].

    PubMed

    Qu-Knafo, L; Auregan-Giocanti, A

    2017-02-01

    We report a case of optic disc granuloma due to sarcoidosis. A 64-year-old, caucasian female with a history of pulmonary sarcoidosis presented with a vision loss on her left eye. The ophthalmologic examination revealed a discrete optic disc infiltrate compatible with the diagnosis of optic disc granuloma. Fluorescein angiography showed diffusion and impregnation of the granuloma without vascularitis. The optical coherence tomography demonstrated a homogenous and isoreflective lesion at the optic disc. The patient recovered her visual acuity after systemic corticosteroid treatment. Isolated optic disc granuloma is a rare condition of ocular sarcoidosis.

  6. Air bearing vacuum seal assembly

    DOEpatents

    Booth, Rex

    1978-01-01

    An air bearing vacuum seal assembly capable of rotating at the speed of several thousand revolutions per minute using an air cushion to prevent the rotating and stationary parts from touching, and a two stage differential pumping arrangement to maintain the pressure gradient between the air cushion and the vacuum so that the leak rate into the vacuum is, for example, less than 1 .times. 10.sup.-4 Pa m.sup.3 /s. The air bearing vacuum seal has particular application for mounting rotating targets to an evacuated accelerator beam tube for bombardment of the targets with high-power charged particle beams in vacuum.

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

    PubMed

    Neville-Towle, Jack; Sakals, Sherisse

    2015-09-01

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

  8. Herniated disks unchanged over time: Size reduced after oxygen-ozone therapy.

    PubMed

    Bonetti, Matteo; Zambello, Alessio; Leonardi, Marco; Princiotta, Ciro

    2016-08-01

    The spontaneous regression of disk herniation secondary to dehydration is a much-debated topic in medicine. Some physicians wonder whether surgical removal of the extruded nucleus pulposus is really necessary when the spontaneous disappearance of a herniated lumbar disk is a well-known phenomenon. Unfortunately, without spontaneous regression, chronic pain leads to progressive disability for which surgery seems to be the only solution. In recent years, several studies have demonstrated the utility of oxygen-ozone therapy in the treatment of disk herniation, resulting in disk shrinkage. This retrospective study evaluates the outcomes of a series of patients with a history of herniated disks neuroradiologically unchanged in size for over two years, treated with oxygen-ozone therapy at our center over the last 15 years. We treated 96 patients, 84 (87.5%) presenting low back pain complicated or not by chronic sciatica. No drug therapy had yielded significant benefits. A number of specialists had been consulted in two or more years resulting in several neuroradiological scans prior to the decision to undertake oxygen-ozone therapy. Our study documents how ozone therapy for slipped disks "unchanged over time" solved the problem, with disk disruption or a significant reduction in the size of the prolapsed disk material extruded into the spinal canal.

  9. Herniation pits in the femoral neck: a radiographic indicator of femoroacetabular impingement?

    PubMed

    Kim, Jin Ah; Park, Ji Seon; Jin, Wook; Ryu, Kyungnam

    2011-02-01

    The purpose was to assess the significance of herniation pits in the femoral neck for radiographic diagnosis of femoroacetabular impingement (FAI). Eighty hips in 62 patients (bilateral in 18) with neutral pelvic orientation were enrolled. Herniation pits were diagnosed when they were located at the anterosuperior femoral neck, close to the physis, and with a diameter of >3 mm. The five radiographic signs of FAI were used: lateral center edge angle (LCE) >39°, acetabular index (AI) ≤0, extrusion index (EI) <25%, acetabular retroversion, and pistol-grip deformity. Patients with radiographs suggesting FAI were retrospectively correlated with their clinical symptoms. Positive radiographic signs were observed in 7 hips with LCE, 7 with AI, and 80 with EI criteria. Only 3 hips out of 80 (3.8%) showed all of the signs. The acetabular retroversion and pistol-grip deformity were seen in 12/80 and 3/80 hips, respectively. The total number of hips that met radiographic criteria for FAI, including pincer type and cam type, was 18 (23%). However, none of these hips were clinically diagnosed with FAI. All symptomatic hips (11/80) presented only with nonspecific pain, and 2 hips out of 11 showed radiographic signs of FAI. The low frequency of positive radiographic signs suggesting FAI with related symptoms among patients with herniation pits suggests that herniation pits have limited significance in the diagnosis of FAI. Therefore it can be concluded that an incidental finding of herniation pits does not necessarily imply a correlation with FAI.

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

    PubMed Central

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

    2012-01-01

    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

  11. Vacuum bell therapy

    PubMed Central

    Sesia, Sergio

    2016-01-01

    Background For specific therapy to correct pectus excavatum (PE), conservative treatment with the vacuum bell (VB) was introduced more than 10 years ago in addition to surgical repair. Preliminary results using the VB were encouraging. We report on our 13-year experience with the VB treatment including the intraoperative use during the Nuss procedure and present some technical innovations. Methods A VB with a patient-activated hand pump is used to create a vacuum at the anterior chest wall. Three different sizes of vacuum bells, as well as a model fitted for young women, exist. The appropriate size is selected according to the individual patient’s age and ventral surface. The device should be used at home for a minimum of 30 minutes (twice a day), and may be used up to a maximum of several hours daily. The intensity of the applied negative pressure can be evaluated with an integrated pressure gauge during follow-up visits. A prototype of an electronic model enables us to measure the correlation between the applied negative pressure and the elevation of the anterior chest wall. Results Since 2003, approx. 450 patients between 2 to 61 years of age started the VB therapy. Age and gender specific differences, depth of PE, symmetry or asymmetry, and concomitant malformations such as scoliosis and/or kyphosis influence the clinical course and success of VB therapy. According to our experience, we see three different groups of patients. Immediate elevation of the sternum was confirmed thoracoscopically during the Nuss procedure in every patient. Conclusions The VB therapy has been established as an alternative therapeutic option in selected patients suffering from PE. The initial results up to now are encouraging, but long-term results comprising more than 15 years are so far lacking, and further evaluation and follow-up studies are necessary. PMID:27747177

  12. Rolling through a vacuum

    NASA Astrophysics Data System (ADS)

    van der Schaar, Jan Pieter; Yang, I.-Sheng

    2013-12-01

    We clarify under what conditions slow-roll inflation can continue almost undisturbed, while briefly evolving through a (semi-classically) metastable false vacuum. Furthermore, we look at potential signatures in the primordial power spectrum that could point towards the existence of traversed metastable false vacua. Interestingly, the theoretical constraints for the existence of traversable metastable vacua imply that Planck should be able to detect the resulting features in the primordial power spectrum. In other words, if Planck does not see features this immediately implies the non-existence of metastable false vacua rolled through during the inflationary epoch.

  13. Avoiding Death by Vacuum

    NASA Astrophysics Data System (ADS)

    Barroso, A.; Ferreira, P. M.; Ivanov, I.; Santos, R.; Silva, João P.

    2013-07-01

    The two-Higgs doublet model (2HDM) can have two electroweak breaking, CP-conserving, minima. The possibility arises that the minimum which corresponds to the known elementary particle spectrum is metastable, a possibility we call the "panic vacuum". We present analytical bounds on the parameters of the softly broken Peccei-Quinn 2HDM which are necessary and sufficient conditions to avoid this possibility. We also show that, for this particular model, the current LHC data already tell us that we are necessarily in the global minimum of the theory, regardless of any cosmological considerations about the lifetime of the false vacua.

  14. Vacuum Beat Wave Accelerator

    NASA Astrophysics Data System (ADS)

    Moore, C. I.; Hafizi, B.; Ting, A.; Burris, H. R.; Sprangle, P.; Esarey, E.; Ganguly, A.; Hirshfield, J. L.

    1997-11-01

    The Vacuum Beat Wave Accelerator (VBWA) is a particle acceleration scheme which uses the non-linear ponderomotive beating of two different frequency laser beams to accelerate electrons. A proof-of-principle experiment to demonstrate the VBWA is underway at the Naval Research Laboratory (NRL). This experiment will use the beating of a 1054 nm and 527 nm laser pulse from the NRL T-cubed laser to generate the beat wave and a 4.5 MeV RF electron gun as the electron source. Simulation results and the experimental design will be presented. The suitability of using axicon or higher order Gaussian laser beams will also be discussed.

  15. Thermal Vacuum Test Facility.

    DTIC Science & Technology

    1984-01-31

    tne power has a rear terminal sensor input for this Probe, use it. Otherwiseq connect the probe to the front panel. The end of the sensor should be...outlet on the front panel of the vacuum chamber. BUS CONNECTtONS: Plug the 1/0 expander card into one of the three calculator slots. Cover the other two...mating cable. Soth connectors on the slave disk are identical, so either one can be used. This cable also locks into place at each end . Connect the other

  16. Posterior Trans-Dural Repair of Iatrogenic Spinal Cord Herniation after Resection of Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Kim, Hong-Ki; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2016-01-01

    Iatrogenic spinal cord herniation is a rare complication following spinal surgery. We introduce a posterior trans-dural repair technique used in a case of thoracic spinal cord herniation through a ventral dural defect following resection of ossification of the posterior longitudinal ligament (OPLL) in the cervicothoracic spine. A 51-year-old female was suffering from paraplegia after laminectomy alone for cervicothoracic OPLL. Magnetic resonance imaging revealed a severely compressed spinal cord with pseudomeningocele identified postoperatively. Cerebrospinal fluid leak and iatrogenic spinal cord herniation persisted despite several operations with duroplasty and sealing agent. Finally, the problems were treated by repair of the ventral dural defect with posterior trans-dural duroplasty. Several months after surgery, the patient could walk independently. This surgical technique can be applied to treat ventral dural defect and spinal cord herniation. PMID:27114779

  17. Proto-planetary disc evolution and dispersal

    NASA Astrophysics Data System (ADS)

    Rosotti, Giovanni Pietro

    2015-05-01

    Planets form from gas and dust discs in orbit around young stars. The timescale for planet formation is constrained by the lifetime of these discs. The properties of the formed planetary systems depend thus on the evolution and final dispersal of the discs, which is the main topic of this thesis. Observations reveal the existence of a class of discs called "transitional", which lack dust in their inner regions. They are thought to be the last stage before the complete disc dispersal, and hence they may provide the key to understanding the mechanisms behind disc evolution. X-ray photoevaporation and planet formation have been studied as possible physical mechanisms responsible for the final dispersal of discs. However up to now, these two phenomena have been studied separately, neglecting any possible feedback or interaction. In this thesis we have investigated what is the interplay between these two processes. We show that the presence of a giant planet in a photo-evaporating disc can significantly shorten its lifetime, by cutting the inner regions from the mass reservoir in the exterior of the disc. This mechanism produces transition discs that for a given mass accretion rate have larger holes than in models considering only X-ray photo-evaporation, constituting a possible route to the formation of accreting transition discs with large holes. These discs are found in observations and still constitute a puzzle for the theory. Inclusion of the phenomenon called "thermal sweeping", a violent instability that can destroy a whole disc in as little as 10 4 years, shows that the outer disc left can be very short-lived (depending on the X-ray luminosity of the star), possibly explaining why very few non accreting transition discs are observed. However the mechanism does not seem to be efficient enough to reconcile with observations. In this thesis we also show that X-ray photo-evaporation naturally explains the observed correlation between stellar masses and accretion

  18. R&D ERL: Vacuum

    SciTech Connect

    Mapes, M.; Smart, L.; Weiss, D.; Steszyn, A.; Todd, R.

    2010-01-01

    The ERL Vacuum systems are depicted in a figure. ERL has eight vacuum volumes with various sets of requirements. A summary of vacuum related requirements is provided in a table. Five of the eight volumes comprise the electron beamline. They are the 5-cell Superconducting RF Cavity, Superconducting e-gun, injection, loop and beam dump. Two vacuum regions are the individual cryostats insulating the 5-cell Superconducting RF Cavity and the Superconducting e-gun structures. The last ERL vacuum volume not shown in the schematic is the laser transport line. The beamline vacuum regions are separated by electropneumatic gate valves. The beam dump is common with loop beamline but is considered a separate volume due to geometry and requirements. Vacuum in the 5-cell SRF cavity is maintained in the {approx}10{sup -9} torr range at room temperature by two 20 l/s ion pumps and in the e-gun SRF cavity by one 60 l/s ion pump. Vacuum in the SRF cavities operated at 2{sup o}K is reduced to low 10{sup -11} torr via cryopumping of the cavity walls. The cathode of the e-gun must be protected from poisoning, which can occur if vacuum adjacent to the e-gun in the injection line exceeds 10-11 torr range in the injection warm beamline near the e-gun exit. The vacuum requirements for beam operation in the loop and beam dump are 10-9 torr range. The beamlines are evacuated from atmospheric pressure to high vacuum level with a particulate free, oil free turbomolecular pumping cart. 25 l/s shielded ion pumps distributed throughout the beamlines maintain the vacuum requirement. Due to the more demanding vacuum requirement of the injection beamline proximate to the e-gun, a vacuum bakeout of the injection beamline is required. In addition, two 200 l/s diode ion pumps and supplemental pumping provided by titanium sublimation pumps are installed in the injection line just beyond the exit of the e-gun. Due to expected gas load a similar pumping arrangement is planned for the beam dump. The

  19. Calculation of the Hadronic Vacuum Polarization Disconnected Contribution to the Muon Anomalous Magnetic Moment.

    PubMed

    Blum, T; Boyle, P A; Izubuchi, T; Jin, L; Jüttner, A; Lehner, C; Maltman, K; Marinkovic, M; Portelli, A; Spraggs, M

    2016-06-10

    We report the first lattice QCD calculation of the hadronic vacuum polarization (HVP) disconnected contribution to the muon anomalous magnetic moment at physical pion mass. The calculation uses a refined noise-reduction technique that enables the control of statistical uncertainties at the desired level with modest computational effort. Measurements were performed on the 48^{3}×96 physical-pion-mass lattice generated by the RBC and UKQCD Collaborations. We find the leading-order hadronic vacuum polarization a_{μ}^{HVP(LO)disc}=-9.6(3.3)(2.3)×10^{-10}, where the first error is statistical and the second systematic.

  20. MOLECULAR VACUUM PUMP

    DOEpatents

    Eckberg, E.E.

    1960-09-27

    A multiple molecular vacuum pump capable of producing a vacuum of the order of 10/sup -9/ mm Hg is described. The pump comprises a casing of an aggregate of paired and matched cylindrical plates, a recessed portion on one face of each plate concentrically positioned formed by a radially extending wall and matching the similarly recessed portion of its twin plate of that pair of plates and for all paired and matched plates; a plurality of grooves formed in the radially extending walls of each and all recesses progressing in a spiral manner from their respective starting points out at the periphery of the recess inwardly to the central area; a plurality of rotors rotatably mounted to closely occupy the spaces as presented by the paired and matched recesses between all paired plates; a hollowed drive-shaft perforated at points adjacent to the termini of all spiral grooves; inlet ports at the starting points of all grooves and through all plates at common points to each respectively; and a common outlet passage presented by the hollow portion of the perforated hollowed drive-shaft of the molecular pump. (AEC)

  1. Motor actuated vacuum door

    NASA Astrophysics Data System (ADS)

    Hanagud, A. V.

    1986-10-01

    Doors that allow scientific instruments to record and retrieve the observed data are often required to be designed and installed as a part of sounding rocket hardware. The motor-actuated vacuum door was designed to maintain a medium vacuum of the order of 0.0001 torr or better while closed, and to provide an opening 15 inches long x 8.5 inches wide while open for cameras to image Halley's comet. When the electric motor receives the instruction to open the door through the payload battery, timer, and relay circuit, the first operation is to unlock the door. After unlatching, the torque transmitted by the motor to the main shaft through the links opens the door. A microswitch actuator, which rides on the linear motion conversion mechanism, is adjusted to trip the limit switch at the end of the travel. The process is repeated in the reverse order to close the door. 'O' rings are designed to maintain the seal. Door mechanisms similar to the one described have flown on Aerobee 17.018 and Black Brant 27.047 payloads.

  2. Portable vacuum object handling device

    DOEpatents

    Anderson, G.H.

    1983-08-09

    The disclosure relates to a portable device adapted to handle objects which are not to be touched by hand. A piston and bore wall form a vacuum chamber communicating with an adaptor sealably engageable with an object to be lifted. The piston is manually moved and set to establish vacuum. A valve is manually actuatable to apply the vacuum to lift the object. 1 fig.

  3. Vacuum leak detector and method

    DOEpatents

    Edwards, Jr., David

    1983-01-01

    Apparatus and method for detecting leakage in a vacuum system involves a moisture trap chamber connected to the vacuum system and to a pressure gauge. Moisture in the trap chamber is captured by freezing or by a moisture adsorbent to reduce the residual water vapor pressure therein to a negligible amount. The pressure gauge is then read to determine whether the vacuum system is leaky. By directing a stream of carbon dioxide or helium at potentially leaky parts of the vacuum system, the apparatus can be used with supplemental means to locate leaks.

  4. Close-packing of growing discs

    SciTech Connect

    Bursill, L.A.; Xudong, F. . School of Physics)

    1988-12-01

    Spiral lattices are derived by allowing growing discs to aggregate under a close-packing rule. Both Fibonacci and Lucas numbers of visible spirals arise naturally, dependent only on the choice of growth centre. Both the rate of convergence towards an ideal spiral, and chirality, are determined by the initial placement of the first few discs (initial conditions). Thus the appearance of spiral packings is no more or less mysterious than the appearance of hexagonal packed arrays of equal discs.

  5. Accretion Discs Show Their True Colours

    NASA Astrophysics Data System (ADS)

    2008-07-01

    Quasars are the brilliant cores of remote galaxies, at the hearts of which lie supermassive black holes that can generate enough power to outshine the Sun a trillion times. These mighty power sources are fuelled by interstellar gas, thought to be sucked into the hole from a surrounding 'accretion disc'. A paper in this week's issue of the journal Nature, partly based on observations collected with ESO's Very Large Telescope, verifies a long-standing prediction about the intensely luminous radiation emitted by these accretion discs. Uncovering the disc ESO PR Photo 21/08 Uncovering the inner disc "Astronomers were puzzled by the fact that the best models of these discs couldn't quite be reconciled with some of the observations, in particular, with the fact that these discs did not appear as blue as they should be," explains lead-author Makoto Kishimoto. Such a discrepancy could be the signal that there was something very wrong with the models. With his colleagues, he investigated this discrepancy by studying the polarised light from six quasars. This enabled them to demonstrate that the disc spectrum is as blue as predicted. "The crucial observational difficulty here has been that the disc is surrounded by a much larger torus containing hot dust, whose light partly outshines that of the disc," says Kishimoto. "Because the light coming from the disc is scattered in the disc vicinity and thus polarised, by observing only polarised light from the quasars, one can uncover the buried light from the disc." In a similar way that a fisherman would wear polarised sunglasses to help get rid of the glare from the water surface and allow him to see more clearly under the water, the filter on the telescope allowed the astronomers to see beyond surrounding clouds of dust and gas to the blue colour of the disc in infrared light. The observations were done with the FORS and ISAAC instruments on one of the 8.2-m Unit Telescopes of ESO's Very Large Telescope, located in the Atacama

  6. The quiescent phase of galactic disc growth

    NASA Astrophysics Data System (ADS)

    Aumer, Michael; Binney, James; Schönrich, Ralph

    2016-07-01

    We perform a series of controlled N-body simulations of growing disc galaxies within non-growing, live dark matter haloes of varying mass and concentration. Our initial conditions include either a low-mass disc or a compact bulge. New stellar particles are continuously added on near-circular orbits to the existing disc, so spiral structure is continuously excited. To study the effect of combined spiral and giant molecular cloud (GMC) heating on the discs, we introduce massive, short-lived particles that sample a GMC mass function. An isothermal gas component is introduced for a subset of the models. We perform a resolution study and vary parameters governing the GMC population, the histories of star formation and radial scale growth. Models with GMCs and standard values for the disc mass and halo density provide the right level of self-gravity to explain the age-velocity dispersion relation of the solar neighbourhood (Snhd). GMC heating generates remarkably exponential vertical profiles with scaleheights that are radially constant and agree with observations of galactic thin discs. GMCs are also capable of significantly delaying bar formation. The amount of spiral-induced radial migration agrees with what is required for the metallicity distribution of the Snhd. However, in our standard models, the outward-migrating populations are not hot enough vertically to create thick discs. Thick discs can form in models with high baryon fractions, but the corresponding bars are too long, the young stellar populations too hot and the discs flare considerably.

  7. Circumplanetary discs around young giant planets: a comparison between core-accretion and disc instability

    NASA Astrophysics Data System (ADS)

    Szulágyi, J.; Mayer, L.; Quinn, T.

    2017-01-01

    Circumplanetary discs can be found around forming giant planets, regardless of whether core accretion or gravitational instability built the planet. We carried out state-of-the-art hydrodynamical simulations of the circumplanetary discs for both formation scenarios, using as similar initial conditions as possible to unveil possible intrinsic differences in the circumplanetary disc mass and temperature between the two formation mechanisms. We found that the circumplanetary discs' mass linearly scales with the circumstellar disc mass. Therefore, in an equally massive protoplanetary disc, the circumplanetary discs formed in the disc instability model can be only a factor of 8 more massive than their core-accretion counterparts. On the other hand, the bulk circumplanetary disc temperature differs by more than an order of magnitude between the two cases. The subdiscs around planets formed by gravitational instability have a characteristic temperature below 100 K, while the core-accretion circumplanetary discs are hot, with temperatures even greater than 1000 K when embedded in massive, optically thick protoplanetary discs. We explain how this difference can be understood as the natural result of the different formation mechanisms. We argue that the different temperatures should persist up to the point when a full-fledged gas giant forms via disc instability; hence, our result provides a convenient criterion for observations to distinguish between the two main formation scenarios by measuring the bulk temperature in the planet vicinity.

  8. Total Disc Replacement in Lumbar Degenerative Disc Diseases

    PubMed Central

    2015-01-01

    More than 10 years have passed since lumbar total disc replacement (LTDR) was introduced for the first time to the world market for the surgical management of lumbar degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where LTDR stands on now, and is heading forward to. The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, LTDR has been expected to replace fusion surgery. A great deal of LTDR reports has come out. Among them, more than 5-year follow-up prospective randomized controlled studies including USA IDE trials were expected to elucidate whether for LTDR to have therapeutic benefit compared to fusion. The results of these studies revealed that LTDR was not inferior to fusion. Most of clinical studies dealing with LTDR revealed that there was no strong evidence for preventive effect of LTDR against symptomatic degenerative changes of adjacent segment disease. LTDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications. LTDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above. PMID:26713139

  9. Grain charging in protoplanetary discs

    NASA Astrophysics Data System (ADS)

    Ilgner, M.

    2012-02-01

    Context. Recent work identified a growth barrier for dust coagulation that originates in the electric repulsion between colliding particles. Depending on its charge state, dust material may have the potential to control key processes towards planet formation such as magnetohydrodynamic (MHD) turbulence and grain growth, which are coupled in a two-way process. Aims: We quantify the grain charging at different stages of disc evolution and differentiate between two very extreme cases: compact spherical grains and aggregates with fractal dimension Df = 2. Methods: Applying a simple chemical network that accounts for collisional charging of grains, we provide a semi-analytical solution. This allowed us to calculate the equilibrium population of grain charges and the ionisation fraction efficiently. The grain charging was evaluated for different dynamical environments ranging from static to non-stationary disc configurations. Results: The results show that the adsorption/desorption of neutral gas-phase heavy metals, such as magnesium, effects the charging state of grains. The greater the difference between the thermal velocities of the metal and the dominant molecular ion, the greater the change in the mean grain charge. Agglomerates have more negative excess charge on average than compact spherical particles of the same mass. The rise in the mean grain charge is proportional to N1/6 in the ion-dust limit. We find that grain charging in a non-stationary disc environment is expected to lead to similar results. Conclusions: The results indicate that the dust growth and settling in regions where the dust growth is limited by the so-called "electro-static barrier" do not prevent the dust material from remaining the dominant charge carrier.

  10. Prevalence of Propionibacterium acnes in Intervertebral Discs of Patients Undergoing Lumbar Microdiscectomy: A Prospective Cross-Sectional Study

    PubMed Central

    Capoor, Manu N.; Ruzicka, Filip; Machackova, Tana; Jancalek, Radim; Smrcka, Martin; Schmitz, Jonathan E.; Hermanova, Marketa; Sana, Jiri; Michu, Elleni; Baird, John C.; Ahmed, Fahad S.; Maca, Karel; Lipina, Radim; Alamin, Todd F.; Coscia, Michael F.; Stonemetz, Jerry L.; Witham, Timothy; Ehrlich, Garth D.; Gokaslan, Ziya L.; Mavrommatis, Konstantinos; Birkenmaier, Christof; Fischetti, Vincent A.; Slaby, Ondrej

    2016-01-01

    Background The relationship between intervertebral disc degeneration and chronic infection by Propionibacterium acnes is controversial with contradictory evidence available in the literature. Previous studies investigating these relationships were under-powered and fraught with methodical differences; moreover, they have not taken into consideration P. acnes’ ability to form biofilms or attempted to quantitate the bioburden with regard to determining bacterial counts/genome equivalents as criteria to differentiate true infection from contamination. The aim of this prospective cross-sectional study was to determine the prevalence of P. acnes in patients undergoing lumbar disc microdiscectomy. Methods and Findings The sample consisted of 290 adult patients undergoing lumbar microdiscectomy for symptomatic lumbar disc herniation. An intraoperative biopsy and pre-operative clinical data were taken in all cases. One biopsy fragment was homogenized and used for quantitative anaerobic culture and a second was frozen and used for real-time PCR-based quantification of P. acnes genomes. P. acnes was identified in 115 cases (40%), coagulase-negative staphylococci in 31 cases (11%) and alpha-hemolytic streptococci in 8 cases (3%). P. acnes counts ranged from 100 to 9000 CFU/ml with a median of 400 CFU/ml. The prevalence of intervertebral discs with abundant P. acnes (≥ 1x103 CFU/ml) was 11% (39 cases). There was significant correlation between the bacterial counts obtained by culture and the number of P. acnes genomes detected by real-time PCR (r = 0.4363, p<0.0001). Conclusions In a large series of patients, the prevalence of discs with abundant P. acnes was 11%. We believe, disc tissue homogenization releases P. acnes from the biofilm so that they can then potentially be cultured, reducing the rate of false-negative cultures. Further, quantification study revealing significant bioburden based on both culture and real-time PCR minimize the likelihood that observed

  11. The Effect of Discectomy and the Dependence on Degeneration of Human Intervertebral Disc Strain in Axial Compression

    PubMed Central

    O’Connell, Grace D.; Malhotra, Neil R.; Vresilovic, Edward J; Elliott, Dawn M.

    2011-01-01

    Study Design Biomechanics of human intervertebral discs before and after nucleotomy. Objective To noninvasively quantify the effect of nucleotomy on internal strains under axial compression in flexion, neutral, and extension positions, and to determine whether the change in strains depended on degeneration. Summary of Background Data Herniation and discectomy may accelerate the progression of disc degeneration. Removal of NP tissue has resulted in altered disc mechanics in vitro, including in a decrease in internal pressure and an increase in the deformations at physiologically relevant strains. We recently presented a technique to quantify internal disc strains using magnetic resonance imaging. Methods Degeneration was quantitatively assessed by the T1ρ relaxation in the nucleus pulposus (NP). Samples were prepared from human levels L3-L4 and/or L4-L5. A 1000N compressive load was applied while in the MR scanner. Nucleotomy was performed by removing 2g of NP through the posterior-lateral AF. The discs were rehydrated, reimaged and retested. The analyzed parameters include axial deformation, AF radial bulge and strains. Results The axial deformation was more compressive following nucleotomy. In the neutral position, the axial deformation following nucleotomy correlated with degeneration (as quantified by T1ρ in the NP), with minimal alteration in nondegenerated discs. Nucleotomy altered the radial displacements and strains in the neutral position, such that the inner AF radial bulge decreased and the radial strains were more tensile in the lateral AF and less tensile in the posterior AF. In the bending loading positions the radial strains were not affected by nucleotomy. Conclusions Nucleotomy alters the internal radial and axial AF strains in the neutral position, which may leave the AF vulnerable to damage and microfractures. In bending, the effects of nucleotomy were minimal; likely due to more of the applied load being directed over the AF. Some of the

  12. LIGO vacuum system study

    NASA Technical Reports Server (NTRS)

    Livas, Jeffrey C.; Moore, Boude C.

    1988-01-01

    A laser interferometer gravitational wave observatory (LIGO) is being developed with sensitivities which will have a high probability of detecting gravitational waves from astrophysical sources. A major component of LIGO is a total of 16 km of 1.2 m (48 inch) diameter tube at a pressure of less than 10 to the minus 8th power torr. It will be of 304L stainless steel procured directly from the steel mills with the initial hydrogen content specially reduced. Projections of the outgassing rates of hydrogen and of water vapor as a function of time are given and the uncertainties discussed. Based on these, a preliminary analysis of the vacuum system is presented.

  13. ULTRA HIGH VACUUM VALVE

    DOEpatents

    Fry, W.A.

    1962-05-29

    A valve for high vacuum applications such as the CStellarator where chamber pressures as low as 2 x 10/sup -10/ mm Hg are necessary is designed with a line-of-sight path through the valve for visual inspection of the contents of reactants in such chambers. The valve comprises a turnable resilient metal ball having an aperture therethrough, means for selectively turning the ball to rotate the axis of its line-of-sight path, and soft, deformable opposing orifices that are movable relatively toward said ball to seal with opposite ball surfaces upon said movement of said axis of said line-of-sight path. The valve also includes a bellows seal connected between said orifices and internal actuating means that eliminates the requirement for gasketed turnable valve closing stems. (AEC)

  14. THERMOCOUPLE VACUUM GAUGE

    DOEpatents

    Price, G.W.

    1954-08-01

    A protector device is described for use in controlling the pressure within a cyclotron. In particular, an electrical circuit functions to actuate a vacuum pump when a predetermined low pressure is reached and disconnect the pump when the pressure increases abcve a certain value. The principal feature of the control circuit lies in the use of a voltage divider network at the input to a relay control tube comprising two parallel, adjustable resistances wherein one resistor is switched into the circuit when the relay connects the pump to a power source. With this arrangement the relay is energized at one input level received from a sensing element within the cyclotron chamber and is de-energized when a second input level, representing the higher pressure limit, is reached.

  15. [Standardized terminology for disc disease].

    PubMed

    Sánchez Pérez, M; Gil Sierra, A; Sánchez Martín, A; Gallego Gómez, P; Pereira Boo, D

    2012-01-01

    This article reviews the terminology used to describe morphological alterations in the intervertebral discs. Radiologists must be able to communicate information about the type, location, and severity of these alterations to medical and surgical clinicians. It is crucial to use simple, standard, and unified terminology to ensure comprehension not only among radiologists but also with professionals from the different specialties for whom the radiology reports are written (fundamentally traumatologists and neurosurgeons). This terminology will help ensure a more accurate diagnosis and better patient management.

  16. Paradoxical herniation in wartime penetrating brain injury with concomitant skull-base trauma.

    PubMed

    Choi, Jay J; Cirivello, Michael J; Neal, Chris J; Armonda, Rocco A

    2011-11-01

    A case of the syndrome of the trephined progressing to paradoxical herniation is presented in a patient with a penetrating brain injury, postdecompressive craniectomy, and a delayed cerebral spinal fluid leak from a skull base defect. The patient had a penetrating head trauma from a high-velocity ballistic projectile during military wartime operations. The patient's clinical course, which demonstrates a rare presentation of central sleep apnea syndrome or Ondine's curse, is reviewed. Radiographic imaging includes sequential computed tomography (CT) scans with and without intrathecal contrast. Medical management was directed at increasing the intracranial pressures (ICPs) by placing the patient into Trendelenburg position and increasing hydration. Surgical intervention involved correction of the skull base defect by intranasal endoscopic repair. A literature review of paradoxical herniation and delayed neurologic decline in postcraniectomy patients is conducted, and the surgical and neurocritical care management is discussed.

  17. Detection of Myofascial Herniation on Dynamic Sonography and Magnetic Resonance Imaging

    PubMed Central

    Khaladkar, Sanjay M.; Kondapavuluri, Sushen Kumar; Kamal, Anubhav; Kalra, Raghav; Kamal, Vigyat

    2016-01-01

    Muscle hernia is an uncommon cause of leg swelling. It can be detected in the early stages only if there is a high index of suspicion. It is common in lower extremity compared to the upper extremity. Tibialis anterior muscle in the leg is commonly involved. Dynamic sonography and magnetic resonance imaging (MRI) are the mainstay in their diagnosis, which demonstrate a facial defect with herniation of muscle fibers. We report a case of 23-year-old male patient who presented with a painless swelling in the anterolateral aspect of the left upper leg. Dynamic sonography done with high-resolution probe demonstrated a defect in fascia overlying tibialis anterior with herniation of outer muscle fibers which increased during dorsiflexion and reduced in the supine position at rest. MRI of the left leg confirmed the findings. PMID:26885428

  18. Acute gastric incarceration from thoracic herniation in pregnancy following laparoscopic antireflux surgery

    PubMed Central

    Brygger, Louise; Fristrup, Claus Wilki; Harbo, Frederik Severin Gråe; Jørgensen, Jan Stener

    2013-01-01

    Diaphragmatic hernia is a rare complication in pregnancy which due to misdiagnosis or management delays may be life-threatening. We report a case of a woman in the third trimester of pregnancy who presented with sudden onset of severe epigastric and thoracic pain radiating to the back. Earlier in the index pregnancy, she had undergone laparoscopic antireflux surgery (ARS) for a hiatus hernia because of severe gastro-oesophageal reflux. Owing to increasing epigastric pain a CT scan was carried out which diagnosed wrap disruption with gastric herniation into the thoracic cavity and threatened incarceration. This is, to our knowledge, the first report of severe adverse outcome after ARS during pregnancy, with acute intrathoracic gastric herniation. We recommend the avoidance of ARS in pregnancy, and the need to advise women undergoing ARS of the postoperative risks if pregnancy occurs within a few years of ARS. PMID:23378556

  19. Case Report: Frontalis sign for early bedside consideration of impending uncal herniation

    PubMed Central

    Munakomi, Sunil; Mohan Kumar, Bijoy

    2016-01-01

    It is prudent to have early diagnosis and timely management of uncal herniation for better management of neurosurgical patients. There are several clinical and radiological armamentariums that aid in early recognition of the condition. Through this case report, we try to highlight a simple bedside clinical sign that can be a valuable adjunct in early recognition of the impending uncal herniation especially in scenarios wherein it is difficult to assess the pupillary size and reactivity correctly. The improvement in the sign also confirms the resolution of the mass effect in the postoperative period. This is especially helpful for doctors working in the periphery or in resource restrained areas, for a timely referral of the patient to tertiary centre. PMID:27635220

  20. Vacuum Energy Sequestering and Graviton Loops.

    PubMed

    Kaloper, Nemanja; Padilla, Antonio

    2017-02-10

    We recently formulated a local mechanism of vacuum energy sequester. This mechanism automatically removes all matter loop contributions to vacuum energy from the stress energy tensor which sources the curvature. Here we adapt the local vacuum energy sequestering mechanism to also cancel all the vacuum energy loops involving virtual gravitons, in addition to the vacuum energy generated by matter fields alone.

  1. Vacuum Energy Sequestering and Graviton Loops

    NASA Astrophysics Data System (ADS)

    Kaloper, Nemanja; Padilla, Antonio

    2017-02-01

    We recently formulated a local mechanism of vacuum energy sequester. This mechanism automatically removes all matter loop contributions to vacuum energy from the stress energy tensor which sources the curvature. Here we adapt the local vacuum energy sequestering mechanism to also cancel all the vacuum energy loops involving virtual gravitons, in addition to the vacuum energy generated by matter fields alone.

  2. Closed Drainage versus Non-Drainage for Single-Level Lumbar Disc Surgery: Relationship between Epidural Hematoma and Fibrosis

    PubMed Central

    2016-01-01

    Study Design A prospective clinical series with prospectively collected data. Purpose The efficacy of using closed suction drains (CSD) after single-level lumbar disc surgery was evaluated. Postoperative CSD are regularly fitted to prevent postoperative epidural hematomas (EH) after multilevel lumbar decompression, although it remains unclear whether CSD also reduces postoperative EH following single-level lumbar disc surgery. Overview of Literature Few articles have addressed the clinical outcome in patients with single-level lumbar disc disease who were treated by two different operative methods (with and without drainage). Methods Between 2012 and 2014, 115 patients with a single level discectomy underwent two surgical procedures: with CSD (group A, 60 cases) and without CSD (group B, 55 cases). There were no significant differences in age, sex, segment level, herniation type, or disease duration between the groups. Wound infection, EH, and epidural fibrosis (EF) were evaluated by magnetic resonance imaging. Pain intensity was evaluated using the visual analog scale (VAS) and Oswestry disability index (ODI). Reduction in analgesic treatment and patient satisfaction were also recorded. Results The overall rate of postoperative EH was 5% and 16.3% in group A and B, respectively, whereas the rate of postoperative EF was 11.6% in group A and 21.8% in group B. The postoperative VAS score was 0.32 (standard deviation [SD], 0.45) for group A and 2.62 (SD, 06.9) for group B, whereas ODI was 9.11 (SD, 0.68) and 8.23 (SD, 0.78) for group A and and group B, respectively, with no significant differences observed. Conclusions In patients operated on by unilateral, single-level lumbar disc surgery, the use of suction CSD into the operation site results in lower levels of EH and EF radiologically, thereby providing a better clinical outcome. PMID:27994783

  3. Breather cloth for vacuum curing

    NASA Technical Reports Server (NTRS)

    Reed, M. W.

    1979-01-01

    Finely-woven nylon cloth that has been treated with Teflon improves vacuum adhesive bonding of coatings to substrates. Cloth is placed over coating; entire assembly, including substrate, coating, and cloth, is placed in plastic vacuum bag for curing. Cloth allows coating to "breathe" when bag is evacuated. Applications include bonding film coatings to solar concentrators and collectors.

  4. Multipurpose Vacuum Induction Processing System

    NASA Astrophysics Data System (ADS)

    Govindaraju, M.; Kulkarni, Deepak; Balasubramanian, K.

    2012-11-01

    Multipurpose vacuum processing systems are cost effective; occupy less space, multiple functional under one roof and user friendly. A multipurpose vacuum induction system was designed, fabricated and installed in a record time of 6 months time at NFTDC Hyderabad. It was designed to function as a) vacuum induction melting/refining of oxygen free electronic copper/pure metals, b) vacuum induction melting furnace for ferrous materials c) vacuum induction melting for non ferrous materials d) large vacuum heat treatment chamber by resistance heating (by detachable coil and hot zone) e) bottom discharge vacuum induction melting system for non ferrous materials f) Induction heat treatment system and g) directional solidification /investment casting. It contains provision for future capacity addition. The attachments require to manufacture multiple shaped castings and continuous rod casting can be added whenever need arises. Present capacity is decided on the requirement for 10years of development path; presently it has 1.2 ton liquid copper handling capacity. It is equipped with provision for capacity addition up to 2 ton liquid copper handling capacity in future. Provision is made to carry out the capacity addition in easy steps quickly. For easy operational maintenance and troubleshooting, design was made in easily detachable sections. High vacuum system is also is detachable, independent and easily movable which is first of its kind in the country. Detailed design parameters, advantages and development history are presented in this paper.

  5. Vacuum Enhanced Cutaneous Biopsy Instrument

    SciTech Connect

    Collins, Joseph

    1999-06-25

    A syringe-like disposable cutaneous biopsy instrument equipped with a tubular blade at its lower end, and designed so that a vacuum is created during use, said vacuum serving to retain undeformed a plug of tissue cut from a patient's skin.

  6. Purifying Aluminum by Vacuum Distillation

    NASA Technical Reports Server (NTRS)

    Du Fresne, E. R.

    1985-01-01

    Proposed method for purifying aluminum employs one-step vacuum distillation. Raw material for process impure aluminum produced in electrolysis of aluminum ore. Impure metal melted in vacuum. Since aluminum has much higher vapor pressure than other constituents, boils off and condenses on nearby cold surfaces in proportions much greater than those of other constituents.

  7. Vacuum flash evaporated polymer composites

    DOEpatents

    Affinito, J.D.; Gross, M.E.

    1997-10-28

    A method for fabrication of polymer composite layers in a vacuum is disclosed. More specifically, the method of dissolving salts in a monomer solution, vacuum flash evaporating the solution, condensing the flash evaporated solution as a liquid film, and forming the condensed liquid film into a polymer composite layer on a substrate is disclosed.

  8. Vacuum flash evaporated polymer composites

    DOEpatents

    Affinito, John D.; Gross, Mark E.

    1997-01-01

    A method for fabrication of polymer composite layers in a vacuum is disclosed. More specifically, the method of dissolving salts in a monomer solution, vacuum flash evaporating the solution, condensing the flash evaporated solution as a liquid film, and forming the condensed liquid film into a polymer composite layer on a substrate is disclosed.

  9. Vacuum Gas Tungsten Arc Welding

    NASA Technical Reports Server (NTRS)

    Weeks, J. L.; Todd, D. T.; Wooten, J. R.

    1997-01-01

    A two-year program investigated vacuum gas tungsten arc welding (VGTAW) as a method to modify or improve the weldability of normally difficult-to-weld materials. After a vacuum chamber and GTAW power supply were modified, several difficult-to-weld materials were studied and key parameters developed. Finally, Incoloy 903 weld overlays were produced without microfissures.

  10. Vacuum enhanced cutaneous biopsy instrument

    DOEpatents

    Collins, Joseph

    2000-01-01

    A syringe-like disposable cutaneous biopsy instrument equipped with a tubular blade at its lower end, and designed so that a vacuum is created during use, said vacuum serving to retain undeformed a plug of tissue cut from a patient's skin.

  11. Stellar discs in Aquarius dark matter haloes

    NASA Astrophysics Data System (ADS)

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

    2012-10-01

    We investigate the gravitational interactions between live stellar discs and their dark matter haloes, using Λ 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.

  12. Partial left pericardial defect with herniation of the left atrial appendage

    PubMed Central

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

    1972-01-01

    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 presence of a pleuropericardial defect. The surgical procedure included excision of the appendage and closure of the defect. Images PMID:5034603

  13. Poland syndrome involving the left hemithorax with dextrocardia and herniation of the spleen

    PubMed Central

    Panda, Shasanka Shekhar; Bajpai, Minu; Singh, Amit; Jana, Manisha

    2014-01-01

    Poland syndrome is characterised by unilateral absence of the large pectoral muscle, ipsilateral symbrachydactyly and occasionally other malformations of the anterior chest wall and breast. The condition is more frequent among men and usually occurs on the right hemithorax in the unilateral form. This case is unique because we believe it is a rare case of Poland syndrome involving the left hemithorax along with dextrocardia and herniation of the spleen from the left subcostal region. PMID:24567179

  14. The Relation Between Sacral Angle and Vertical Angle of Sacral Curvature and Lumbar Disc Degeneration

    PubMed Central

    Ghasemi, Ahmad; Haddadi, Kaveh; Khoshakhlagh, Mohammad; Ganjeh, Hamid Reza

    2016-01-01

    Abstract The purpose of this study is to determine the reliability and validity of a goniometric measurement of the vertical angle of the sacrum and sacral angle (SA), and their relationships to lumbar degeneration. A herniated lumbar disc is one of the most frequent medical issues. Investigators in a number of studies have reported associated risk factors for prevalent disc degeneration. Atypical lumbosacral angles and curvature are thought to contribute to the degradation of the spine by many researchers. This study analyzed 360 patients referred to our clinic from 2013 to 2015 due to low back pain. A cross-sectional case–control study was designed in order to compare the sagittal alignment of the lumbosacral area in 3 groups of patients suffering from LBP. A total 120 patients were in a control group with a normal lumbar magnetic resonance imaging (MRI), 120 patients had lumbar disk herniation (LDH), and 120 patients had spinal stenosis. From the sagittal plan of lumbar MRI, SA and vertical angle of sacral curvature (VASC) were determined and then analyzed. The means of VASC in these groups were: 38.98 (SD: 6.36 ± 0.58), 40.89 (SD: 7.69 ± 0.69), and 40.54 (SD: 7.13 ± 0.92), respectively (P = 0.089). Moreover, studies of SA in 3 groups showed that the means of SA were: 39.30 (SD: 6.69 ± 0.63), 40.52 (SD: 7.47 ± 0.65), and 35.63 (SD: 6.07 ± 0.79), respectively. Relation between SA and spinal stenosis was just statistically significant (P ≤ 0.05). One significant limitation of our study is the lack of standing MRI for increased accuracy of measurement. However, we were reluctant to give patients needless exposure to radiation from conventional X-ray, and instead used MRI scans. We did not find any significant correlation between the VASC and LDH in lumbar MRI. Also, SA is not an independent risk factor for LDH in men and women. We suggested that there are several biomechanical factors involved in LDH. PMID:26871821

  15. Use NASA GES DISC Data in ArcGIS

    NASA Technical Reports Server (NTRS)

    Yang, Wenli; Pham, Long B.; Kempler, Steve

    2015-01-01

    This presentation describes GIS relevant data at NASA Goddard Earth Sciences Data and Information Services Center (GES DISC), GES DISC Services and Support for GIS Users, and use cases of GES DISC data in ArcGIS.

  16. Bubbling the false vacuum away

    SciTech Connect

    Gleiser, M.; Rogers, B.; Thorarinson, J.

    2008-01-15

    We investigate the role of nonperturbative, bubblelike inhomogeneities on the decay rate of false-vacuum states in two- and three-dimensional scalar field theories. The inhomogeneities are induced by setting up large-amplitude oscillations of the field about the false vacuum, as, for example, after a rapid quench or in certain models of cosmological inflation. We show that, for a wide range of parameters, the presence of large-amplitude bubblelike inhomogeneities greatly accelerates the decay rate, changing it from the well-known exponential suppression of homogeneous nucleation to a power-law suppression. It is argued that this fast, power-law vacuum decay--known as resonant nucleation--is promoted by the presence of long-lived oscillons among the nonperturbative fluctuations about the false vacuum. A phase diagram is obtained distinguishing three possible mechanisms for vacuum decay: homogeneous nucleation, resonant nucleation, and crossover. Possible applications are briefly discussed.

  17. Hadron Contribution to Vacuum Polarisation

    NASA Astrophysics Data System (ADS)

    Davier, M.; Hoecker, A.; Malaescu, B.; Zhang, Z.

    2016-10-01

    Precision tests of the Standard Theory require theoretical predictions taking into account higher-order quantum corrections. Among these vacuum polarisation plays a predominant role. Vacuum polarisation originates from creation and annihilation of virtual particle-antiparticle states. Leptonic vacuum polarisation can be computed from quantum electrodynamics. Hadronic vacuum polarisation cannot because of the non-perturbative nature of QCD at low energy. The problem is remedied by establishing dispersion relations involving experimental data on the cross section for e+ e- annihilation into hadrons. This chapter sets the theoretical and experimental scene and reviews the progress achieved in the last decades thanks to more precise and complete data sets. Among the various applications of hadronic vacuum polarisation calculations, two are emphasised: the contribution to the anomalous magnetic moment of the muon, and the running of the fine structure constant α to the Z mass scale. They are fundamental ingredients to high precision tests of the Standard Theory.

  18. [Meningeal herniation associated to chronic otitis media in an otology center in the City of Mexico].

    PubMed

    Esparza Castro, M; Martínez Gutiérrez, N; Jáuregui Renaud, K

    2006-01-01

    To assess the frequency and clinical characteristics of meningocele and meningoencephalocele into the middle ear, at an otological referral center of Mexico city. After analyzing 586 recordings of middle ear surgery, we identified that 3 (0.5%) had defects of the tegmen timpani, 2 had brain abscesses (0.34%) and 1 had (0.17%) a facial palsy. Two of the patients with defects of the tegmen timpani had herniation of the intracraneal tissue. Case 1. A 38 year old woman with a history of bilateral chronic otitis media, with 2 surgeries in the left ear. She was seeking medical care because of right hearing loss. However, computed tomography and magnetic resonance showed a defect of the tegmen timpani with temporal lobe herniation in the left ear. Case 2 was a 46 year old woman with no history of ear disease, just high blood pressure. She was seeking medical care because of right hearing loss, vertigo and headache. The clinical evaluation suggested tissue in the middle ear and the computed tomography showed a defect of the tegmen timpani, meningocele was confirmed by surgery. In the 2 patients the clinical characteristics did not suggest herniation of intracraneal tissue as the first diagnosis. This show us the importance of an intended evaluation and image studies to make an early diagnosis.

  19. Intervertebral disc replacement. Experimental study.

    PubMed

    Kostuik, J P

    1997-04-01

    Arthrodesis of the lumbosacral spine, although satisfactory for a majority of patients, has long term sequelae in 30% of patients. This is particularly true for adjacent segment degeneration. Numerous attempts at providing a mobile motion segment have been made in the past. The current status of the development of dynamic intervertebral prosthesis, including biomechanical and clinical data have been presented. The relevant material properties of plastics, ceramics, and metal are presented with the conclusion that metals currently present with the greatest longevity without undue fatigue and wear as many as 100,000,000 cycles (40 years use) as an alternative to spinal fusion. An analysis of the kinematics of the motion segment have resulted, together with the material properties in the development of a dynamic intervertebral disc for use in the lumbar spine. The disc resembles a normal motion segment. In motion stiffness and center of rotation, wear debris development in 1/300 equivalent to that of a total hip prosthesis for the same given time. Safety features include immediate screw fixation to prevent displacement, a wedge elastic (spring) shape, and a bony porous ingrowth surface. The prosthesis is constructed of cobalt chromium and titanium with minimal corrosive properties on long term testing.

  20. Spiral Waves in Accretion Discs - Theory

    NASA Astrophysics Data System (ADS)

    Boffin, H. M. J.

    Spirals shocks have been widely studied in the context of galactic dynamics and protostellar discs. They may however also play an important role in some classes of close binary stars, and more particularly in cataclysmic variables. In this paper, we review the physics of spirals waves in accretion discs, present the results of numerical simulations and consider whether theory can be reconcilied with observations.

  1. Circular plate capacitor with different discs

    NASA Astrophysics Data System (ADS)

    Paffuti, Giampiero; Cataldo, Enrico; Di Lieto, Alberto; Maccarrone, Francesco

    2016-10-01

    In this paper, we write a system of integral equations for a capacitor composed of two discs of different radii, generalizing Love's equation for equal discs. We compute the complete asymptotic form of the capacitance matrix for both large and small distances obtaining a generalization of Kirchhoff's formula for the latter case.

  2. The inner cavity of the circumnuclear disc

    NASA Astrophysics Data System (ADS)

    Blank, M.; Morris, M. R.; Frank, A.; Carroll-Nellenback, J. J.; Duschl, W. J.

    2016-06-01

    The circumnuclear disc (CND) orbiting the Galaxy's central black hole is a reservoir of material that can ultimately provide energy through accretion, or form stars in the presence of the black hole, as evidenced by the stellar cluster that is presently located at the CND's centre. In this paper, we report the results of a computational study of the dynamics of the CND. The results lead us to question two paradigms that are prevalent in previous research on the Galactic Centre. The first is that the disc's inner cavity is maintained by the interaction of the central stellar cluster's strong winds with the disc's inner rim, and secondly, that the presence of unstable clumps in the disc implies that the CND is a transient feature. Our simulations show that, in the absence of a magnetic field, the interaction of the wind with the inner disc rim actually leads to a filling of the inner cavity within a few orbital time-scales, contrary to previous expectations. However, including the effects of magnetic fields stabilizes the inner disc rim against rapid inward migration. Furthermore, this interaction causes instabilities that continuously create clumps that are individually unstable against tidal shearing. Thus the occurrence of such unstable clumps does not necessarily mean that the disc is itself a transient phenomenon. The next steps in this investigation are to explore the effect of the magnetorotational instability on the disc evolution and to test whether the results presented here persist for longer time-scales than those considered here.

  3. Rapid radiative clearing of protoplanetary discs

    NASA Astrophysics Data System (ADS)

    Haworth, Thomas J.; Clarke, Cathie J.; Owen, James E.

    2016-04-01

    The lack of observed transition discs with inner gas holes of radii greater than ˜50 au implies that protoplanetary discs dispersed from the inside out must remove gas from the outer regions rapidly. We investigate the role of photoevaporation in the final clearing of gas from low mass discs with inner holes. In particular, we study the so-called `thermal sweeping' mechanism which results in rapid clearing of the disc. Thermal sweeping was originally thought to arise when the radial and vertical pressure scalelengths at the X-ray heated inner edge of the disc match. We demonstrate that this criterion is not fundamental. Rather, thermal sweeping occurs when the pressure maximum at the inner edge of the dust heated disc falls below the maximum possible pressure of X-ray heated gas (which depends on the local X-ray flux). We derive new critical peak volume and surface density estimates for rapid radiative clearing which, in general, result in rapid dispersal happening less readily than in previous estimates. This less efficient clearing of discs by X-ray driven thermal sweeping leaves open the issue of what mechanism (e.g. far-ultraviolet heating) can clear gas from the outer disc sufficiently quickly to explain the non-detection of cold gas around weak line T Tauri stars.

  4. 49 CFR 570.56 - Vacuum brake assist unit and vacuum brake system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 6 2011-10-01 2011-10-01 false Vacuum brake assist unit and vacuum brake system... Vehicles With GVWR of More Than 10,000 Pounds § 570.56 Vacuum brake assist unit and vacuum brake system. The following requirements apply to vehicles with vacuum brake assist units and vacuum brake...

  5. 49 CFR 570.56 - Vacuum brake assist unit and vacuum brake system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 6 2014-10-01 2014-10-01 false Vacuum brake assist unit and vacuum brake system... Vehicles With GVWR of More Than 10,000 Pounds § 570.56 Vacuum brake assist unit and vacuum brake system. The following requirements apply to vehicles with vacuum brake assist units and vacuum brake...

  6. 49 CFR 570.56 - Vacuum brake assist unit and vacuum brake system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 6 2013-10-01 2013-10-01 false Vacuum brake assist unit and vacuum brake system... Vehicles With GVWR of More Than 10,000 Pounds § 570.56 Vacuum brake assist unit and vacuum brake system. The following requirements apply to vehicles with vacuum brake assist units and vacuum brake...

  7. 49 CFR 570.56 - Vacuum brake assist unit and vacuum brake system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 6 2010-10-01 2010-10-01 false Vacuum brake assist unit and vacuum brake system... Vehicles With GVWR of More Than 10,000 Pounds § 570.56 Vacuum brake assist unit and vacuum brake system. The following requirements apply to vehicles with vacuum brake assist units and vacuum brake...

  8. 49 CFR 570.56 - Vacuum brake assist unit and vacuum brake system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 6 2012-10-01 2012-10-01 false Vacuum brake assist unit and vacuum brake system... Vehicles With GVWR of More Than 10,000 Pounds § 570.56 Vacuum brake assist unit and vacuum brake system. The following requirements apply to vehicles with vacuum brake assist units and vacuum brake...

  9. About detection of precessing circumpulsar discs

    NASA Astrophysics Data System (ADS)

    Grimani, Catia

    2016-08-01

    Detections of circumpulsar discs and planetary systems through electromagnetic observations appear quite rare. In the case of PSR 1931+24 and B0656+14, the hypothesis of a precessing disc penetrating the pulsar light cylinder is found consistent with radio and gamma observations from these stars. Disc self-occultation and precession may affect electromagnetic measurements. We investigate here under which conditions gravitational waves generated by circumpulsar disc precession may be detected by the proposed second-generation space interferometers DECI-hertz Interferometer Gravitational Wave Observatory and Big Bang Observer. The characteristics of circumpulsar detectable precessing discs are estimated as a function of distance from the Solar system. Speculations on detection rates are presented.

  10. Strongly magnetized accretion discs require poloidal flux

    NASA Astrophysics Data System (ADS)

    Salvesen, Greg; Armitage, Philip J.; Simon, Jacob B.; Begelman, Mitchell C.

    2016-08-01

    Motivated by indirect observational evidence for strongly magnetized accretion discs around black holes, and the novel theoretical properties of such solutions, we investigate how a strong magnetization state can develop and persist. To this end, we perform local simulations of accretion discs with an initially purely toroidal magnetic field of equipartition strength. We demonstrate that discs with zero net vertical magnetic flux and realistic boundary conditions cannot sustain a strong toroidal field. However, a magnetic pressure-dominated disc can form from an initial configuration with a sufficient amount of net vertical flux and realistic boundary conditions. Our results suggest that poloidal flux is a necessary prerequisite for the sustainability of strongly magnetized accretion discs.

  11. Roentgenographic measurement of lumbar intervertebral disc height.

    PubMed

    Andersson, G B; Schultz, A; Nathan, A; Irstam, L

    1981-01-01

    The influences of differences in both intervertebral motion segment orientations and in reader judgments on measurements of the apparent intervertebral disc heights in lateral roentgenographs of the lumbar spine were examined. Forty-nine roentgenographs were obtained of nine discs that were titled laterally up to +/- 10 degrees, and rotated longitudinally up to +/- 20 degrees. Three orthopaedic surgeons and three radiologists measured disc heights from five of these roentgenographs, all using the same measurement method. The differences in apparent height that resulted from the orientation changes and differences in judgments among the six readers were considerable, usually of the order of one half of the nominal disc height. The results show that, while roentgenographic measurements can be used to estimate disc height, accurate measurements cannot readily be made from routine roentgenographs, and the interpretation should always be cautious.

  12. Hypovitaminosis D and Cervical Disk Herniation among Adults Undergoing Spine Surgery

    PubMed Central

    Stoker, Geoffrey E.; Buchowski, Jacob M.; Chen, Christopher T.; Kim, Han Jo; Park, Moon Soo; Riew, K. Daniel

    2013-01-01

    Study Design Single-center, retrospective study. Objective Suboptimal concentrations of vitamin D have been linked to hip and knee osteoarthritis in large, population-based cohort studies. We sought to examine the association of vitamin D levels with intervertebral disk disease. Methods From January 2010 through May 2011, 91 consecutive, eligible adult spine surgery patients who had undergone cervical magnetic resonance imaging (MRI) and preoperative serum 25-hydroxyvitamin D (s25D) measurement were retrospectively included. MRI was read for C2–T1 disk herniation and degeneration (grades I to V). Logistic regressions were performed. Results Compared with the 384 disks of nondeficient patients, 162 disks of vitamin D-deficient (< 20 ng/mL) patients were more frequently herniated (40% versus 27%, p = 0.004); deficiency was not predictive of individual disk grade (unadjusted odds ratio [uOR] = 0.98, p = 0.817). On regression analysis, deficiency was associated with increased number of herniations per patient (uOR = 2.17, 95% confidence interval [CI] = 1.22 to 3.87, p = 0.009; adjusted odds ratio [aOR] = 2.12, 95% CI = 1.11 to 4.03, p = 0.023). When disks were analyzed individually, and levels (e.g., C5 to C6), additionally controlled for, deficiency correlated with greater likelihood of herniation per disk (uOR = 1.81, 95% CI = 1.22 to 2.66, p = 0.003; aOR = 2.06, 95% CI = 1.25 to 3.41, p = 0.005). Conclusion Among adults undergoing spine surgery at our institution, vitamin D deficiency was associated with cervical disk herniation. Considering the current epidemics of vitamin D insufficiency and neck pain, further investigation is warranted, as these data were retrospectively collected and subject to sampling bias. PMID:24436874

  13. The role of thermodynamics in disc fragmentation

    NASA Astrophysics Data System (ADS)

    Stamatellos, Dimitris; Whitworth, Anthony P.

    2009-12-01

    Thermodynamics play an important role in determining the way a protostellar disc fragments to form planets, brown dwarfs and low-mass stars. We explore the effect that different treatments of radiative transfer have in simulations of fragmenting discs. Three prescriptions for the radiative transfer are used: (i) the diffusion approximation of Stamatellos et al.; (ii) the barotropic equation of state (EOS) of Goodwin et al. and (iii) the barotropic EOS of Bate et al. The barotropic approximations capture the general evolution of the density and temperature at the centre of each proto-fragment but (i) they do not make any adjustments for particular circumstances of a proto-fragment forming in the disc and (ii) they do not take into account thermal inertia effects that are important for fast-forming proto-fragments in the outer disc region. As a result, the number of fragments formed in the disc and their properties are different, when a barotropic EOS is used. This is important not only for disc studies but also for simulations of collapsing turbulent clouds, as in many cases in such simulations stars form with discs that subsequently fragment. We also examine the difference in the way proto-fragments condense out in the disc at different distances from the central star using the diffusion approximation and following the collapse of each proto-fragment until the formation of the second core (ρ ~= 10-3gcm-3). We find that proto-fragments forming closer to the central star tend to form earlier and evolve faster from the first to the second core than proto-fragments forming in the outer disc region. The former have a large pool of material in the inner disc region that they can accrete from and grow in mass. The latter accrete more slowly and they are hotter because they generally form in a quick abrupt event.

  14. Vacuum Brazing of Accelerator Components

    NASA Astrophysics Data System (ADS)

    Singh, Rajvir; Pant, K. K.; Lal, Shankar; Yadav, D. P.; Garg, S. R.; Raghuvanshi, V. K.; Mundra, G.

    2012-11-01

    Commonly used materials for accelerator components are those which are vacuum compatible and thermally conductive. Stainless steel, aluminum and copper are common among them. Stainless steel is a poor heat conductor and not very common in use where good thermal conductivity is required. Aluminum and copper and their alloys meet the above requirements and are frequently used for the above purpose. The accelerator components made of aluminum and its alloys using welding process have become a common practice now a days. It is mandatory to use copper and its other grades in RF devices required for accelerators. Beam line and Front End components of the accelerators are fabricated from stainless steel and OFHC copper. Fabrication of components made of copper using welding process is very difficult and in most of the cases it is impossible. Fabrication and joining in such cases is possible using brazing process especially under vacuum and inert gas atmosphere. Several accelerator components have been vacuum brazed for Indus projects at Raja Ramanna Centre for Advanced Technology (RRCAT), Indore using vacuum brazing facility available at RRCAT, Indore. This paper presents details regarding development of the above mentioned high value and strategic components/assemblies. It will include basics required for vacuum brazing, details of vacuum brazing facility, joint design, fixturing of the jobs, selection of filler alloys, optimization of brazing parameters so as to obtain high quality brazed joints, brief description of vacuum brazed accelerator components etc.

  15. Laser photoacoustic detection of CO2 in old disc tree-rings.

    PubMed

    Ageev, Boris; Ponomarev, Yurii; Sapozhnikova, Valeria

    2010-01-01

    A homemade CO2-laser photoacoustic spectrometer has been used for monitoring CO2 in gas samples extracted under vacuum from the wood of old spruce disc tree-rings for a ∼60 year series. The experimental results show that (1) the CO2 concentration exhibits annual trends correlated with an increase in atmospheric CO2 in a number of cases; (2) at the time when the annual CO2 trend changes from positive to negative, the annual tree-ring stable carbon isotope ratios (δ13C) of CO2 change as well; (3) the disc tree-ring widths are observed to decrease in most cases where the annual CO2 increased; (4) simultaneously with the annual CO2 variation, annual H2O distribution was detected in gas samples of the wood tree-rings of one spruce disc. The observed patterns of the annual CO2 distribution in the disc tree-rings are assumed to be the evidence of the impact of the atmospheric CO2 increase. In other words, a change in the concentration gradient between the stem and the atmospheric CO2 may lead to a gradual CO2 accumulation in the stem because of a decrease in the diffusion rate and to a change in the tree parameters.

  16. Optical effects related to Keplerian discs orbiting Kehagias-Sfetsos naked singularities

    NASA Astrophysics Data System (ADS)

    Stuchlík, Zdeněk; Schee, Jan

    2014-10-01

    We demonstrate possible optical signatures of the Kehagias-Sfetsos (KS) naked singularity spacetimes representing a spherically symmetric vacuum solution of the modified Hořava gravity. In such spacetimes, accretion structures significantly different from those present in standard black hole spacetimes occur due to the ‘antigravity’ effect, which causes an internal static sphere surrounded by Keplerian discs. We focus our attention on the optical effects related to the Keplerian accretion discs, constructing the optical appearance of the Keplerian discs, the spectral continuum due to their thermal radiation, and the spectral profiled lines generated in the innermost parts of such discs. The KS naked singularity signature is strongly encoded in the characteristics of predicted optical effects, especially in cases where the spectral continuum and spectral lines are profiled by the strong gravity of the spacetimes due to the vanishing region of the angular velocity gradient influencing the effectiveness of the viscosity mechanism. We can conclude that optical signatures of KS naked singularities can be well distinguished from the signatures of standard black holes.

  17. Influence of high-permeability discs in an axisymmetric model of the Cadarache dynamo experiment

    NASA Astrophysics Data System (ADS)

    Giesecke, A.; Nore, C.; Stefani, F.; Gerbeth, G.; Léorat, J.; Herreman, W.; Luddens, F.; Guermond, J.-L.

    2012-05-01

    Numerical simulations of the kinematic induction equation are performed on a model configuration of the Cadarache von-Kármán-sodium dynamo experiment. The effect of a localized axisymmetric distribution of relative permeability μr that represents soft iron material within the conducting fluid flow is investigated. The critical magnetic Reynolds number Rmc for dynamo action of the first non-axisymmetric mode roughly scales like Rmcμr - Rmc∞∝μ-1/2r, i.e. the threshold decreases as μr increases. This scaling law suggests a skin effect mechanism in the soft iron discs. More important with regard to the Cadarache dynamo experiment, we observe a purely toroidal axisymmetric mode localized in the high-permeability discs which becomes dominant for large μr. In this limit, the toroidal mode is close to the onset of dynamo action with a (negative) growth rate that is rather independent of the magnetic Reynolds number. We qualitatively explain this effect by paramagnetic pumping at the fluid/disc interface and propose a simplified model that quantitatively reproduces numerical results. The crucial role of the high-permeability discs in the mode selection in the Cadarache dynamo experiment cannot be inferred from computations using idealized pseudo-vacuum boundary conditions (H × n = 0).

  18. Vacuum phenomenon: Clinical relevance.

    PubMed

    Gohil, Ishan; Vilensky, Joel A; Weber, Edward C

    2014-04-01

    Vacuum phenomenon (VP) is an anatomical entity of potential confusion in the diagnosis and evaluation of joint pathology. Observation of this phenomenon has been demonstrated on basic radiographs, computed tomography, and magnetic resonance imaging. Although VP is most often associated with degenerative joint disease, it is observed with other pathologies. Two problematic scenarios can occur: a false-positive diagnosis of serious pathology instead of benign VP and a false-negative diagnosis of benign VP with a more serious underlying process Despite this potential for confusion, criteria for distinguishing VP from other causes of joint pain and for evaluating a suspected case of VP have not been fully established. We reviewed the literature to determine underlying mechanism, symptomology, associated pathologies, and clinical importance of VP. The formation of VP can be explained by gas solubility, pressure-volume relationships, and human physiology. CT, GRE-MRI, and multipositional views are the best imaging studies to view VP. Although most cases of VP are benign, it can be associated with clinical signs and symptoms. VP outside the spine is an underreported finding on imaging studies. VP should be on the differential diagnosis for joint pain, especially in the elderly. We have proposed criteria for diagnosing VP and generated a basic algorithm for its workup. Underreporting of this phenomenon shows a lack of awareness of VP on the part of physicians. By identifying true anatomic VP, we can prevent harm from suboptimal treatment of patients.

  19. Compact vacuum insulation

    DOEpatents

    Benson, David K.; Potter, Thomas F.

    1992-01-01

    Improved compact insulation panel is provided which is comprised of two adjacent metal sheets spaced close together with a plurality of spherical, or other discretely shaped, glass or ceramic beads optimally positioned between the sheets to provide support and maintain the spacing between the metal sheets when the gases therebetween are evacuated to form a vacuum. These spherical glass beads provide the maximum support while minimizing thermal conductance. In its preferred embodiment; these two metal sheets are textured with ribs or concave protrusions in conjunction with the glass beads to maximize the structural integrity of the panels while increasing the spacing between beads, thereby reducing the number of beads and the number of thermal conduction paths. Glass or porcelain-enameled liners in combination with the glass spacers and metal sidewalls effectively decrease thermal conductivity, and variious laminates, including wood, porcelain-enameled metal, and others effectively increase the strength and insulation capabilities of the panels. Also, a metal web is provided to hold the spacers in place, and strategic grooves are shown to accommodate expansion and contraction or shaping of the panels.

  20. Compact vacuum insulation

    DOEpatents

    Benson, D.K.; Potter, T.F.

    1992-10-27

    Improved compact insulation panel is provided which is comprised of two adjacent metal sheets spaced close together with a plurality of spherical, or other discretely shaped, glass or ceramic beads optimally positioned between the sheets to provide support and maintain the spacing between the metal sheets when the gases there between are evacuated to form a vacuum. These spherical glass beads provide the maximum support while minimizing thermal conductance. In its preferred embodiment; these two metal sheets are textured with ribs or concave protrusions in conjunction with the glass beads to maximize the structural integrity of the panels while increasing the spacing between beads, thereby reducing the number of beads and the number of thermal conduction paths. Glass or porcelain-enameled liners in combination with the glass spacers and metal sidewalls effectively decrease thermal conductivity, and various laminates, including wood, porcelain-enameled metal, and others effectively increase the strength and insulation capabilities of the panels. Also, a metal web is provided to hold the spacers in place, and strategic grooves are shown to accommodate expansion and contraction or shaping of the panels. 35 figs.

  1. Quantum Vacuum Pathway Theory

    NASA Astrophysics Data System (ADS)

    Habegger, Eric John

    2005-02-01

    It is theorized that the quantum vacuum is a random electromagnetic field that permeates the universe. It will be shown that acceleration between a quark and a random electromagnetic energy field is an analog of the reaction between a charge moving at constant velocity with respect to an organized electromagnetic field. The difference is that with a quark any natural perpendicular deflection during that motion, as predicted by Lorentz, is contained by the strong force, which results in a change in the angular momentum of the spin of a quark. The first derivative of the equations of motion of charges in an organized electromagnetic field may be used when applied to a random electromagnetic field to invoke the same fields modeled by Maxwell's equations. Mass is intimately bound up with a quark's spin angular momentum and the energy for that increase comes directly from the local field. The underlying randomness of the local field normally remains intact through these energy exchanges but it is speculated that in a quantum entanglement, an absolute level of order is imposed on the field along a path between two particles. This causes the non local effects seen in quantum entanglement. The mechanism that may cause this effect is discussed and a simple experiment is proposed that can test the hypothesis. Also discussed are new theoretical constructs for electromagnetic radiation, mass, the skin effect, self-inductance, superposition, and gravity. The emphasis will be on an intuitive and logical approach more than a mathematical approach.

  2. Precooler Ring Vacuum System

    SciTech Connect

    Moenich, J.

    1980-10-02

    The precooler vacuum system, as proposed by FNAL, is based on a suitable modification of the existing Electron Cooling Ring System. Because of the magnetic cycle of the bending magnets, distributed ion pumping, as exists in the Electron Cooling Ring, is not applicable. Instead, the proposed pumping will be done with commercial appendage ion pumps mounted approximately every two meters around the circumference of the ring. The loss of effective pumping speed and non-uniformity of system pressure with appendage pumps may not be major considerations but the large number required does effect experimental and analytical equipment placement considerations. There is a distributed pumping technique available which: (1) is not affected by the magnetic cycle of the bending magnets; (2) will provide a minimum of four times the hydrogen pumping speed of the proposed appendage ion pumps; (3) will require no power during pumping after the strip is activated; (4) will provide the heat source for bakeout; (5) is easily replaceable; and (6) can be purchased, installed, and operated at a generous economic advantage over the presently proposed ion pumped system. The pumping technique referred to is non-evaporable gettering with ST101 Zr/Al pumping strip. A technical description of this pumping strip is given on Data Sheet 1 and 2 attached to this report.

  3. KEKB vacuum system

    NASA Astrophysics Data System (ADS)

    Kanazawa, K.; Kato, S.; Suetsugu, Y.; Hisamatsu, H.; Shimamoto, M.; Sato, M.; Shirai, M.

    2001-01-01

    For KEK B-factory (KEKB), two rings with a circumference of 3016 m, mainly made of copper have been constructed. One ring stores a maximum of 2.6 A positron beam with the energy at 3.5 GeV, the other stores 1.1 A, 8 GeV electron beam. These stored currents far exceed those of existing electron storage rings. The inside of a beam duct is designed to minimize an effect of beam induced fields. A gap between flanges is filled using Helicoflex as a vacuum seal. Contact force of a RF finger in a bellows is assured by the use of a spring finger. Pumping slots are backed by crossing bars to prevent the penetration of beam induced fields. To obtain a pressure of 10 -7 Pa with beam, a pumping speed is designed to realize 0.1 m 3 s -1 m -1 assuming that the photodesorption coefficient reaches 10 -6 molecules/photon. The NEG strip is used as a main pump element. Chemical polishing is applied to clean the extruded surface of copper chambers. Almost all chambers are baked before installation. Only ion pumps are baked in situ. From beginning to end, a completely oil free pumping system is used. The photodesorption coefficient at the start of the commissioning was slightly higher than expected, but the decrease of the coefficient is as expected on the whole. There is no trouble on the RF contact for bellows.

  4. Vacuum still bottoms viscometer

    SciTech Connect

    Dinsmore, T.V.; Wilson, J.H.

    1985-01-01

    A viscometer system that is capable of measuring VSB viscosity on-line has been designed, constructed, and tested. The viscometer will not only provide continuous on-line measurements for process control purposes, but will also determine viscosity as functions of temperature and shear rate. The latter results may be used to verify design-base information for direct coal liquefaction demonstration plants. The viscosities of Wilsonville samples of VSB and LSRC were determined as functions of shear rate and, in the case of LSRC, temperature. The VSB viscosity was found to be shear-rate sensitive, while the LSRC viscosity was temperature sensitive. A 24-h test run was unsuccessful, apparently because the check valves in the pump plugged; however, all other mechanical, electrical, and electronic equipment operated satisfactorily. The source of the plugging was thought to be degradation products, which should not cause difficulties in the pilot plant where fresh vacuum bottoms feed is always available. In summary, the results obtained in this study indicate that the viscometer system is ready to be transported to a plant such as Wilsonville and operated on-line. 7 figs., 5 tabs.

  5. Photoelectron backscattering in vacuum phototubes

    NASA Astrophysics Data System (ADS)

    Lubsandorzhiev, B. K.; Vasiliev, R. V.; Vyatchin, Y. E.; Shaibonov, B. A. J.

    2006-11-01

    In this article we describe results of studies of a photoelectron backscattering effect in vacuum phototubes: classical photomultipliers (PMT) and hybrid phototubes (PH). Late pulses occurring in PMTs are attributed to the photoelectron backscattering and distinguished from pulses due to an anode glow effect. The late pulses are measured in a number of PMTs and HPs with various photocathode sizes covering 1 50 cm range and different types of the first dynode materials and construction designs. It is shown that the late pulses are a generic feature of all vacuum photodetectors—PMTs and PHs—and they do not deteriorate dramatically amplitude and timing responses of vacuum phototubes.

  6. Autologous adipose stem cells and polylactide discs in the replacement of the rabbit temporomandibular joint disc

    PubMed Central

    Ahtiainen, Katja; Mauno, Jari; Ellä, Ville; Hagström, Jaana; Lindqvist, Christian; Miettinen, Susanna; Ylikomi, Timo; Kellomäki, Minna; Seppänen, Riitta

    2013-01-01

    The temporomandibular joint (TMJ) disc lacks functional replacement after discectomy. We investigated tissue-engineered bilayer polylactide (PLA) discs and autologous adipose stem cells (ASCs) as a potential replacement for the TMJ disc. These ASC discs were pre-cultured either in control or in differentiation medium, including transforming growth factor (TGF)-β1 for one week. Prior to implantation, expression of fibrocartilaginous genes was measured by qRT-PCR. The control and differentiated ASC discs were implanted, respectively, in the right and left TMJs of rabbits for six (n = 5) and 12 months (n = 5). Thereafter, the excised TMJ areas were examined with cone beam computed tomography (CBCT) and histology. No signs of infection, inflammation or foreign body reactions were detected at histology, whereas chronic arthrosis and considerable condylar hypertrophy were observed in all operated joints at CBCT. The left condyle treated with the differentiated ASC discs appeared consistently smoother and more sclerotic than the right condyle. The ASC disc replacement resulted in dislocation and morphological changes in the rabbit TMJ. The ASC discs pre-treated with TGF-β1 enhanced the condylar integrity. While adverse tissue reactions were not shown, the authors suggest that with improved attachment and design, the PLA disc and biomaterial itself would hold potential for TMJ disc replacement. PMID:23720535

  7. Intervertebral disc properties: challenges for biodevices.

    PubMed

    Costi, John J; Freeman, Brian J C; Elliott, Dawn M

    2011-05-01

    Intervertebral disc biodevices that employ motion-preservation strategies (e.g., nucleus replacement, total disc replacement and posterior stabilization devices) are currently in use or in development. However, their long-term performance is unknown and only a small number of randomized controlled trials have been conducted. In this article, we discuss the following biodevices: interbody cages, nuclear pulposus replacements, total disc replacements and posterior dynamic stabilization devices, as well as future biological treatments. These biodevices restore some function to the motion segment; however, contrary to expectations, the risk of adjacent-level degeneration does not appear to have been reduced. The short-term challenge is to replicate the complex biomechanical function of the motion segment (e.g., biphasic, viscoelastic behavior and nonlinearity) to improve the quality of motion and minimize adjacent level problems, while ensuring biodevice longevity for the younger, more active patient. Biological strategies for regeneration and repair of disc tissue are being developed and these offer exciting opportunities (and challenges) for the longer term. Responsible introduction and rigorous assessment of these new technologies are required. In this article, we will describe the properties of the disc, explore biodevices currently in use for the surgical treatment of low back pain (with an emphasis on lumbar total disc replacement) and discuss future directions for biological treatments. Finally, we will assess the challenges ahead for the next generation of biodevices designed to replace the disc.

  8. The Quiescent Growth Of Galactic Discs

    NASA Astrophysics Data System (ADS)

    Binney, James

    2016-09-01

    We use N-bodies to simulate the growth since redshift 2 of an isolated disc in a live halo. Giant molecular clouds (GMCs), The bar and spiral structure all play key roles in the evolution of the disc. Our GMCs are short-lived and have masses drawn from a mass spectrum. Their number density is related to the SFR. For the expected number densities and likely maximum masses of GMCs, they heat the disc very effectively at early times, and either postpone or cancel bar formation. They generate remarkably exponential vertical profiles. Spiral structure drives a level of radial migration that agrees well with that predicted by models of local chemical evolution. The radial patterns of star formation include different levels of inside-out growth. The radial scale length of the final disc is always greater than any of the scale lengths used for star formation and rather independent of the extent of inside-out growth. The only way to obtain a thick disc nearly as massive as those observed is to include in the initial conditions a massive, extended object that will be compressed into the present thick disc by the gravity of the thin disc.

  9. Stem cells sources for intervertebral disc regeneration

    PubMed Central

    Vadalà, Gianluca; Russo, Fabrizio; Ambrosio, Luca; Loppini, Mattia; Denaro, Vincenzo

    2016-01-01

    Intervertebral disc regeneration field is rapidly growing since disc disorders represent a major health problem in industrialized countries with very few possible treatments. Indeed, current available therapies are symptomatic, and surgical procedures consist in disc removal and spinal fusion, which is not immune to regardable concerns about possible comorbidities, cost-effectiveness, secondary risks and long-lasting outcomes. This review paper aims to share recent advances in stem cell therapy for the treatment of intervertebral disc degeneration. In literature the potential use of different adult stem cells for intervertebral disc regeneration has already been reported. Bone marrow mesenchymal stromal/stem cells, adipose tissue derived stem cells, synovial stem cells, muscle-derived stem cells, olfactory neural stem cells, induced pluripotent stem cells, hematopoietic stem cells, disc stem cells, and embryonic stem cells have been studied for this purpose either in vitro or in vivo. Moreover, several engineered carriers (e.g., hydrogels), characterized by full biocompatibility and prompt biodegradation, have been designed and combined with different stem cell types in order to optimize the local and controlled delivery of cellular substrates in situ. The paper overviews the literature discussing the current status of our knowledge of the different stem cells types used as a cell-based therapy for disc regeneration. PMID:27247704

  10. Alumina barrier for vacuum brazing

    NASA Technical Reports Server (NTRS)

    Beuyukian, C. S.

    1980-01-01

    Heating platens of vacuum-brazing press will not stick to workpiece if aluminum oxide "paper" is interposed. Paper does not disintegrate in press, will not contaminate braze alloy, and helps form smoothly contoured, regular fillet at brazed edges.

  11. APS storage ring vacuum system

    SciTech Connect

    Niemann, R.C.; Benaroya, R.; Choi, M.; Dortwegt, R.J.; Goeppner, G.A.; Gonczy, J.; Krieger, C.; Howell, J.; Nielsen, R.W.; Roop, B.; Wehrle, R.B.

    1990-01-01

    The Advanced Photon Source synchrotron radiation facility, under construction at the Argonne National Laboratory, incorporates a large ring for the storage of 7 GeV positrons for the generation of photon beams for the facility's experimental program. The Storage Ring's 1104 m circumference is divided into 40 functional sectors. The sectors include vacuum, beam transport, control, acceleration and insertion device components. The vacuum system, which is designed to operate at a pressure of 1 n Torr, consists of 240 connected sections, the majority of which are fabricated from an aluminum alloy extrusion. The sections are equipped with distributed NeG pumping, photon absorbers with lumped pumping, beam position monitors, vacuum diagnostics and valving. The details of the vacuum system design, selected results of the development program and general construction plans are presented. 11 refs., 6 figs., 3 tabs.

  12. Vacuum lamination of photovoltaic modules

    NASA Technical Reports Server (NTRS)

    Burger, D. R.

    1982-01-01

    Vacuum lamination of terrestrial photovoltaic modules is a new high volume process requiring new equipment and newly develop materials. Equipment development, materials research, and some research in related fields and testing methods are discussed.

  13. IRIS Leaves Thermal Vacuum Chamber

    NASA Video Gallery

    This video shows the transportation of the IRIS observatory from the thermal vacuum chamber back to the clean tent for final testing and preparations for delivery to the launch site at Vandenberg A...

  14. [Endoscopic vacuum-assisted closure].

    PubMed

    Wedemeyer, J; Lankisch, T

    2013-03-01

    Anastomotic leakage in the upper and lower intestinal tract is associated with high morbidity and mortality. Within the last 10 years endoscopic treatment options have been accepted as sufficient treatment option of these surgical complications. Endoscopic vacuum assisted closure (E-VAC) is a new innovative endoscopic therapeutic option in this field. E-VAC transfers the positive effects of vacuum assisted closure (VAC) on infected cutaneous wounds to infected cavities that can only be reached endoscopically. A sponge connected to a drainage tube is endoscopically placed in the leakage and a continuous vacuum is applied. Sponge and vacuum allow removal of infected fluids and promote granulation of the leakage. This results in clean wound grounds and finally allows wound closure. Meanwhile the method was also successfully used in the treatment of necrotic pancreatitis.

  15. Chemical separation of disc components using RAVE

    NASA Astrophysics Data System (ADS)

    Wojno, Jennifer; Kordopatis, Georges; Steinmetz, Matthias; McMillan, Paul; Matijevič, Gal; Binney, James; Wyse, Rosemary F. G.; Boeche, Corrado; Just, Andreas; Grebel, Eva K.; Siebert, Arnaud; Bienaymé, Olivier; Gibson, Brad K.; Zwitter, Tomaž; Bland-Hawthorn, Joss; Navarro, Julio F.; Parker, Quentin A.; Reid, Warren; Seabroke, George; Watson, Fred

    2016-10-01

    We present evidence from the RAdial Velocity Experiment (RAVE) survey of chemically separated, kinematically distinct disc components in the solar neighbourhood. We apply probabilistic chemical selection criteria to separate our sample into α-low (`thin disc') and α-high (`thick disc') sequences. Using newly derived distances, which will be utilized in the upcoming RAVE DR5, we explore the kinematic trends as a function of metallicity for each of the disc components. For our α-low disc, we find a negative trend in the mean rotational velocity (Vφ) as a function of iron abundance ([Fe/H]). We measure a positive gradient ∂Vφ/∂[Fe/H] for the α-high disc, consistent with results from high-resolution surveys. We also find differences between the α-low and α-high discs in all three components of velocity dispersion. We discuss the implications of an α-low, metal-rich population originating from the inner Galaxy, where the orbits of these stars have been significantly altered by radial mixing mechanisms in order to bring them into the solar neighbourhood. The probabilistic separation we propose can be extended to other data sets for which the accuracy in [α/Fe] is not sufficient to disentangle the chemical disc components a priori. For such data sets which will also have significant overlap with Gaia DR1, we can therefore make full use of the improved parallax and proper motion data as it becomes available to investigate kinematic trends in these chemical disc components.

  16. VACUUM DEPOSITION OF THIN FILMS,

    DTIC Science & Technology

    The book deals with methods of obtaining and processing thin films , methods of measuring the deposition rate and thickness of thin-film layers, and...the main fields of application of thin films . Vacuum requirements and the requirements for the composition of the residual medium in thermal...evaporation and cathode sputtering are given, and modern methods of producing and measuring vacuums and the equipment used in obtaining thin films are described. (Author)

  17. Systemic Delivery of Bone Marrow Mesenchymal Stem Cells for In Situ Intervertebral Disc Regeneration.

    PubMed

    Cunha, Carla; Almeida, Catarina R; Almeida, Maria Inês; Silva, Andreia M; Molinos, Maria; Lamas, Sofia; Pereira, Catarina L; Teixeira, Graciosa Q; Monteiro, António T; Santos, Susana G; Gonçalves, Raquel M; Barbosa, Mário A

    2017-03-01

    Cell therapies for intervertebral disc (IVD) regeneration presently rely on transplantation of IVD cells or stem cells directly to the lesion site. Still, the harsh IVD environment, with low irrigation and high mechanical stress, challenges cell administration and survival. In this study, we addressed systemic transplantation of allogeneic bone marrow mesenchymal stem cells (MSCs) intravenously into a rat IVD lesion model, exploring tissue regeneration via cell signaling to the lesion site. MSC transplantation was performed 24 hours after injury, in parallel with dermal fibroblasts as a control; 2 weeks after transplantation, animals were killed. Disc height index and histological grading score indicated less degeneration for the MSC-transplanted group, with no significant changes in extracellular matrix composition. Remarkably, MSC transplantation resulted in local downregulation of the hypoxia responsive GLUT-1 and in significantly less herniation, with higher amounts of Pax5+ B lymphocytes and no alterations in CD68+ macrophages within the hernia. The systemic immune response was analyzed in the blood, draining lymph nodes, and spleen by flow cytometry and in the plasma by cytokine array. Results suggest an immunoregulatory effect in the MSC-transplanted animals compared with control groups, with an increase in MHC class II+ and CD4+ cells, and also upregulation of the cytokines IL-2, IL-4, IL-6, and IL-10, and downregulation of the cytokines IL-13 and TNF-α. Overall, our results indicate a beneficial effect of systemically transplanted MSCs on in situ IVD regeneration and highlight the complex interplay between stromal cells and cells of the immune system in achieving successful tissue regeneration. Stem Cells Translational Medicine 2017;6:1029-1039.

  18. Outcomes of single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion.

    PubMed

    Tracey, Robert W; Kang, Daniel G; Cody, John P; Wagner, Scott C; Rosner, Michael K; Lehman, Ronald A

    2014-11-01

    Several studies have established the short-term safety and efficacy of cervical disc arthroplasty (CDA) as compared to anterior cervical discectomy and fusion (ACDF). However, few single-center comparative trials have been performed, and current studies do not contain large numbers of patients. We retrospectively reviewed all patients from a single military tertiary medical center between August 2008 to August 2012 who underwent single-level CDA or single-level ACDF and compared their clinical outcomes and complications. A total of 259 consecutive patients were included in the study, 171 patients in the CDA group with an average follow-up of 9.8 (±9.9)months and 88 patients in the ACDF group with an average follow-up of 11.8 (±9.6)months. Relief of pre-operative symptoms was 90.1% in the CDA group and 86.4% in the ACDF group with rates of return to full pre-operative activity of 93.0% and 88.6%, respectively. Patients who underwent CDA had a higher rate of persistent posterior neck pain (15.8% versus 12.5%), and patients who underwent ACDF were at risk for symptomatic pseudarthrosis at a rate of 3.4%. Reoperation rates were higher in the ACDF group (5.7% versus 3.5%). To our knowledge, this review is the largest, non-funded, comparison study between single-level CDA and single-level ACDF. This study demonstrates that CDA is a safe and reliable alternative to ACDF in the treatment of cervical radiculopathy and myelopathy resulting from spondylosis and acute disc herniation.

  19. Enhancing cell migration in shape-memory alginate-collagen composite scaffolds: In vitro and ex vivo assessment for intervertebral disc repair.

    PubMed

    Guillaume, Olivier; Naqvi, Syeda Masooma; Lennon, Kerri; Buckley, Conor Timothy

    2015-04-01

    Lower lumbar disc disorders pose a significant problem in an aging society with substantial socioeconomic consequences. Both inner tissue (nucleus pulposus) and outer tissue (annulus fibrosus) of the intervertebral disc are affected by such debilitating disorders and can lead to disc herniation and lower back pain. In this study, we developed an alginate-collagen composite porous scaffold with shape-memory properties to fill defects occurring in annulus fibrosus tissue of degenerated intervertebral discs, which has the potential to be administered using minimal invasive surgery. In the first part of this work, we assessed how collagen incorporation on preformed alginate scaffolds influences the physical properties of the final composite scaffold. We also evaluated the ability of annulus fibrosus cells to attach, migrate, and proliferate on the composite alginate-collagen scaffolds compared to control scaffolds (alginate only). In vitro experiments, performed in intervertebral disc-like microenvironmental conditions (low glucose and low oxygen concentrations), revealed that for alginate only scaffolds, annulus fibrosus cells agglomerated in clusters with limited infiltration and migration capacity. In comparison, for alginate-collagen scaffolds, annulus fibrosus cells readily attached and colonized constructs, while preserving their typical fibroblastic-like cell morphology with spreading behavior and intense cytoskeleton expression. In a second part of this study, we investigated the effects of alginate-collagen scaffold when seeded with bone marrow derived mesenchymal stem cells. In vitro, we observed that alginate-collagen porous scaffolds supported cell proliferation and extracellular matrix deposition (collagen type I), with secretion amplified by the local release of transforming growth factor-β3. In addition, when cultured in ex vivo organ defect model, alginate-collagen scaffolds maintained viability of transplanted mesenchymal stem cells for up to 5

  20. Technical specification for vacuum systems

    SciTech Connect

    Khaw, J.

    1987-01-01

    The vacuum systems at the Stanford Linear Accelerator Center (SLAC) are primarily of all-metal construction and operate at pressures from 10/sup -5/ to 10/sup -11/ Torr. The primary gas loads during operation result from thermal desorption and beam-induced desorption from the vacuum chamber walls. These desorption rates can be extremely high in the case of hydrocarbons and other contaminants. These specifications place a major emphasis on eliminating contamination sources. The specifications and procedures have been written to insure the cleanliness and vacuum integrity of all SLAC vacuum systems, and to assist personnel involved with SLAC vacuum systems in choosing and designing components that are compatible with existing systems and meet the quality and reliability of SLAC vacuum standards. The specification includes requirements on design, procurement, fabrication, chemical cleaning, clean room practices, welding and brazing, helium leak testing, residual gas analyzer testing, bakeout, venting, and pumpdown. Also appended are specifications regarding acceptable vendors, isopropyl alcohol, bakeable valve cleaning procedure, mechanical engineering safety inspection, notes on synchrotron radiation, and specifications of numerous individual components. (LEW)

  1. Cold cathode vacuum gauging system

    DOEpatents

    Denny, Edward C.

    2004-03-09

    A vacuum gauging system of the cold cathode type is provided for measuring the pressure of a plurality of separate vacuum systems, such as in a gas centrifuge cascade. Each casing is fitted with a gauge tube assembly which communicates with the vacuum system in the centrifuge casing. Each gauge tube contains an anode which may be in the form of a slender rod or wire hoop and a cathode which may be formed by the wall of the gauge tube. The tube is provided with an insulated high voltage connector to the anode which has a terminal for external connection outside the vacuum casing. The tube extends from the casing so that a portable magnet assembly may be inserted about the tube to provide a magnetic field in the area between the anode and cathode necessary for pressure measurements in a cold cathode-type vacuum gauge arrangement. The portable magnetic assembly is provided with a connector which engages the external high voltage terminal for providing power to the anode within in the gauge tube. Measurement is made in the same manner as the prior cold cathode gauges in that the current through the anode to the cathode is measured as an indication of the pressure. By providing the portable magnetic assembly, a considerable savings in cost, installation, and maintenance of vacuum gauges for pressure measurement in a gas centrifuge cascade is realizable.

  2. How Does Lumbar Degenerative Disc Disease Affect the Disc Deformation at the Cephalic Levels In Vivo?

    PubMed Central

    Wang, Shaobai; Xia, Qun; Passias, Peter; Li, Weishi; Wood, Kirkham; Li, Guoan

    2013-01-01

    Study Design Case-control study. Objective . To evaluate the effect of lumbar degenerative disc disease (DDD) on the disc deformation at the adjacent level and at the level one above the adjacent level during end ranges of lumbar motion. Summary of Background Data It has been reported that in patients with DDD, the intervertebral discs adjacent to the diseased levels have a greater tendency to degenerate. Although altered biomechanics have been suggested to be the causative factors, few data have been reported on the deformation characteristics of the adjacent discs in patients with DDD. Methods Ten symptomatic patients with discogenic low back pain between L4 and S1 and with healthy discs at the cephalic segments were involved. Eight healthy subjects recruited in our previous studies were used as a reference comparison. The in vivo kinematics of L3–L4 (the cephalic adjacent level to the degenerated discs) and L2–L3 (the level one above the adjacent level) lumbar discs of both groups were obtained using a combined magnetic resonance imaging and dual fluoroscopic imaging technique at functional postures. Deformation characteristics, in terms of areas of minimal deformation (defined as less than 5%), deformations at the center of the discs, and maximum tensile and shear deformations, were compared between the two groups at the two disc levels. Results In the patients with DDD, there were significantly smaller areas of minimal disc deformation at L3–L4 and L2–L3 than the healthy subjects (18% compared with 45% of the total disc area, on average). Both L2–L3 and L3–L4 discs underwent larger tensile and shear deformations in all postures than the healthy subjects. The maximum tensile deformations were higher by up to 23% (of the local disc height in standing) and the maximum shear deformations were higher by approximately 25% to 40% (of the local disc height in standing) compared with those of the healthy subjects. Conclusion Both the discs of the adjacent

  3. Intervertebral disc biomechanical analysis using the finite element modeling based on medical images.

    PubMed

    Li, Haiyun; Wang, Zheng

    2006-01-01

    In this paper, a 3D geometric model of the intervertebral and lumbar disks has been presented, which integrated the spine CT and MRI data-based anatomical structure. Based on the geometric model, a 3D finite element model of an L1-L2 segment was created. Loads, which simulate the pressure from above were applied to the FEM, while a boundary condition describing the relative L1-L2 displacement is imposed on the FEM to account for 3D physiological states. The simulation calculation illustrates the stress and strain distribution and deformation of the spine. The method has two characteristics compared to previous studies: first, the finite element model of the lumbar are based on the data directly derived from medical images such as CTs and MRIs. Second, the result of analysis will be more accurate than using the data of geometric parameters. The FEM provides a promising tool in clinical diagnosis and for optimizing individual therapy in the intervertebral disc herniation.

  4. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Interarticular disc prosthesis (interpositional... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis... Food and Drug Administration on or before March 30, 1999, for any interarticular disc...

  5. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Interarticular disc prosthesis (interpositional... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis... Food and Drug Administration on or before March 30, 1999, for any interarticular disc...

  6. 21 CFR 872.3970 - Interarticular disc prosthesis (interpositional implant).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Interarticular disc prosthesis (interpositional... disc prosthesis (interpositional implant). (a) Identification. An interarticular disc prosthesis... Food and Drug Administration on or before March 30, 1999, for any interarticular disc...

  7. Paraplegia caused by giant intradural herniation of a lumbar disk after combined spinal-epidural anesthesia in total hip arthroplasty.

    PubMed

    Sawai, Toshiyuki; Nakahira, Junko; Minami, Toshiaki

    2016-08-01

    Total paraplegia after epidural or spinal anesthesia is extremely rare. We herein report a case of total paraplegia caused by a giant intradural herniation of a lumbar disk at the L3-L4 level after total hip arthroplasty for coxarthrosis. The patient had no preoperative neurologic abnormalities. Intraoperative anesthetic management involved combined spinal-epidural anesthesia at the L3-L4 level with continuous intravenous propofol administration. Postoperatively, the patient complained of numbness and total paraplegia of the lower extremities. Magnetic resonance imaging showed a giant herniation of a lumbar disk compressing the spinal cord at the L3-L4 level. The intradural herniation was surgically treated, and the patient's symptoms completely resolved.

  8. Vacuum-Gauge Connection For Shipping Container

    NASA Technical Reports Server (NTRS)

    Henry, Robert H.

    1990-01-01

    External connector enables measurement of vacuum in stored part. Remote-readout connector added to shipping container and connected to thermo-couple vacuum gauge in vacuum-insulated cryogenic line packed in container. Enables monitoring of condition of vacuum without opening container.

  9. Archival-grade optical disc design and international standards

    NASA Astrophysics Data System (ADS)

    Fujii, Toru; Kojyo, Shinichi; Endo, Akihisa; Kodaira, Takuo; Mori, Fumi; Shimizu, Atsuo

    2015-09-01

    Optical discs currently on the market exhibit large variations in life span among discs, making them unsuitable for certain business applications. To assess and potentially mitigate this problem, we performed accelerated degradation testing under standard ISO conditions, determined the probable disc failure mechanisms, and identified the essential criteria necessary for a stable disc composition. With these criteria as necessary conditions, we analyzed the physical and chemical changes that occur in the disc components, on the basis of which we determined technological measures to reduce these degradation processes. By applying these measures to disc fabrication, we were able to develop highly stable optical discs.

  10. Genetics Home Reference: intervertebral disc disease

    MedlinePlus

    ... link) National Institute of Neurological Disorders and Stroke: Low Back Pain Fact Sheet Educational Resources (8 links) American Association ... MalaCards: intervertebral disc disease Merck Manual Consumer Version: Low Back Pain Merck Manual Consumer Version: Neck Pain The Children's ...

  11. Dynamical modelling of galactic disc outskirts

    NASA Astrophysics Data System (ADS)

    Athanassoula, E.

    2017-03-01

    I review briefly some dynamical models of structures in the outer parts of disc galaxies, including models of polar rings, tidal tails and bridges. I then discuss the density distribution in the outer parts of discs. For this, I compare observations to results of a model in which the disc galaxy is in fact the remnant of a major merger, and find good agreement. This comparison includes radial profiles of the projected surface density and of stellar age, as well as time evolution of the break radius and of the inner and outer disc scale lengths. I also compare the radial projected surface density profiles of dynamically motivated mono-age populations and find that, compared to older populations, younger ones have flatter density profiles in the inner region and steeper in the outer one. The break radius, however, does not vary with stellar age, again in good agreement with observations.

  12. [Disc electrophoresis of collagen protein (author's transl)].

    PubMed

    Reitmayr, P; Verzár, F

    1975-01-01

    The composition of proteins extracted from tendon collagen is investigated by disc electrophoresis. No qualitative differences can be demonstrated between young and old collagen. The action of formaldehyde and methionine on the tendons has no effect on the electrophoretic picture.

  13. Investigation of cryogenic rupture disc design

    NASA Technical Reports Server (NTRS)

    Keough, J. B.; Oldland, A. H.

    1973-01-01

    Rupture disc designs of both the active (command actuated) and passive (pressure ruptured) types were evaluated for performance characteristics at cryogenic temperatures and for capability to operate in a variety of cryogens, including gaseous and liquid fluorine. The test results, coupled with information from literature and industry searches, were used to establish a statement of design criteria and recommended practices for application of rupture discs to cryogenic rocket propellant feed and vent systems.

  14. Disc valve for sampling erosive process streams

    DOEpatents

    Mrochek, John E.; Dinsmore, Stanley R.; Chandler, Edward W.

    1986-01-01

    A four-port disc valve for sampling erosive, high temperature process streams. A rotatable disc defining opposed first and second sampling cavities rotates between fired faceplates defining flow passageways positioned to be alternatively in axial alignment with the first and second cavities. Silicon carbide inserts and liners composed of .alpha. silicon carbide are provided in the faceplates and in the sampling cavities to limit erosion while providing lubricity for a smooth and precise operation when used under harsh process conditions.

  15. Pulmonary sequestration mimicking a pancreas herniation in a case of recurrent Bochdalek hernia

    PubMed Central

    Perentes, Jean Yannis; Ris, Hans-Beat; Halkic, Nermin

    2017-01-01

    In the reported scenario, the patient known for a history of operated Bochdalek hernia or congenital diaphragmatic hernia (CDH) presented with new abdominal pain. The CT-scan suspected the presence of pancreas herniation through a recurrent CDH. Intraoperatively, the patient was found to have a recurrent CDH containing greater omentum concomitantly with a pulmonary sequestration (PS). This case report highlights the fact that intraoperative findings can be different from preoperative radiological diagnosis. In this patient the unusual diaphragmatic hernia content was not identified on preoperative CT. PMID:28203431

  16. Prolapsed vesicostomy results in a strangulated bowel herniation: a rare complication of cutaneous vesicostomy.

    PubMed

    Chu, C C; Diau, G Y

    1994-11-01

    A 3-year-old girl presented with a prolapsed cutaneous vesicostomy, and symptoms and signs of acute intestinal obstruction. The vesicostomy had been performed when she was 19 months old for bilateral vesicoureteral reflux. Postoperatively, prolapse of the bladder from the stoma occurred almost daily. The prolapsed part retracted naturally when the patient was relaxed and reclining. Intestinal obstruction was due to strangulated herniation of the bowel into the prolapsed bladder via the stoma of vesicostomy. Treatment consisted of manual reduction and the stoma of the vesicostomy was revised with the patient under general anesthesia.

  17. Lumbar spine after surgery for herniated disk: imaging findings in the early postoperative period.

    PubMed

    Dina, T S; Boden, S D; Davis, D O

    1995-03-01

    Imaging the lumbar spine after surgery for disk herniation is all too often an unrewarding challenge. A constellation of findings is inevitable, and determining their significance is often impossible. The challenge is greatest during the first few months following surgery, when the rules of scar enhancement, deformity, and mass effect do not apply to differentiation of the abnormal from the normal. A clear understanding of normal postoperative healing is necessary to avoid overreaction to misleading findings. This report reviews imaging of the lumbar spine in the early postoperative period (i.e., the first 6 months after surgery), focusing on the normal healing process that so often mimics complicating or recurrent disease.

  18. Diaphragmatic herniation in the horse: 31 cases from 2001-2006.

    PubMed

    Romero, Alfredo E; Rodgerson, Dwayne H

    2010-11-01

    Diaphragmatic rent and visceral herniation in the horse is seldom diagnosed, but historically carries a poor prognosis. The objective of this study was to document the presentation and surgical management of all diaphragmatic rents as presented to 2 referral institutions over a 5-year period. A review of 31 cases demonstrated that even with advances in surgical management of abdominal and thoracic conditions, little has been done to change the prognosis for this condition. Success rate was 23% for all horses presented for colic and were ultimately diagnosed with a diaphragmatic hernia, and 46% for those cases for which surgical management was elected.

  19. Gastritis of the Herniated Stomach in Patients with Esophageal Hiatus Hernia

    PubMed Central

    Forstner, G. G.; Bogoch, A.

    1963-01-01

    Seven illustrative cases of gastritis of the herniated stomach in patients with sliding esophageal hiatus hernia are reported. Five had superficial gastritis (three mild, one moderate and one severe); two had atrophic gastritis. Gastritis was present in two patients whose mucosa appeared normal at esophagoscopy. Interstitial hemorrhage into the lamina propria was present in four of the seven biopsy specimens. The possibility that interstitial hemorrhage may be related to the development of gastric erosions is considered. The pathogenesis of this form of gastritis is discussed. ImagesFig. 1Fig. 2Fig. 3 PMID:13958838

  20. Vacuum Packaging for Microelectromechanical Systems (MEMS)

    DTIC Science & Technology

    2002-10-01

    The Vacuum Packaging for MEMS Program focused on the development of an integrated set of packaging technologies which in totality provide a low cost...high volume product-neutral vacuum packaging capability which addresses all MEMS vacuum packaging requirements. The program balanced the need for...near term component and wafer-level vacuum packaging with the development of advanced high density wafer-level packaging solutions. Three vacuum