1/31. chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation.OBJECTIVE: To describe the nonsurgical treatment of acute S1 radiculopathy from a large (12 x 12 x 13 mm) L5-S1 disk herniation. CLINICAL FEATURES: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. His symptoms began 5 days before the initial visit and progressed despite nonsteroidal anti-inflammatory drugs and analgesic medication. An absent left Achilles reflex, left S1 dermatome hypesthesia, and left gastrocnemius/soleus weakness was noted. magnetic resonance imaging demonstrated a large L5-S1 disk herniation. INTERVENTION AND OUTCOME: Initial treatment of this patient included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy. counseling was provided to reduce abnormal illness behavior risk. Later, flexion distraction and side-posture manipulation were provided to improve joint function. Sensory motor training, trunk stabilization exercises, and trigger point therapy were also used. He returned to modified work 27 days after symptom onset. A follow-up, comparative magnetic resonance imaging (MRI) study was unchanged. He was discharged as symptomatic (zero rating on both the Oswestry and numerical pain scales) after 50 days and 20 visits, although the left S1 reflex remained absent. Reassessment 169 days later revealed neither significant symptoms nor lifestyle restrictions. CONCLUSION: This case demonstrates the potential benefit of a chiropractic rehabilitation strategy by use of multimodal therapy for lumbar radiculopathy associated with disk herniation.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/31. Use of cervical spine manipulation under anesthesia for management of cervical disk herniation, cervical radiculopathy, and associated cervicogenic headache syndrome.OBJECTIVE: To demonstrate the benefits of cervical spine manipulation with the patient under anesthesia as an approach to treating a patient with chronic cervical disk herniation, associated cervical radiculopathy, and cervicogenic headache syndrome. CLINICAL FEATURES: The patient had neck pain with radiating paresthesia into the right upper extremity and incapacitating headaches and had no response to 6 months of conservative therapy. Treatment included spinal manipulative therapy, physical therapy, anti-inflammatory medication, and acupuncture. magnetic resonance imaging, electromyography, and somatosensory evoked potential examination all revealed positive diagnostic findings. INTERVENTION AND OUTCOME: Treatment included 3 successive days of cervical spine manipulation with the patient under anesthesia. The patient had immediate relief after the first procedure. Her neck and arm pain were reported to be 50% better after the first trial, and her headaches were better by 80% after the third trial. Four months after the last procedure the patient reported a 95% improvement in her overall condition. CONCLUSION: Cervical spine manipulation with the patient under anesthesia has a place in the chiropractic arena. It is a useful tool for treating chronic discopathic disease complicated by cervical radiculopathy and cervicogenic headache syndrome. The beneficial results of this procedure are contingent on careful patient selection and proper training of qualified chiropractic physicians.- - - - - - - - - - ranking = 0.71428571428571keywords = herniation (Clic here for more details about this article) |
3/31. Acute postoperative aggravation of radiculopathy as a complication of free fat transplantation in lumbar disc surgery: case report.This case report illustrates a rare case of motor weakness caused by a free fat graft herniation. A 40-year-old woman who had undergone surgery for a herniated lumbar intervertebral disc experienced right lower leg weakness. On magnetic resonance image (MRI) a herniated free fat graft was noted. An emergent operation was performed and the herniated fat graft was removed. Postoperatively, the patient recovered well with improvement of the motor weakness. MRI is a good method for diagnosis of fat graft herniation. The mechanisms of this complication have been documented, and the size of the fat graft plays an important role. The methods for prevention of this herniation are also discussed. Although the transplantation of adipose tissue has many advantages, including the prevention of postoperative epidural fibrosis, great care is needed when applying a fat graft intra-operatively. When a postoperative neurologic deficit develops, herniation of the fat graft must be considered. An emergent operation is the treatment of choice for this particular complication.- - - - - - - - - - ranking = 0.57142857142857keywords = herniation (Clic here for more details about this article) |
4/31. Lumbar disc herniation in a 27-month-old child. Case report.The occurrence of disc herniation is rare in children. A 27-month-old child fell from his cradle and developed, in the following 2 weeks, irritability, low-back pain, and difficulty in walking. On physical examination a compensatory gait, paravertebral muscle spasm, and a restricted right straight-leg raising test were demonstrated. Plain x-ray films revealed a narrowed L4-5 intervertebral space. magnetic resonance imaging of the lumbosacral spine demonstrated decreased signal in the L4-5 disc, with posterior disc protrusion. At surgery, blood infiltrating the subperiosteal plane was observed. Via a left hemilaminectomy and under microscopic magnification, the left L-5 nerve root was found to be intact, and on the right side significant nerve root compression was identified. During dissection an accidental dural tear occurred. A right L-4 hemilaminectomy was performed, and the disc fragments were removed until a complete nerve root decompression was obtained and the dura was repaired. The child recovered uneventfully and was asymptomatic 7 years postsurgery. This child is one of the youngest patients with a herniated disc reported in the world literature. The authors discuss the diagnostic difficulties and management of this entity in children.- - - - - - - - - - ranking = 0.71428571428571keywords = herniation (Clic here for more details about this article) |
5/31. Treatment of cervical radiculopathy with flexion distraction.OBJECTIVE: To discuss the nonsurgical treatment of a cervical disk herniation with flexion distraction manipulation. CLINICAL FEATURES: A case study of cervical disk syndrome with radicular symptoms is presented. magnetic resonance imaging revealed a large C5-C6 disk herniation. Degenerative changes at the affected level were demonstrated on cervical spine plain film radiographs. INTERVENTION AND OUTCOME: The patient received treatment in the form of flexion distraction manipulation and adjunctive therapies. A complete resolution of the patient's subjective complaints was achieved. CONCLUSION: Flexion distraction has been a technique associated with musculoskeletal conditions of the lumbar spine. Flexion distraction applied to the cervical spine might be an effective therapy in the treatment of cervical disk herniations. Although further controlled studies are needed, treatment of cervical disk syndromes with flexion distraction might be a viable form of conservative care.- - - - - - - - - - ranking = 0.42857142857143keywords = herniation (Clic here for more details about this article) |
6/31. Dermatomal somatosensory evoked potential demonstration of nerve root decompression after VAX-D therapy.Reductions in low back pain and referred leg pain associated with a diagnosis of herniated disc, degenerative disc disease or facet syndrome have previously been reported after treatment with a VAX-D table, which intermittently distracts the spine. The object of this study was to use dermatomal somatosensory evoked potentials (DSSEPs) to demonstrate lumbar root decompression following VAX-D therapy. Seven consecutive patients with a diagnosis of low back pain and unilateral or bilateral L5 or S1 radiculopathy were studied at our center. Disc herniation at the L5-S1 level was documented by MRI or CT in all patients. All patients were studied bilaterally by DSSEPs at L5 and S1 before and after VAX-D therapy. All patients had at least 50% improvement in radicular symptoms and low back pain and three of them experienced complete resolution of all symptoms. The average pain reduction was 77%. The number of treatment sessions varied from 12 to 35. DSSEPs were considered to show improvement if triphasic characteristics returned or a 50% or greater increase in the P1-P2 amplitude was seen. All patients showed improvement in DSSEPs after VAX-D therapy either ipsilateral or contralateral to the symptomatic leg. Two patients showed deterioration in DSSEPs in the symptomatic leg despite clinically significant improvement in pain and radicular symptoms. overall, 28 nerve roots were studied before and after VAX-D therapy. Seventeen nerve root responses were improved, eight remained unchanged and three deteriorated. The significance of DSSEP improvement contralateral to the symptomatic leg is emphasized. Direct compression of a nerve root by a disc herniation is probably not the sole explanation for referred leg pain.- - - - - - - - - - ranking = 0.28571428571429keywords = herniation (Clic here for more details about this article) |
7/31. Multiple independent, sequential, and spontaneously resolving lumbar intervertebral disc herniations: a case report.STUDY DESIGN: A case report is presented. OBJECTIVE: To highlight the potential for spontaneous resolution of large extruded intervertebral lumbar disc herniations in a patient with three independent herniations. SUMMARY OF BACKGROUND DATA: The most effective methods of treatment for lumbar intervertebral disc herniations remain in question. This is partly because the potential for intrinsic spontaneous resolution is not understood, and because many believe that large extruded lumbar intervertebral disc herniations require surgical intervention. This case report addresses both issues. methods: A case is reported and the literature is reviewed. RESULTS: In the patient described, multiple independent lumbar intervertebral disc herniations resolved spontaneously both clinically and radiographically with nonoperative treatment. CONCLUSIONS: Not only is the question concerning the cause of disc herniation unresolved, but the best methods of treatment also are generally unclear. This case report documents a patient with the intrinsic capability not only to herniate multiple lumbar intervertebral discs, but also to resolve them clinically and anatomically. Extruded lumbar intervertebral disc herniations may be treated without surgery, as highlighted by this case report. The immunohistologic pathomechanism for resorption remains unclear.- - - - - - - - - - ranking = 1.5714285714286keywords = herniation (Clic here for more details about this article) |
8/31. Lumboradiculopathy due to epidural varices: two case reports and a review of the literature.Lumbar radicular pain caused by epidural varices is rare. Its incidence is evaluated at 4.5% of operations for disc herniation. We report 2 cases which were only diagnosed during surgery for a herniated disk as is usually observed in the literature. The mechanism behind radicular pain is not fully understood. It may be compression by the varix itself but it may also be secondary to diffculty in venous return. Several anatomical types are described: thrombosed varix (type 1), non thrombosed varix (type 2), localized hematoma (type 3). Our 2 cases corresponded to type 2. The diagnosis can established by MRI at the pre-operative stage. The images vary according to the anatomical type and the age of the lesions. Treatment is by surgery.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
9/31. An unusual presentation of a lumbar synovial cyst: case report.STUDY DESIGN: A case of intraforaminal synovial cyst is reported. OBJECTIVES: To stress the importance of the way intraforaminal synovial cyst, a very rare condition, causes a peculiar position of the nerve root in the foramen and to describe the required surgical approach. SUMMARY OF BACKGROUND DATA: Intraforaminal synovial cyst is a highly unusual finding. The existence of this rare entity raises the problem of differential diagnosis with other space-occupying lesions of the neural foramen, such as herniated disc, neurinoma, neurofibroma, and metastatic lesions methods AND RESULTS: A 64-year-old woman suffered a right L4 radiculopathy with motor deficit. Computed tomography showed a space-occupying lesion in the L4-L5 foramen isodense with the disc. Magnetic resonance images showed a right intraforaminal cystic lesion at the L4-L5 level with no enhancement after intravenous infusion of gadolinium. A 3-cm cystic lesion, which appeared to arise from the L4-L5 facet joint without direct communication, was excised from the L4-L5 foramen. In contrast with intraforaminal disc herniation, downward displacement of the L4 nerve root was observed. Two months after surgery, the patient was pain-free and neurologic examination revealed no motor deficit. CONCLUSIONS: An unusual intraforaminal presentation of a lumbar synovial cyst demonstrates the importance of considering this entity and of adapting the surgical technique to avoid injury to the nerve root.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
10/31. Herniated nucleus pulposus with radiculopathy in an adolescent: successful nonoperative treatment.The following report describes a 17-year old girl with a central herniated nucleus pulposus (HNP) at L4-5. The diagnosis of lumbar disk herniation was based on findings from magnetic resonance imaging (MRI). A decision to use conservative treatment was unanimously agreed upon by a team of orthopedists, a neurosurgeon, and an internist. This report follows the patient's course from the onset of pain through the completion of the nonoperative treatment and shows that HNP of a lumbar intervertebral disk with radiculopathy can be treated successfully with aggressive nonoperative care.- - - - - - - - - - ranking = 0.14285714285714keywords = herniation (Clic here for more details about this article) |
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