Lumbar Disc Disease Jae-Won You, M.D. Department of Orthopaedic Surgery, College of Medicine, Chosun University, Kwangju, Korea Address reprint reques

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1 Lumbar Disc Disease Jae-Won You, M.D. Department of Orthopaedic Surgery, College of Medicine, Chosun University, Kwangju, Korea Address reprint requests to Jae-Won You, M.D. Department of Orthopaedic Surgery, College of Medicine, Chosun University, Kwangju, Korea #588 Seosuk-dong, Dong-gu, Kwangju, , Korea Tel : , Fax : ,

2 Fig. 1. MRI finding(t2 weighted image) of disc degeneration showing low signal intensity of the L3-4 disc, increased signal intensity on the inferior endplate of L4 and superior endplate of L5, and collapsed disc space of L5-S

3 Fig. 2. Types of intervertebral disc herniation. 1. Protruding type 2. Extruding type a. Subligamentous b. Transligamentous 3. Sequestrating type Fig. 3. Anamalies of lumbosacral nerve root. Type - Intradural anastomosis Type - Anomalous origin of nerve roots Type - Extradural anastomosis Type - Extradural division

4 Fig. 4. Sensory, motor and tendon reflex changes on the level of disc herniation

5 Fig. 5. Waddell s nonorganic test

6

7 Fig. 6. CT and MRI findings of lumbar spine

8 Fig. 7. Wiltse paraspinal approach for excision of foraminal and far lateral herniated disc is intermuscular dissection between multifidus and longissimus

9 Fig. 8. MRI finding of foraminal and fat lateral disc herniation showing disc material in the intervertebral foramen and left posterolateral corner of the disc

10 Table 1. 5 stages of disc degeneration(adams et al, 1986)

11 11) Bush K, Cowan N, Katz DE, and Phillip Gishen : The natural history of sciatica associated with disc pathology: a prospective study with clinical and independent radiologic follow-up. Spine Vol 17:10: , ) Coscia M, Leipzig T, and Cooper D : Acute cauda equina syndrome. Spine 19: , pain: A prospective, randomized, double-blinded study. J Bone Joint Surg 67A:63-66, ) Deyo RA, Diehl AK, Rosentahl M : How many days of bedrest for acute low back pain? N Engl J Med 315: , ) Frymoyer JW, Pope MH and Clements JH : Risk factor in low back pain. An epidemiologic survey. J Bone Joint REFERENCES 1) :,, 5, , ) :,, , ) Adams MA, Dolan P and Hutton WC : The stages of disc degeneration as revealed by discogram. J Bone Joint Surg, 68-B:36-41, ) Albert T, Balderston RA, Heller JG, Herkowitz HN, Garfin SR, Tomancy K, An HA, Simeone FA : U p p e r lumbar disc herniation. J. Spin.Dis. 6: , ) An HS : Synopsis of spine surgery. pp , Williams & Wilkins, ) Bell GR, Rothman RH, Booth RE, Cuckler JM, Garfin S, Herkowitz H, Simeone FA, Dolinkas C, and Han SS : A study of computer-assisted tomography. II. Comparison of Metrizamide myelography and computed tomography in the diagnosis of herniated lumbar disc and spinal stenosis. Spine 9: , ) Bernard TN : Repeat lumbar spine surgery. Factors influencing outcome. Spine 18: , ) Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW : Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. 72A: , ) Broom MJ : Foraminal and extra-foraminal lumbar disk herniations. Clin Orthop and Rel Res. 289: , ) Buirski G : Magnetic resonance signal patterns of lumbar discs in patients with low back pain. Spine 17:10: , ) Cuckler JM, Bernini PA, Wiesel SW et al : The use of epidural steroids in the treatment of lumbar radicular Surg. 65A: , ) Gleave JRW and McFarlane R : Prognosis for recovery od bladder function following lumbar central disc prolapse. Br J Neurosurg, 76: , ) Hasue M, Kunogi J, Konno S and Kikuchi S : C l a s s i f i - cation by position of dorsal root ganglia in the lumbosacral region. Spine, 14: , ) Kadish L, and Simmons EH : Anomalies of the lumbosacral nerve roots and anatomical investigation and myelographic study. J. Bone Joint Surg. 66B:411, ) Kahanovitz N, Viola K, and Muculloch J : L i m i t e d surgical discectomy and microdiscectomy. A clinical comparison. Spine 14:79-81, ) Kelsey JL, Githens PB and White AA III : A n epidemiologic study of lifting and twisting on the job and risk for acute prolapsed lumbar intervertebral disc. J Orthop Res, 2:61-66, ) Kirkaldy-Willis WH : The relationship of structural pathology to the nerve root. Spine 9:49-52, ) Kostuik JP, Harrington I, Alexander D, et al : C a u d a equina syndrome and lumbar disc herniation. J Bone Jont Surg 68A: , ) Kunogi J and Hasue M : Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 16: , ) Lee CK : Lumbar spinal instability (olisthesis) after extensive posterior spinal decompression. Spine 8: , ) Mixter WJ and Barr JS : Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med, 211: , ) Modic MT, Masaryk TJ and Ross JS : Imaging of

12 degenerative disc disease. Radiology, 168: , ) Osti OL, Vernon-Roberts B, Moore R, and Fraser RD : Annular tears and disc degeneration in the lumbar spine. J Bone Joint Surg(Br) 74-B:678-82, ) Parke WW, Watanabe R : The intrinsic vasculature of the lumbosacral spinal nerve roots. Spine 10: , ) Rydevik B, Pedowitx RA and Hargens RA : Effects of acute graded compression on spinal nerve root function and structure. Spine, 16: , ) Schwarzer AC, April CN, Derby R, Fortin J, Kine G and Bogduk N : The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine, 20: ) Spengler DM : Lumbar discectomy : results with limited disc excision and selective foraminotomy, Spine 7: , ) The Executive Committee of the North American Spine Society : Position statement on discography. Spine, 13: 1343, ) Waddell G, McCulloch JA, Kummel E, Venner RM : Nonorganic physical signs in low-back pain. Spine 5: , ) Waddell G, Sommerville D, Henderson L et al : Objective clinical evaluation of physical impairment in chronic low back pain. Spine 17: , ) Weber H : Lumbar disc herniation: A controlled prospective study with ten years of observation. Spine 8: , ) Weinstein JN and Gordon SL : Low back pain-a scientific and clinical overview. AAOS, , ) Wetzel FT, LaRocca SH, Lowry GL and April CN : T h e treatment of lumbar spinal pain syndromes diagnosed by discography. Lumbar arthrodesis. Spine, 19: , ) Williams R : Microlumbar discectomy. A conservative surgical approach to the virgin herniated lumbar disc. Spine, 3: , ) Yanashita K, Hiroshima K, and Kurata A : Gadolinium-DTPA-enhanced magnetic resonance imaging of a seques-tered lumbar intervertebral disc and its correlation with pathologic findings. Spine Vol 19: ,

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