User Tools

Site Tools


lumbar_disc_herniation

Lumbar disc herniation (LDH)

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 1).

Epidemiology

Classification

Pathophysiology

It is debatable whether a local inflammatory tissue response caused by herniated disc material contributes to pain and/or sensorimotor deficits. The impact of inflammatory changes on local tissue remodelling, the healing process and the clinical course of disease remains unclear.

Patients who suffer from disc protrusion will experience more back pain and less radicular pain as a result of stretching of the posterior longitudinal ligament. In contrast, the tension in posterior longitudinal ligament is reduced by exit of disc materials through a tear associated with disc extrusion. This may explain why patients who suffer from an extruded disc often experience a decrease or resolution of back pain, when root symptoms commence or are aggravated.

LDH is a dynamic disease and a herniated disc is not always spontaneously resorbed, in contrast to what has been reported previously. Alleviation of clinical symptoms can be achieved via conservative treatment even if the volume of the herniated disc changes. Spinal surgeons should not only present an option of initial non-surgical treatment to LDH patients but should also inform them that the LDH may change in size during daily activity or exercise 2).

Clinical Features

Diagnosis

Gadolinium-enhanced MRI is a sensitive method to detect unspecific inflammatory reactions in disc herniations. However, the neuroradiological and histological evidence of peridiscal inflammation was not correlated with the severity of pain or sensorimotor deficits. Additional research is needed because the occurrence of local inflammation may indicate an ongoing degradation of herniated fragments and thus be helpful in therapeutic decision-making. 3).

Treatment

Complications

Case series

Case reports

Lumbar disc herniation in children aged 10 years or less is extremely uncommon and posterior apophyseal ring separation is not a common injury that usually occurs in adolescents or young adults after a sports-related microtraumatism. The authors report an unique case of 10-year-old boy who presented with low back pain and radiating pain on both legs. The boy received conservative treatment, which included anti-inflammatory medication, muscle relaxants, and physical therapy, but symptoms were not improved. Computed tomography and magnetic resonance imaging revealed a huge central disc herniation combined with posterior apophyseal ring separation. Microscopic lumbar discectomy with the removal of apophyseal ring separation was performed due to the intractable pain. At six months after surgery, the child was symptom free 4).

References

1)
Radło P, Smetkowski A, Tesiorowski M. [Polish nomenclature of lumbar disc disease]. Przegl Lek. 2014;71(7):394-9. Review. Polish. PubMed PMID: 25338336.
2)
Seo JY, Roh YH, Kim YH, Ha KY. Three-dimensional analysis of volumetric changes in herniated discs of the lumbar spine: does spontaneous resorption of herniated discs always occur? Eur Spine J. 2014 Sep 25. [Epub ahead of print] PubMed PMID: 25253299.
3)
Löhr M, Lebenheim L, Berg F, Stenzel W, Hescheler J, Molcanyi M, Ernestus RI, Bosche B. Gadolinium enhancement in newly diagnosed patients with lumbar disc herniations are associated with inflammatory peridiscal tissue reactions–evidence of fragment degradation? Clin Neurol Neurosurg. 2014 Apr;119:28-34. doi: 10.1016/j.clineuro.2014.01.008. Epub 2014 Jan 18. PubMed PMID: 24635921.
4)
Kim P, Kim SW, Ju CI, Kim HS. Lumbar Disc Herniation Combined with Posterior Apophyseal Ring Separation in a Young Child: A Case Report. Korean J Spine. 2015 Sep;12(3):143-5. doi: 10.14245/kjs.2015.12.3.143. Epub 2015 Sep 30. PubMed PMID: 26512269; PubMed Central PMCID: PMC4623169.
lumbar_disc_herniation.txt · Last modified: 2018/11/07 23:03 by administrador