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Article
Cauda Equina Syndrome (CES) Due to Lumbar Disc Herniation; Correlation between Delayed Decompression and Clinical Outcome

Author: Mousa Imran Alghazali
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 2 Pages: 323-328
Publisher: Babylon University جامعة بابل

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Abstract

Twenty-six patients presented with fully developed CES with delay of 48 hrs to two months, with average age of 40 years ranging from 20-60 years. The follow-up of patients was for two years post-operatively. All patients underwent surgical decompression. The result is not dramatic, but it takes time, leg and back pain relieved in all patients, nineteen patients regained full control of urination, five patients urinate with straining and two patients remained needing catheterization to treat retention. We concluded that surgical decompression is beneficial for those patients presenting late with fully developed CES. So we recommend to do decompression to all patients with CES in spite of the delay in presentation. Further urodynamic studies and monitoring of the intrathecal pressure preoperatively is required.


Article
Correlation between magnetic resonance imaging and intra-operative findings in disc herniation at lumbo-sacral region

Author: Correlation between magnetic resonance imaging and intra-operative findings in disc herniation at lumbo-sacral region
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2015 Volume: 11 Issue: 1 Pages: 25-27
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Prolapsed intervertebral disc is an important and common cause of low backache. MRI has now become universally accepted investigation for prolapsed intervertebral disc. We, however, regularly come across situations, when MRI shows diffuse disc bulges, even at multiple levels, which cannot be correlated clinically and when such cases are operated, no significant disc prolapse is found resulting in negative exploration.Objective: To evaluate the role of M.R.I. finding not only for diagnosis of disc herniation at lumbar region but also for localization the level of herniationMethods: A prospective study on seventy five symptomatic low backache and MRI confirmed prolapsed intervertebral disc patients at lumbo-sacral region were operated on, all of the cases required excision of disc through posterior approach in knee elbow position. The time between MRI taken and surgery was two weeks, from which the data were taken in a questioner forma which include name , age ,gender , occupation , chief complaint , duration, MRI findings and intra operative finding , from June 2011 to October 2013 at Al- Kindy teaching hospital .Results: In our study 75 patients were diagnosed by clinical examination and MRI finding to have disc herniation at lumbar region . The female more than male( 36 females , 12 males) and the ratio was 5-1, the accuracy of MRI against intra operative finding in deciding the provisional diagnosis as disc herniation was 68% .The commonest site was L4-5 disc herniation 43 patients (57.3 % ) , and L5-S1 prolapse is the next common disc herniation level 27 patient (36 % ) , L3-L4 disc herniation was two cases (2.7 %) and L4-L5 ,L5-S1 disc herniation was 3 cases (4% ).Conclusion: The most common level was L4-5 followed by L5S1.The MRI is more accurate in diagnosis of the lumbo-sacral disc herniation and its level in single one is more than multiple levels.Keywords: Disc herniation, MRI, Surgery, posterior approachAl


Article
Results and predictive factors for single level L4-5, and L5-S1 disc herniation surgery
النتائج والعوامل التنبوئية للعمليات الجراحية لاستأصال الفتق الغضروفي للفقرات القطنية الرابعة – الخامسة والقطنية الخامسة – العجزية الاولى

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Abstract

Background: The disc prolapse is a common condition especially in young adults. Different levels are affected in the lumber region; the L4/L5 disc is more susceptible to longitudinal load and is the most common site of lumbar disc prolapse. The L5/S1 disc is protected from torsion load by strong ilio-lumbar ligaments but it is more susceptible to axial compressive forces. Many factors affect the result and outcome of surgery in these levels.Objective: The aim of this study is to correlate operative data, short-term results, complications, and prognostic factors (age, gender, mobility, hospital stay, and level of pain) for one-level lumber discectomybetween different levels (L4–L5 vs. L5–S1).Methods In this prospective study, 32 patientsin Al-Yarmouk teaching hospital undergoing survey form March 2008-December 2012.Six patients were excluded from this study because they were diabetics and multilevel disc degeneration .Fifteen (57.6%) patients undergoL5-S1 discectomy and 11 (42.4%) patients undergoL4-5 discectomy. Questionnaires for leg and back pain intensity (Visual Analogue Scale ;VAS), duration of leg pain, and disability (Oswestry Disability Index; ODI), were obtained preoperatively, 3 months, 6 months, 1-year- and 2 year follow-up.Analyses were utilized to evaluate the relationship between surgical outcomes and variable (gender, age, lumber segment, pre-operative ODI, and pre-operative VAS).Results: Mean operative time was[73.44 ± 26.25] min, mean hospital stay was [3-7] days, and mean mobilitywas [2.55 ± 0.93] days. At 2-year follow up, patients revealed a statistical significant improvement inVAS pain (P < 0.05), and ODI lumbar function (P < 0.05).The complications rate were 20.3 %.Our study elaborates good results for one-segmental L5-S1overL4-L5 discectomy. Discectomy of the L4–L5 disc wasassociated with an increased risk of complication (P < 0.05). The comparison revealed that operative time was influenced by age (P = 0.034); hospital stay was influenced by level (P = 0.036) and pre-op VAS (P = 0.006); while complications were influenced by level (P = 0.001) and pre-op ODI (P = 0.049Conclusion: The study revealed significant results for L5-S1 discectomy over L4-L5 discectomy in the late follow up period; the complications rate were higher in L4-L5 level discectomy.

الخلفيه: الأنزلاق الغضروفي حالة شائعة خاصة عند متوسطي العمر. عدة مستويات في الفقرات القطنية ممكن أن تتأثر بالنزلاق الغضروفي ، والغضروفالرابع – الخامس – الخامس القطني ھو أكثر عرضه للجھد العامودي وھو المستوى الكثر للأنزلاق الغضروفي. الغضروف القطني الخامس – العجزيالاول محمي من الجھد الدوراني بواسطة الوتار القطنية – الحرقفية القوية لاكنه عرضٮة أكثر للقوة الضاغطة المحورية. عدة عوامل تؤثر على نتيجةوحصية العمليات الجراحية لھذه المستويات.الھدف: ھدف ھذه الدراسة ھو اقامة علاقة متبادلة بين البيانات الجراحية ، النتائج قصيرة الأجل ، المضاعفات ،العوامل التكھنية (العمر ، الجنس ، العودة الى المشي ، البقاء في المستشفى ، و مستوى الألم) لعمليات أستأصال الغضروف القطني الواحد للمستوياتلمختلفة (القطنية الرابعة – الخامسة مع القطنية الخامسة – الأولى).طريقة البحث :في ھذه الدراسة المستقبلية ، ٢٦ مريض أجريت لھم عمليات في مستشفى٢٠١٢ . خمسة عشر ( ٥٦,٧ %) من المرضى. أجريت لھم عمليات استأصل الأنزلاق الغضروفي القطني – اليرموك التعليمي خلال الفترة من ٢٠٠٨٤٢,٤ %) من المرضى أجريت لھم عمليات أستأصل الأنزلاق الغضروفي القطني الرباع – الخامس. أجري أستطلاع ) الخامس – العجزي الأول و ١١مدة ألم الساق ، ومؤشر أوسوستري للعجز ، وتم جمع المعلومات قبل العملية ، ٣ أشھر ، ٦ أشھر ، سنة ، وسنتين ، (VAS) لمقياس شدة ألم الظھر والساقمن المتابعة. تحليلات أستخدمت لتقييم العلاقة بين الحصيلة الجراحية والمتغيرات (الجنس ، العمر ، مستوى الأنزلاق المعالج ، مؤشر أوستري للعجز ،


Article
HISTOLOGICAL CHANGES OF LIGAMENTA FLAVA IN ‎LUMBAR DISC HERNIATION AND SPINAL CANAL ‎STENOSIS

Authors: Hatem A Hatem --- Khalida K Jbara --- Thamer A Hamdan
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2005 Volume: 11 Issue: 2 Pages: 24-37
Publisher: Basrah University جامعة البصرة

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Abstract

‏ ‏Samples of ligamenta flava were obtained after surgical operations from 50 patients with a ‎lumbar disc herniation, another 50 patients with a lumbar canal stenosis, and 25 patients with ‎spinal fractures who were used as control group. ‎‎ Ligamenta flava from control patients aged below 46 years consisted of large elastic fibers, ‎thin bundles of collagen fibers, and few spindle-shaped fibroblast cells.‎In close proximity to the laminal insertion, the ligamentum flavum had fibrocartilagineous ‎features. in the control patients who were aged 46 or older, the areas that had fewer and thinner ‎elastic fibers and a more abundant collagen component were visible occasionally. The spindle-‎shaped fibroblast cells were fewer compared with control patients aged below 46 years. Also ‎remnants of necrotic cells and few, short, thin, interwoven, fragmented, non-branching elastic ‎fibers, as well as small calcified areas, were occasionally visible. ‎‎ In close proximity to the laminal insertion, the ligamentum flavum had larger fibrocartilaginous ‎features with more collagen fibers compared with younger patients. ‎‎ In patients with disc herniation, the ligamenta flava had nearly similar morphologic features to ‎those of the control patients of similar ages. The ligamenta flava from patients with lumbar ‎spinal stenosis aged below 46 years showed areas of fibrosis in which the cells were often ‎represented by fibroblast cells and in stenotic patients older than 46 years, central portion of ‎ligamentum flavum showed areas of fibrosis, in which the elastic fibers appear normal in some ‎areas, showed little changes in others and in most of these areas showed great changes. ‎Fibrous septa, degenerating elastic fibers as well as small calcified areas were observed often.‎‎ In conclusion, Lumbar ligamentum flavum as any tissue in human body undergo degenerative ‎changes during aging. In lumbar canal stenosis, the degenerative changes were more obvious ‎compared with normal spine or lumbar disc herniation. In stenotic patients, ligamenta flava ‎show a significant decrease in the elastic component as a result of fibrosis and chondroid ‎metaplasia of the tissue, as well as degeneration of the elastic fibers. These changes, and the ‎presence of calcified areas within the tissue, decrease the elasticity of the ligaments. An elastic ‎tissue can be deformed under traction and gradually return to its normal size, proportional to ‎the decrease of the elastic tension. Ligamenta flava do not normally bulge into the spinal canal ‎when spine is in the neutral position.‎


Article
Lumbar Disc Herniation in Adolescents and Young Adults in Erbil Teaching Hospital: A clinical, Radiological and Surgical Study
الإنزلاق الغضروفي الحاصل في سن المراهقة وبداية البلوغ في مستشفى أربيل التعليمي: دراسة سريرية وشعاعية وجراحية

Author: Emad Kh. Hammood د.عماد خليل حمود
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2017 Volume: 13 Issue: 1 Pages: 94-102
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Degenerative changes in the intervertebral disc begin at the late teens and early adult life, after the completion of the physical growth and development. Lumbar disc herniation is rare in children and adolescents. The clinical presentation and etiology of lumber disc herniation may differ from that in adults. Objective: To determine the rate of lumber disc herniation among adolescents and to describe the radiological, clinical features and surgical outcomes of lumber disc herniation in a group of adolescent and young adult patients.Patients and Methods: A retrospective revision of 1045 cases of lumbar disc excisions performed at the neurosurgical unit of Erbil teaching hospital between 2001 and 2015 was done. In all cases, the diagnosis was achieved pre-operatively by lumbar spine MRI with or without CT scan. Initially all patients were treated conservatively for more than 3 months without success. The indications for surgery were failure of conservative treatment, intractable pain and/or progressive neurological impairment. Surgical posterior discectomy with fenestration or partial laminectomy or hemi-laminectomy was performed. On the day of discharge Kirkaldy-Willis criteria was used to assess the patient post-operatively.Results: Thirteen (1.22%) of the 1045 patients were adolescents and young adults between 13 and 21 years of age with a male: female ratio of 1.16: 1. Nearly 70 % of patients had a history of trauma. Lumbar back pain and radicular sciatica were the main complaints in 77% of the patients. Two patients had radicular leg pain. Only one patient of the 13 patients experienced lumbar back pain without leg pain. Only one patient was found to have neurological deficit with partial foot drop. Prior to surgical intervention, straight leg raising test was positive in all 13 patients. All of the patients had symptoms duration for more than 3 months. The radiological and surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Epiphyseal ring fracture was found in 4 of the 5 patients who underwent CT study. Results of Kirkaldy-Willis criteria were excellent or good in 92 % of patients. The follow-up period ranged from 4 months to 2 years with an average of 14 months.Conclusion: Young adults and adolescents disc herniation is uncommon and is often precipitated by trauma. Surgical treatment of such patients relieves clinical symptoms quickly and is associated with good and excellent results in nearly all patients.

خلفية الدراسة: تبدأ التغيرات الإنحلالية الحاصلة في غضروف الفقرات في نهاية المراهقة وبداية البلوغ بعد إنتهاء مرحلة النمو الجسماني والتطور. والإنزلاق الغضروفي القطني نادر الحصول عند الأطفال والمراهقين وتختلف أعراضه السريرية والأسباب عن تلك لدى البالغين.اهداف الدراسة: لتقييم معدل الإنزلاق الغضروفي القطني عند المراهقين ودراسة النتائج السريرية والاشعاعية والجراحية عند مجموعة من المرضى المراهقين وفي بداية البلوغ .المرضى والطرائق : تمت هذه الدراسة الإسترجاعية على 1045 حالة رفع الغضروف جراحياً والتي تم إجراؤها سابقا في وحدة جراحة الأعصاب في مستشفى أربيل التعليمي بين عام 2001 وعام 2015 . تم تشخيص كافة الحالات قبل العملية بواسطة إجراء رنين مغناطيسي للفقرات القطنية مع أو بدون فحص المفراس .في البداية كافة الحالات عولجت تحفظيا لمدة تجاوزت ثلاثة أشهر ولكن بدون نجاح، تم بعدها إجراء العملية الجراحية الملائمة للمرضى غير المستجيبين للعلاج التحفظي والذين لم يتحملوا الألم الشديد أو بدء ظهور ضرر عصبي متطور مع الوقت. وفي يوم إخراج المريض من الردهة تم تقييم حالة المريض بعد العملية من خلال إستعمال kirkaldy –Willis criteria .النتائج: كان 13 من ال 1045 مريض في سن المراهقة وفي بداية البلوغ بين عمر 13 سنة و21 سنة وكانت نسبة الذكور الى الاناث 1,16:1. كان حوالي 70% من المرضى لديهم تاريخ سابق لشدة خارجية. وكانت المعاناة الرئيسية عند. 77% من المرضى هي وجود ألم الظهر في المنطقة القطنية وعرق النسا. استمرت اعراض المرض لمدة تجاوزت ثلاثة اشهر. كانت نتائج kirkaldy –Willis criteria ممتازة او جيدة عند92% من المرضى. تم متابعة المرضى لفترة تتراوح بين 4 أشهر وسنتين وبمعدل 14 شهر.الاستنتاجات: الانزلاق الغضروفي عند المراهقين وفي بداية البلوغ غير شائع وفي كثير من الحالات يعود سببه الى التعرض لشدة خارجية. التداخل الجراحي للمرضى يزيل او يسكن الاعراض السريرية بسرعة ويتصاحب بنتائج جيدة وممتازة عند الاكثرية من المرض


Article
Laminectomy versus interlaminar approach for Lumbar disc herniation
عمليات فتح الظهر بطريقة فتح الصفائح العظمية مقابل عمليات الفتحة الصغيرة بدون فتح الصفائح العظمية لحالات انزلاق الفقرات القطنية

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Abstract

Background: Low back pain is the most common health problem in men and women between the ages of 20and 50 years. The lumbar disc prolapse has a major role in this condition. Treatment is either conservative orsurgical. The most common surgical interventions are either laminectomy or interlaminar approach.Objective: To determine which is the best surgical approach for the patient according to his/her type ofdisc herniation.Patients and methods: A comparative clinical study conducted in the Neurosciences Hospital, Baghdad,Iraq from January 2016 to January 2018. In this paper we evaluated the clinical outcome following bothapproachesResults: We studied sixty cases; thirty-four patients had interlaminar approach for lumbar discectomy whiletwenty-six patients had laminectomy with discectomy.Conclusion: Both methods can manage different types of lumbar disc prolapse, apart from far-lateral discwhich favors laminectomy approach.

ومن اهم اسبابه الانزلاق الغضروفي بالفقرات القطنية. تكون المعالجة عادة تحفظيا وفي حالة عدم الاستفادة يكون التداخل الجراحي هو البديل. يوجدنوعين من التداخل، اما بفتح الصفائح العظمية او بدونهالهدف: ارتأينا في هذه الدراسة مقارنة مخرجات المرضى الذين اجري لهم أحد هذين النوعين من التداخل الجراحي وايهما أفضل حسب نوع الانزلاقالغضروفي لكل مريضالمرضى والطريقة: اجريت الدراسة في مستشفى العلوم العصبية ببغداد للفترة من كانون الثاني ٢٠١٦ ولغاية كانون الثاني ٢٠٠٨ . وشملت ستين مريضااجري لكل منهم نوع من التداخل الجراحيالنتائج: كلتا الطريقتين حققتا النتائج المرجوة للمرضى ماعدا في حالة الانزلاق الوحشي البعيد حيث كانت النتائج أفضل لمن اجرى العملية بفتح الصفائحالعظميةالاستتنتاج: العملية الجراحية تبقى الخيار الاخير في علاج الانزلاق الغضروفي للفقرات القطنية وتعتمد على مهارة الجراح في اي نوع من العملياتيفضل ان يجريها والنتائج متقاربة ويفضل في حالات الانزلاق الوحشي البعيد ان تجرى بفتح الصفائح العظمية

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