Several studies have demonstrated that a genetic factor or familial predisposition contribute to the development of lumbar disc herniation. These studies suggest that there may be a genetic factor in the development of lumbar disc disease. Recently, a polymorphism has been identified in the region of the human aggrecan gene. The purpose of this study was to investigate the relationship between the aggrecan gene polymorphism and lumbar disc disease. Materials and Methods: Sixty-four women, ages 20 to 29 with a mean age of 21.3 years, were the subjects of this study. All patients had MRI analysis in the lumbar spine. The T2-weighted sagittal MRI of the lumbar spine was taken. The degree of disc degeneration was determined according to Schneiderman’s four-grade classification. Disc herniations was evaluated according to MacNab’s classification. Peripheral blood was collected and genomic DNA was extracted from the samples. The polymorphism of the aggrecan gene was detected using a PCR assay. The expressed variable number of tandem repeat (VNTR) polymorphism used in this study occurs in the highly conserved repeat region and results in indivisuals with different length aggrecan core proteins. Results: Thirty two subjects had normal intervertebral discs with high intensity and no herniation. Disc degeneration was observed in 32 subjects. Five subjects demonstrated severe disc degeneration at more than 3 intervertebral levels. A total of 13 alleles have been observed for the aggrecan VNTR and 8 of these were discovered in this study. This distribution was significantly different with an over-representation of the shorter alleles which were 18 and 21 repeats in cases with multi-level disc degeneration and degeneration in the upper lumbar spine. Disc herniation was present in 23 subjects. Fifteen subjects demonstrated protrusion, 7 had extrusion and 1 had sequestration types of herniation. No significant association was found between any of the alleles and the severity and number of disc herniation. Discussion: This study revealed that multi-level and upper lumbar disc degeneration was present in the subjects with shorter VNTR of aggrecan gene. This suggests that the subjects with shorter VNTR of aggrecan gene are at risk for developing disc degeneration at an early age. In contrast, the length of aggrecan VNTR was not related to the existence and the type of disc herniation. Thus, other as yet unspecified and unexplored factors, including the coexistence of several environmental risks and other candidate genes, might contribute to the development of lumbar disc herniation.
The relations between VAS and lumbar JOA were examined. 54 outpatients complaining of acute low back pain were selected at randam. VAS, lumbar JOA, age, sex, and occupation were picked up and studied. Results: Regarding the item of low back pain in lumbar JOA, the kinds of pain were distributed from 1 to 8 degrees in the VAS chart. Correlation between VAS and total point 29 in lumbar JOA was good (r=0.51). But the assessment of the degree of pain was not sufficient with the lumbar JOA alone. Namely, VAS for the direct assessment of low back pain is very useful as another view point of lumbar JOA.
Microdiscectomy for the lumbar disc herniation (LDH) is being done more frequently and numerous studies have shown the results to be just as acceptable as a standard (open) discectomy. We compared clinical results of microdiscectomy versus standard (open) discectomy. Patients and Methods: Microdiscectomies were performed on twenty patients (Group A: mean age 44.4 yrs.), and standard (open) discectomy were performed on twenty patients (Group B: mean age 37.3 yrs.). Clinical results were evaluated by using the Japanese Orthopaedic Association scoring system (JOA score) plus looking at and scoring patient outcomes based on such variables as operation time, blood loss, duration of bed rest and the degree of low back pain at follow up. Results and Discussion: JOA score, mean surgical time and blood loss were not statistically different between patients in Group A and Group B. The duration of bed rest of the patients in Group A was significantly shorter than the duration of bed rest for patients in Group B. Patients in Group A reported less severe low back pain than patients in Group B. Microdiscectomy can preserve the paravertebral muscle better than the standard (open) discectomy. The preservation the soft tissue might lead to the better surgical results and earlier return to normal levels of daily activity. Conclusion: Our study points to better clinical outcomes for patients treated by microdiscectomy than for patients treated by the standard (open) discectomy, particularly with regard to quicker recovery and reduced levels of low back pain at follow up.
This study reviewed the results of the conservative treatment and operative treatment for lumbar degenerative spondylolisthesis (DS). 95 patients with DS were included in this study. 22 were men and 73 were women and the average age at admission was 67 years old. The average follow up period was 2 years. We evaluated their JOA score, the neurological symptoms and the findings of the myelograms and the CTM at the time of admission. JOA score and the symptoms correlated with the prognosis, the operations were performed in almost the patients with cauda equina syndrome. In all cases, the area of the bony canal measured by the CTM correlated with the prognosis, and in the cases with radicular symptoms, there was a correlation between the diameter of the lateral recess and the prognosis. The percent of slip did not correlate with the prognosis.
Thirty-six patients with lumbar canal stenosis were treated with restorative laminotomy(RL: 25 patients)or laminectomy (LE: 11 patients), and the postoperative clinical results were compared between two groups. The mean improvement rates were 70.0% in RL and 59.5% in LE. The mean hospital stay after surgery in RL was shortened statistically, and the mean low-back-pain score six months after surgery in RL was superior statistically. In RL, bony union of restored laminae was observed on CT scan 4 months after surgery on average. The short-term clinical results of restorative laminotomy for lumbar canal stenosis were encouraging.
Anterior direct decompression and fusion using Z-Plate fixation was done on 23 patients with burst fractures of thoracolumbar vertebral bodies. The postoperative results were evaluated clinically and radiologically. The mean age of patient at surgery was 44.2 years. The mean follow-up period on all patients was 1.8 years. Neurologic evaluation was assessed according to a modified Frankel classification. There were 17 patients had neurological deficit at trauma and after surgery 13 patients were improved neurologically. Post-operatively, there were no major complications, such as infection, hardware breakage, and nonunion. The kyphosis gradually advanced postoperatively, by an averaged angle of 3 degrees at final follow-up as measured by the Cobb method. The Z-Plate system is simple and easy to install surgically. The low profile of the screw head helps to prevent late vascular complications. Postoperative assessment by MRI is possible to examine because the fixation system components are fabricated from titanium. The Z-Plate proved useful for anterior spinal column reconstruction.
A 15-year-old (young) woman was admitted to our hospital with a 3 months history of increasingly lower back pain, accompanied by a low grade fever. She complained of back pain exacerbated by movement. There was tenderness on palpation along the lumbar spine posteriorly, associated with paravertebral muscle spasms. There were no neurological finding. Her blood cell (WBC) count was 6,970μl, with 69%neutrophils, and her erythrocyte sedimentation rate was 120 mm/h. No clinically evident systemic or gastrointestinal illness preceded the onset of symptoms. Blood cultures taken at the time of admission remained negative. Bacteriologic examination of feces and urine cultures were negative. Radiographs of the lumbar spine demonstrated narrowing of L3/4 disc space, and irregularity of vertebral end plates of L3/4. Computerized tomography (CT) scan revealed a paravertebral abscess, and magnetic resonance imaging (MRI) showed a change in signal intensity on both T1-and T2-weighted images. Needle biopsy of disc space between the third and fourth lumbar vertebrae and of the fourth lumbar vertebral body was performed under local anesthesia. Culture of L3/4 disc material grew Salmonella oranienburg, but culture material drawn from the fourth lumbar vertebral body grew nothing. The patient received Fosfomycin Sodium (2 g/24 h) for three days, Aztreonam (2 g/24 h) for two weeks, Amikacin sulfate (100 mg/24 h) for five days and Sulfamethoxazole (2 tablets/24 h) for two weeks. She was placed on complete bed rest, and lumbosacral corset was applied. She was reevaluated 4 months after the onset of symptoms. She was well pain-free. She had normal movement of the lumbar spine. Radiographs confirmed spontaneous interbody fusion of the involved adjacent vertebral bodies. Laboratory-test results (WBC count, sedimentation rate, and C-reactive protein), were normal. Salmonellosis rarely causes osteomyelitis in previously healthy young adults. This 15-year-old female was found to have vertebral osteomyelitis due to Salmonella oranienburg. Standard treatment with aztreonam and sulfamethoxazole cured the infection. She recovered after a course of moxaiactam therapy.
Laminectomy is a common surgical intervention for the surgical treatment of lumbar canal stenosis (LCS). However, maintaining posterior column integrity is important for spinal stability, a conclusion confirmed in many biomechanical studies. Many patients after laminectomy complain of low back pain which might be due to a surgically induced weakness of posterior aspect of the spinal column. We devised and performed an original operation that involved en bloc laminotomy or pediculotomy followed by total restoration of posterior thoracic and lumbar spinal arch. From 1997, this method have been applied the treatment of LCS. A significant objective for the development of this surgical approach was to develop a non destructive procedure by which surgeons could address the posterior column of patients who required a laminectomy for the treatment of LCS. To prevent the lamina from entering the spinal canal, the bilateral sides of the laminae are cut obliquely by chisel, and the spinous process of the subadjacent side is cut obliquely to retain interspinous and supraspinous ligaments. After decompression of the spinal canal, each lamina is replaced and fixed crosswise with two Poly-L-lactic acid (PLLA) pins, and the spinous processes are fixed with thread. Between July 1997 and August 1998, this procedure was performed on 28 patients who required an operation for LCS. Thirteen of the 28 patients who demonstrated lumbar instability preoperatively required additional pedicle screw fixation (PSF). Average age at surgery was 66 years (47-84years), The number of restored laminae were 53 (mean 1.9 laminae per one case). Mean operation time was 166 minutes, and the mean blood loss was 438 ml (operation time and blood loss exclude cases required PSF was 129 minutes and 276 ml). Total improvement rate was 80.2% on average. Improvement rates for back pain was 91.3% in average (95.0% in without PSF group and 87.9% in PSF group). Bony union rate was 90.9% in CT scans 4 months postoperatively. Complications such as injury of dural tube and nerve roots, dislocation of lamina, and infection, were not found. Conclusion: Restorative laminotomy for LCS would be superior compared with simple laminectomy.
For analysis of causative and preventive factors influencing low back pain, questionnaire survey concerning on low back pain was carried out on 345 nurses. Complete replies were obtained from 307 nurses (89.0%). Low back pain was occurred in 151 nurses (49.2%). Eighty-nine nurses (58.9%) occurred low back pain aged from 20 to 24 years. Low back pain was more frequently seen on the nurses who were younger and with fewer years of experience. Approximately 50% of the nurses were compelled heavy lifting in excess of 40 kg. Additionally, low back pain was aggravated by a half-sitting and twisting posture. It is essential for nurses to be educated for preventing work related low back pain immediately after employment, and working conditions need to be improved.