Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features

Far lateral lumbar disc herniations(FLLDH)represent a separate category of disc pathology which includes both intraforaminal and extraforaminal lumbar disc herniations,that are characterized by a peculiar clinical presentation,diagnostic and treatment modalities as compared to the more frequent median and paramedian disc hernias.Surgical treatment often represents the only effective weapon for the cure of this disease and over the years different approaches have been developed that can reach the region of the foramen or external to it,with different degrees of invasiveness.The diagnosis is more demanding and still underestimated as it requires a more detailed knowledge in the spine anatomy and dedicated radiological studies.Computerized tomography and in particular magnetic resonance imaging are the appropriate tools for the diagnosis of FLLDH.Despite the widespread use of these diagnostic tests,many cases of FLLDH are overlooked due to insufficiently detailed radiological examinations or due to the execution of exams not focused to the foraminal or the extraforaminal region.Neurophysiological studies represent a valid aid in the diagnostic classification of this pathology and in some cases they can facilitate the differential diagnosis with other types of radiculopathies.In the present study,a comprehensive review of the clinical presentation,epidemiology,radiological study and the neurophysiological aspects is presented.

臭氧联合胶原酶注射治疗腰椎间盘突出症的临床观察

目的:观察臭氧联合胶原酶注射治疗腰椎间盘突出症的临床疗效。方法:在C形臂X线下,对108例腰椎间盘突出症患者臭氧联合胶原酶注射术,术后2周、3月、6月随访,根据Macnab标准评定术前及术后疗效。结果:术后2周、3月、6月优良率分别为80.6%、85.2%、91.7%,各例术中及术后无严重并发症发生。结论:臭氧联合胶原酶治疗腰椎间盘突出症安全有效,且中远期疗效更稳定。

极外型腰椎间盘突出症的诊断和改良术式治疗经验体会(附8例报告)

目的 探讨极外型腰椎间盘突出症较为合理的手术方式 ,总结复习 8例病人的临床特点、影像学资料和手术方式及治疗效果。 方法 5例行关节突外侧开窗式椎间盘摘除术 ,3例合并有侧隐窝狭窄行关节突内侧部分切除减压加关节突外侧开窗椎间盘摘除术。 结果 术后随访未见复发和腰椎不稳 ,优 4例 ,良 4例。 结论 对于单纯的极外型椎间盘突出 ,采用小关节突外侧开窗 ,术中只切除少量的关节突和椎板峡部骨质 ;对合并有侧隐窝狭窄或椎管内椎间盘突出者 ,采用小关节内侧部分切除 ,加小关节外侧开窗椎间盘摘除术式 ,保留部分关节突和椎板峡部。这两种术式均既处理了病灶 ,又最大限度地保留了骨性结构 。