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Gait in relation to the level of lumbar disc herniation

On December 19, 2011, in Studies, by admin
Lumbar Disc Herniation Influences Gait

Lumbar Disc Herniation Influences Gait: Muscle weakness, reduced motor function, and change in walking capacity are potential complications resulting from an herniated disc. Other clinical symptoms include pain, sensory changes and impaired reflexes, although the specific effects of disc herniation on muscle function during gait have not been adequately documented in the literature.

Abstract

STUDY DESIGN:

A comparison between gait in patients undergoing surgery for L4 and L5 lumbar disc herniations and that in an age- and weight-matched control group.

OBJECTIVES:

To study whether changes in the moments produced at the ankle and knee joints during walking reflect the neurologic level of a herniated nucleus pulposus.

SUMMARY OF BACKGROUND DATA:

Lumbar herniated discs often cause muscle weakness, reduced motor function, and change in walking capacity. The specific effects of a disc herniation on muscle function during gait is poorly documented.

METHODS:

Conventional physical examination and kinetic analysis of gait were performed on 16 patients who subsequently underwent surgery for herniated discs (eight with L4-L5 and eight with L5-S1 disc herniations) and 16 healthy control subjects. The three components of the external moment at the ankle and knee were computed. The peak magnitudes of specific components of the external moments were compared with those of the control group.

RESULTS:

Reduced external ankle plantar flexion moment, indicating a decreased function of the ankle dorsiflexors, was found in patients with herniated nucleus pulposus of both L4-L5 and L5-S1. Reduced external ankle dorsiflexion moment, indicating a decreased function of the ankle plantar flexors, was found only in patients with a lesion to the L5-S1 disc, but not in those with herniations at L4-L5.

CONCLUSIONS:

Preoperative gait analysis identified functional deficits of the muscles about the ankle and foot that relate to the level of the herniation. Kinetic measurements can assist in understanding the functional limitations associated with specific levels of a herniation.

Morag E, Hurwitz DE, Andriacchi TP, et al., Abnormalities in muscle function during gait in relation to the level of lumbar disc herniation, Spine, April 1, 2000:25(7), pp829-33.

Optimum Signs for Presence and Degree of Lumbar Disc Herniation

On December 19, 2011, in Studies, by admin
There is a way to predict the presence of a lumbar disc herniation how serious the herniated disc is.

There is a way to predict the presence of a lumbar disc herniation how serious the herniated disc is.

It appears from a study by Vucetic and Svensson1 that only three physical signs are of real diagnostic value in predicting whether there is a lumbar disc herniation and the degree or grade of herniation.

This study was a prospective rather than a retrospective study on 163 consecutive patients operated on for probable herniated discs. The three signs were the range of lumbar sagittal motion, the Lasegue sign, and the crossed Lasegue sign. They found that these tests were significant for the presence of a herniation and the degree of herniation, but not accurate for the level of herniation.

Neurologic signs, while important for distinguishing between radicular and referred pain, are not of great value in diagnosing the grade or level of a herniation.2 One third of patients with an absent Achilles reflex had a hernia above L5-Sl and the diagnostic value of an absent Achilles reflex may decrease with age.3 The absence of an Achilles reflex is more reliable than a diminished reflex as a sign of disc herniation, and its diagnostic value increases markedly if correlated with diagnostic imaging.4 Although patellar areflexia is six to seven times more common in L3-L4 hernias than other levels, only one-quarter of the patients with this sign had L3-L4 hernias.1

The strongest indicator for the grade of hernia was the range of sagittal lumbar motion. The range of lumbar motion decreased with increasing grades of herniation. The range was negligible for protruded hernia (generalized bulge with root involvement), and progressively decreased with an extruded disc hernia (posterior ligament still intact) and sequestrated (complete hernia beyond the posterior ligament). The crossed Lasegue sign, which was meaningful only if it was associated with the unilateral positive Laseque sign, was also proportionate to the grade of the hernia. Therefore the use of both the lumbar range-of-motion and crossed Lasegue sign predicted 74 percent of uncontained (sequestrated hernias), and 68 percent of contained hernias (protruded and extruded). In this study the Lasegue was only considered positive if pain radiated to the foot.

References

  1. Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clinical Orthopaedics & Rel. Research. (333);192-201:1996.
  2. Deburge A, Benoist M, Boyer D. The diagnosis of disc sequestration. Spine 9;496-499:1984. In: Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clinical Orthopaedics & Rel. Research. (333);192-201:1996.
  3. Spangfort EV. The lumbar disc herniation. A computer-aided analysis of 2,504 operations. Acta Orthop Scand 142(Suppl):70-71, 1972; In: Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clinical Orthopaedics & Rel. Research. (333);192-201:1996.
  4. Hakeliu A, Hindmarsh J. The significance of neurological signs and myelographic findings in the diagnosis of lumbar root compression. Acta Orthop Scand 43:239-24, 1972: In: Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clinical Orthopaedics & Rel. Research. (333);192-201:1996.

By Dr. Warren Hammer, MS, DC, DABCO

Published in: Dynamic Chiropractic – March 10, 1997, Vol. 15, Issue 06

Spinal decompression

On September 27, 2010, in , by admin
Spinal decompression: an effective treatment for herniated disc and chronic back pain.   Non-surgical spinal decompression therapy is: Noninvasive Conservative Painless Safe Supervised by a health professional who holds a doctorate degree Effective for a variety of back conditions (herniated disc, chronic pain, arthrosis, facet syndrome, etc.)   If you are visiting our website …It […]

Spinal decompression: an effective treatment for herniated disc and chronic back pain.

 

Non-surgical spinal decompression therapy is:

  • Noninvasive
  • Conservative
  • Painless
  • Safe
  • Supervised by a health professional who holds a doctorate degree
  • Effective for a variety of back conditions (herniated disc, chronic pain, arthrosis, facet syndrome, etc.)

 

If you are visiting our website …It is because you suffer from a condition described below!

This site was designed for those who suffer from chronic back pain, herniated disc or disc herniation, bulging of a disc, sciatica, leg pain, degenerative disc disease, tingling, numbness, pain in arms, neck pain, and for some patients with spinal stenosis and finally for those who underwent back surgery but still suffering from pain.

 

 What are your treatment options?

 

Types of Care

Efficiency

Acupuncture Unlikely
Heat & cryotherapy (cold) Unlikely
Electrotherapy (ultrasond, tens, etc.) Unlikely
Exercices Unlikely
Osteopathy Unlikely
Massage Therapy Unlikely
Surgery  likely
Spinal decompression  likely

 

Spinal decompression demystified

 

Spinal decompression reduces the pressure that builds up inside the discs. This technique consists of a mechanical disc decompression by suction causing decompression of the disc. The pain decreases because of resorption of the herniated disc, bulging disc or because of the reduced pressure on the nerves or spinal cord: that is to say that the disc returns to its original shape when the bulge or bulging disc disappears and the pressure on the spinal nerves is therefore eliminated.

Spinal decompression achieves this by creating a negative pressure inside the disc, known as negative intra-discal pressure. This essentially creates a vacuum to suck the bulging and herniated material inside the disc space by reducing the pressure.

 

The same phenomenon happens when you break the window of a pressurized airplane flying at high altitude: everything that is inside the airplane (positive pressure) is violently expelled to the outside (negative pressure).

 

When there is a bulging of the intervertebral disc and / or herniated disc, the ligaments that hold up the disk material has become stretched or torn. Spinal Decompression strengthens the ligament bands that hold the disc material in place, allowing healing and preventing a recurrence.

 

In most cases, the healing process requires only a few weeks of outpatient treatment.

 

Next Page – Herniated disc

Outcome study

On September 27, 2010, in , by admin
  Tags: herniated disc, outcome study, spinal decompression

What causes disc herniation

On September 27, 2010, in , by admin
There are several causes which explains why you may end up with an herniated disc. The degenerative discs process leads to a destruction of the latter, a loss of elasticity, and stability. You can feel the vertebrae in your back, but you can not see what lies between each vertebra. If you could, you would […]

There are several causes which explains why you may end up with an herniated disc.

The degenerative discs process leads to a destruction of the latter, a loss of elasticity, and stability.

You can feel the vertebrae in your back, but you can not see what lies between each vertebra. If you could, you would see small discs, mainly composed of water but also a substance resembling jelly. These cushions act as shock absorbers. These gelatinous discs compress and stretch when you move. Over time, jelly compresses and can become less flexible. This, combined with a possible impact, leads to the breakdown of the disk that often exerts pressure on the nerve. When the cartilage between the vertebrae tears, the disc is pushed out of his position and may pinch or rub on the surrounding nerves, which are extremely sensitive to pain. Although this may lead to symptoms, recent studies conducted on people without any back or leg problem have shown that a significant number of people have one or more herniated discs without feeling pain or sumptoms.

Some risk factors:

  • lifting weights inappropriately
  • Overweight
  • Sudden Pressure
  • Arduous repetitive activities
  • Congenital weakness of the discal tissues
  • Sudden trunk rotation
  • In the event of insufficient movement of the vertebral column causes by a job where you are in a constant sitting position, the rear portion of the disc will be compressed and thus weakened. Tears and swelling of the disc can then occur.

The inflammatory and degenerative processes in the connecting structures relate to vertebral discs, ligaments and joints located in the back of the vertebrae. If ligaments start loosening, the entire structure of the column becomes unstable. This produces a misalignment of the vertebrae and an overload of rear joints causing a premature wear out leading to osteoarthritis. This pain is typically limited to the low back region.

This degenerative discs process leads to a destruction of the latter, a loss of elasticity, and stability. Some parts of the disc may protrude (discal hernia) into the spinal cord canal by compressing the spinal cord or nerve roots. This causes the patient to feel a very distinctive radiating pain. If the pain radiates down the leg, we refer to it as sciatic pain or sciatic syndrome.

In the case of an increased vulnerability of the vertebral column, as we just described, the effect of humidity, cold, or the act of lifting heavy loads as well as sudden movements may immediately cause severe pain.

Next page – Spinal decompression Treatment

Spinal Decompression Studies

On September 27, 2010, in , by admin
Can Herniated Discs Reduce in Size or Resorb? by David BenEliyahu,DC,DACBSP,DAAPM In the past, it was believed that once a patient acquired a herniated disc, it was permanent. However, recent research with MRI and CT outcome studies has documented that this is fallacy. Herniated discs in the cervical and lumbar spine have been shown to […]

Can Herniated Discs Reduce in Size or Resorb?

by David BenEliyahu,DC,DACBSP,DAAPM

In the past, it was believed that once a patient acquired a herniated disc, it was permanent. However, recent research with MRI and CT outcome studies has documented that this is fallacy. Herniated discs in the cervical and lumbar spine have been shown to not only reduce in size after a period of conservative care, but in many cases regress and disappear upon reimaging.

Numerous medical studies and some chiropractic studies have been performed and published. In recent studies by Mochida et al., both cervical (CDH) and lumbar (LDH) disc herniations were studied in pre- and post-MR imaging conditions. In CDH cases, they demonstrated that in 40% of the time, there was a reduction in size or regression. In LDH cases, they demonstrated about a 60% reduction or regression in the size of the herniation. They also found that the larger the extrusion or sequestration, the better the rate of regression. They concluded that disc regression or resorption depended upon size, location and the phase of the injury. Discs tended to reduce in size early on after onset, and more so in the lateral or sequestered type of herniation than smaller or subligamentous herniations. It is interesting to note that most patients in Mochida’s study did well clinically with conservative care regardless of the MRI outcome.

In a different study, Mochida found that there is a large percentage of macrophages in excised herniated disc material, as well as evidence of neovascularization. As such, the reduction in size is most likely due to phagocytic or macrophagic digestion, since the body attacks the disc fragment as a foreign protein, much like any other antigen. Immunohistochemistry studies are being conducted at this time to elucidate the pathophysiology of disc herniation and regression.

In a similar study of LDH outcome by Bozzao et al., 63% of the patients treated nonsurgically with epidurals, medication, etc., demonstrated disc resorption upon repeat imaging. In a prospective study of patients with LDH, Ellenberg et al. documented that patients with CT evidence of herniated discs and EMG evidence of radiculopathy had a 78% rate of disc reduction. Matsubara found in a similar study that medical care involving medication, physiotherapy, traction and epidural steroid injections resulted in disc regression in 60% of the cases. In another prospective study, Bush et al. showed disc regression in 12 of the 13 cases studied. The period of care averaged six months, with a range of 2-12 months for good clinical and anatomical MRI outcome.

In one of the few chiropractic care MRI studies, I published a prospective case series of 27 patients with either CDH or LDH. I obtained pre- and post-chiropractic care MRIs and found that in 63% of the cases, there was either a reduction in size, or the disc herniation resorbed completely. I also found that 80% of the cases had good clinical outcomes, and 78% of the patients returned to their preinjury occupations. Chiropractic care was shown to be amenable to the clinical management of the disc herniation not only on a clinical level, but on an anatomical level as well. In a study by Cassidy et al. on the effects of side posture manipulation on CT-documented herniated discs, the authors found that 13 of 14 patients had good clinical results. Of those, about half had a decrease in the size of the herniation on repeat CT followups.

Case Report

In a recent case that I treated, a 48-year-old female patient presented with acute low back and associated leg/extremity pain into the foot. She had evidence of radiculopathy with diminished sensation at the L4/5 dermatomes, and positive root tension signs with a positive straight leg raise at 35 degrees on the left and 45 degrees on the right. DTRs were within normal limits, and there was no significant motor weakness. An MRI of the lumbar spine revealed a large focal disc herniation centrally and to the left.

The patient began treatment on a three times per week schedule and was treated with lumbar flexion/distraction, interferential current and microcurrent delivered by pads and probes. Microcurrent therapy was combined with regular interferential therapy and helped reduce pain and increase circulation to enhance the healing process. Microcurrent was then delivered to the LS spine and lower extremity by probes, stimulating the acupuncture points of the bladder meridian as well as stimulation along the affected dermatome.

The microcurrent therapy helped afford the patient pain management and reduced the healing period. The patient improved significantly with the above mode of care, and repeat MRI imaging showed a reduction in the size of the herniation.

References

  • BenEliyahu DJ. MRI and clinical followup study of 27 patients receiving chiropractic care for cervical and lumbar disc herniation. JMPT 1996;19(9):597-606.
  • Bush K. Pathomorphologic changes that accompany the resolution of cervical radiculopathy. Spine 1997;22(2):183-187.
  • Matsubara Y. Serial changes on MRI in lumbar disc herniations. Neuroradiology 1995;37:378-383.
  • Komori H. Natural history of herniated Nucleus pulposus with radiculopathy. Spine 1996;21(2):225-229.
  • Saal J. Nonoperative management of cervical herniated disc with radiculopathy. Spine 1996;21(16):1877-83.
  • Mochida K. Regression of cervical disc herniation observed on MRI. Spine 1998;23(9):990-997.
  • Ellenberg MR. Prospective evaluation of the course of disc herniations in patients with radiculopathy. Arch Phys Med Rehab 74; Jan 1993, p. 3.
  • Bozzao A. Lumbar disc herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology 1992;185:135-141.
  • Maigne JY. CT followup study of 21 cases of nonoperatively treated cervical soft disc herniation. Spine 1994;19(2):189-191.

Next page – Spinal Decompression Outcome Study

Herniated disc treatment

On September 27, 2010, in , by admin
A gentle conservative treatment for herniated disc: non-surgical spinal decompression therapy Once diagnosed by a competent health professional, the treatment of herniated disc can be done, in some cases, with conservative treatment, without resorting to surgery. Our method is scientifically recognized: it is a distraction with a high-tech device that enables safe treatment. Non-surgical spinal […]

A gentle conservative treatment for herniated disc: non-surgical spinal decompression therapy

Once diagnosed by a competent health professional, the treatment of herniated disc can be done, in some cases, with conservative treatment, without resorting to surgery. Our method is scientifically recognized: it is a distraction with a high-tech device that enables safe treatment.

Non-surgical spinal decompression and its specialized equipment is used in all our clinics.

What will happen during the treatment?

Lumbar treatment : after a comprehensive exam, allowing the clinician to determine the nature of the vertebral infringement, the patient is laid down on the table and a traction force on the lumbar spine is applied, mobilizing the segment of the spine causing the problem. Thus, movements of deep traction or distraction are induced by the practitioner with precision and gentleness: all these movements are done without feeling any pain.

Cervical Treatment : The patient is lying flat on his back on the treatment table, allowing a segmental traction and mobilization of the cervical spine.

Other types of treatment may be required in some cases.

Every patient is unique, no two patients have with exactly the same condition, the same threshold of tolerance to pain and the same resilience.In this regard, we customize our treatment to respond to the unique needs of each of our patients, while maintaining a treatment protocol which has been proven.

Current therapies for disc pathology

  • medication and limited activity
  • spinal rehabilitation
  • interventional pain management
  • spinal manipulation
  • spinal surgery
  • non-surgical spinal decompression

Non-surgical spinal decompression

  • Spinal decompression is a term that describes the relief of pressure on one or many pinched nerves (neural impingement) of the spinal column
  • Spinal decompression can be achieved both surgically and non-surgically and is used to treat conditions that result in chronic back pain such as disc bulge, disc herniation, sciatica, spinal stenosis, and isthmic and degenerative spondylolisthesis.
  • Non-surgical spinal decompression was originally developed and pioneered in 1985, by Dr. Allan Dyer, PhD, MD, a canadian doctor who had served as Deputy Minister of Health in Ontario, Canada.
  • Non-invasive procedure designed to target underlying disc pathology

Goals of treatment

  •  actively distract and passively retract the spine in order to affect intervertebral disc space
  • reduce intradiscal pressures
  • increase fluid and nutrient exchange
  • promote disc regeneration
  • retract nucleic material of bulging or herniated disc

Guarding reflex

  •  Traditional spinal traction causes natural guarding reflex
  • Muscles contract or spasm to prevent distraction (deep traction or decompression) in order to protect the spine
  • Old style traction devices are not able to bypass or overpower reflex contractions and achieve distraction of the disc space – (aka spinal decompression)

Next page – Spinal Decompression Studies

The facts about herniated discs

On September 27, 2010, in , by admin
If you have a herniated disc, you should carefully read the following: A health problem as serious needs to be taken care of by a competent health professional. Such a condition when poorly managed can have a disastrous effect on your health for the rest of your days. [flv:http://www.sosherniateddisc.com/wp-content/uploads/2010/09/Welcome-to-3Drx-HybridOnline.com_.flv] The facts about herniated discs: Herniated […]

If you have a herniated disc, you should carefully read the following:

A health problem as serious needs to be taken care of by a competent health professional. Such a condition when poorly managed can have a disastrous effect on your health for the rest of your days.

[flv:http://www.sosherniateddisc.com/wp-content/uploads/2010/09/Welcome-to-3Drx-HybridOnline.com_.flv]

Herniated disc

Herniated disc click to enlarge

The facts about herniated discs:

  • Herniated Discs are not all inherently painful
  • Most bulging discs are not symptomatic
  • A bulging disc may be as painful as an herniated disc
  • Surgery or non-surgical spinal decompression is required to correct an herniated disc
  • In most cases, surgery actually offers poor curative results for an herniated disc
  • Herniated Discs does notworsen with time but the disc does end up with degenerative disc disease.
  • Most herniated discs won’t resolve on their own. The pain may subside because of posture and structural compensation
  • Herniated discs cannot be diagnosed with an x-ray. You need an MRI
  • Herniated discs are not always due to injury
  • Herniated discs can happen because of a spinal rotational decompensation caused by a pelvis misalignment
  • Medical treatment is not necessary for most herniated discs
  • Many disc pain conditions are misdiagnosed

If I were to gather a group of middle age folks (45 average age) who have NEVER had back pain before and shoot MRIs on them all, here’s what we would find:

  • 38% would have disc bulges,
  • 37% disc protrusions (aka: contained herniations),
  • 11% disc extrusions (aka: non-contained herniations),
  • 0% disc sequestrations (aka: free fragments) and
  • 4% nerve root compression by the disc herniation.

A more shocking statistic is that 60% of asymptomatic middle aged people would have findings of disc bulge or worse (protrusion, extrusion) on MRI!

Disc herniation, the leading cause of lombosciatica, is a result of a long and silent degenerative disc which will decompensate more or less abruptly on the occasion of an effort, sometimes minimal.

The lombosciatica almost never an “accident” occurring on a perfectly healthy spine.

References:
1. Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med – 1994; 331:369-373

2. Boden SD et al. “Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation.” J Bone Joint Surg Am 1990; 72A:403-408

3. Weishaupt D et al. “MRI of the lumbar spine: Prevalence of intervertebral disc extrusion and sequestration, nerve root compression and plate abnormalities, and osteoarthritis of the fact joints in Asymptomatic Volunteers.” Radiology – 1998; 209:661-666

4. Boos N, et al. “1995 Volvo Award in clinical science: The diagnostic accuracy of MRI, work perception, and psychosocial factors in identifying symptomatic disc herniations.” Spine – 1995; 20:2613-2625

5. Powell MC, et al. “Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women.” Lancer – 1986; 2:1366-7

6. Boos N, et al. “Natural history of individuals with asymptomatic disc abnormalities in MRI: Predictors of low back pain-related medical consultation and work incapacity.” Spine 2000; 25:1484

7. Borenstein G, Boden SD, Wiesel SW, et al. “The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic individuals: A 7-year follow-up study. J Bone Joint [am] 2001; 83:320-34

8. Wiesel SW, et al. “A study of computer-associated tomography: I. The incidence of positive CAT scans in asymptomatic group of patients.” Spine 1984;9:549-51

11. Wood KB, et al. ‘Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individual s.’ J Bone Joint Surg Am. 1995 Nov;77(11):1631-8

20. Jarvik JJ, et al. “The longitudinal assessment of imaging and disability of the back (LAIDBack) Study.” Spine 2001;26: 1158-66.

25. Boden SD, et al. “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatci Subjects.” J Bone Joint Surg [AM] 1990; 72:403-408

26. Fraser RD, Sandhu A, Gogan WJ. ‘Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation.’ Spine 1995 Mar 15;20(6):710-4. “The findings of this study indicate that long-term improvement of a patient’s symptoms after treatment of disc herniation may occur with or without resolution of the hernia. This and the similar morphologic findings in the different groups is consistent with the 10-year clinical results after the treatment of disc herniation reported by Weber.”

27. Masui T, et al. ‘Natural History of Patients with Lumbar Disc Herniation Observed by Magnetic Resonance Imaging for Minimum 7 Years.’ J Spinal Disord Tech. 2005 Apr;18(2):121-126. “Clinical outcome did not depend on the size of herniation or the grade of degeneration of the intervertebral disc in the minimum 7-year follow-up.”

517. Giuliano V, et al. ‘The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects.’ Emerg Radiol. 2002 Nov;9(5):249-53.

Next page – chronic back pain

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