Effect of the Transligamentous Extension of Lumbar Disc Herniations on Their Regression and the Clinical Outcome of Sciatica

Ahn, Sungjin; Ahn, Myun-Whan; Byun, Woo-Mok

doi:10.1097/00007632-200002150-00014

Cited by 105 publications

(66 citation statements)

References 20 publications

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“…Significant reduction of symptoms in conservatively followed patients is seen in the long term (16)(17)(18). Comparing the conservative and surgical treatments for LDHR patients, there is no superiority of surgery over long-term conservative treatment (22).…”

Section: Discussionmentioning

confidence: 99%

Effects of Artcure Diffusional Patch application on pain and functional status in lumbar disc herniation patients: a prospective randomized controlled study

Uğurlu¹,

Aksekili²,

Alkan³

et al. 2017

Turk J Med Sci

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IntroductionAmong Western societies 84% of adults suffer from low back pain at some time in their lives (1). Low back pain is the most frequent reason for disability in the population below the age of 45 (2). The treatment costs for low back pain are a significant part of medical costs and at about 34 billion dollars; by adding the economic loss due to workforce loss, this number increases to 100 billion dollars in the United States (3,4). Lumbar disc herniation with associated radiculopathy (LDHR) ranks first among the diseases that cause low back pain. For this reason, an inexpensive, noninvasive, and efficient treatment method is required in order to reduce and delay surgical interventions of LDHR patients and minimize the workforce loss during the period until surgical intervention.Lumbar disc herniation is the displacement of the nucleus pulposus by the breaching of the annulus fibrosus (5). With increasing age disc degeneration and disc height loss occur by the loss of proteoglycan and the effects of proinflammatory cytokines (6). As a result of these, clinical signs such as pressure on nerve roots and the spine occur. The purpose of treatment is reducing the pain and increasing the functional activity by removing the pressure on the nerve roots by either surgical or conservative methods.The decision between surgical and nonsurgical management of LDHR can be challenging for both the patient and the treating physician. Generally surgical intervention is suggested to patients with acute and progressive neurological deficit and those who are nonresponsive to conservative treatments (7). In light of the costs of surgical treatments and the scale of possible complications, noninvasive treatment becomes the best option. Since the intervertebral discs are the largest avascular structures of the body, nourishment is supplied by diffusion. Because of this avascularity, there is no possibility for spontaneous recovery (8).Background/aim: The aim of this study was to assess the efficacy of the Artcure Diffusional Patch, which contains a mixture of 6 herbal oils (oleum thymi, oleum limonis, oleum nigra, oleum rosmarini, oleum chamomilla, oleum lauriexpressum) and has a hypoosmolar lipid structure, in the conservative treatment of lumbar disc herniation patients and to show the advantages and/or possibility of using this as an alternative method to surgery. Materials and methods:Of the 120 patients enrolled, 79 clinically diagnosed patients were included in the study. Clinical evaluations were performed on patients who had findings of protrusion or extrusion in their magnetic resonance results. The treatment group was treated with the Artcure Diffusional Patch while the control group received a placebo transdermal diffusional patch. The functional state of patients was measured using the Oswestry Disability Index and pain intensity was measured with a visual analog scale as primary outcomes. Secondary outcomes of the study were Lasegue's sign, the femoral stretching test, and paravertebral muscle spasm. Results:The trea...

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Section: Discussionmentioning

confidence: 99%

Effects of Artcure Diffusional Patch application on pain and functional status in lumbar disc herniation patients: a prospective randomized controlled study

Uğurlu¹,

Aksekili²,

Alkan³

et al. 2017

Turk J Med Sci

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“…Spontaneous regression as a result of enzymatic degradation is one of the hypothesis, the others are based on the retraction of the disc into the intervertebral space, and on the concept of dehydration with loss of water content of the herniated disc material. Many authors reported various characteristics of the herniations like factors related to the resorption process as penetration through the posterior longitudinal ligament (PLL), size of herniation, and existence of cartilage and anulus fi brosus tissue in the herniated material (13)(14)(15)(16). Migrating and extruding type herniations have a higher tendency to decrease in size in followup studies (13,14).…”

Section: Discussionmentioning

confidence: 99%

“…Many authors reported various characteristics of the herniations like factors related to the resorption process as penetration through the posterior longitudinal ligament (PLL), size of herniation, and existence of cartilage and anulus fi brosus tissue in the herniated material (13)(14)(15)(16). Migrating and extruding type herniations have a higher tendency to decrease in size in followup studies (13,14). Larger migrating type herniations demonstrate the greatest degree of resorption, so they regress more rapidly than smaller ones.…”

Section: Discussionmentioning

confidence: 99%

Histological composition of lumbar disc herniations related to the type of herniation and to the age

Matveeva¹,

Zivadinovik²,

Zdravkovska³

et al. 2012

BLL

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Abstract:Objectives: To compare the data for histologic composition of the herniated disc material between different types of disc herniations and between patients of different age. Background: Lots of studies have investigated the histologic composition of disc herniations. Few studies have examined the presence of granulation tissue related to the type of herniations and age of the subjects. Methods: 120 patients divided in to two age groups underwent MR imaging before microsurgical removal of the herniations. Disc herniations were divided in to two groups, non migrated and large migrated disc herniations. The histologic assessment of the herniated material is done by dividing the intercellular matrix into four types. The existence of areas of granulation tissue and hyaline cartilage is evaluated too. Results: The tissue composition showed signifi cant differences between patients of different age. Areas of granulation tissue and neovascularisation are found in 12 % of 64 protrusions and contained extrusions, and in 29 % of 56 large migrated disc extrusions (p = 0.029 ). In elderly patients the tissue composition changed with a signifi cant decrease of prevailing nucleus pulposus composition in 7 % of 60 (p = 0.000) and a signifi cant increase of prevailing fi brous tissue composition in 40 % of 60 patients (p = 0.000). Areas of granulation tissue and neovascularisation were found in 27 % of 60 patients aged ≤50 and in 13 % of 60 patients aged > 50. Conclusions:The tissue composition of the herniated material showed more expressed differences between subjects of different age. Granulation tissue and neovascularisation were more frequent fi ndings in large migrated disc herniations and in patients aged 35 to 50 years (Fig. 8, Ref. 22). Full Text in PDF www.elis.sk.

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“…12 It is also recognised that greater resorption of herniated discs occurs when there is a sequestered fragment. 13,14 It is possible that this phenomenon of disappearing discs occurs more frequently. These cases are probably not detected because few patients have MRI examinations after the resolution of their symptoms.…”

Section: British Journal Of General Practice September 2008mentioning

confidence: 99%

Spontaneously disappearing lumbar disc protrusion

Ushewokunze¹,

Abbas²,

Dardis³

et al. 2008

Br J Gen Pract

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Effect of the Transligamentous Extension of Lumbar Disc Herniations on Their Regression and the Clinical Outcome of Sciatica

Abstract: Transligamentous extension of herniated disc materials through the ruptured PLL is more important to its reduction in size than is the initial size of the herniated disc. Decrease in herniation ratio of more than 20% seems to correspond to successful clinical outcome.

Cited by 105 publications

References 20 publications

Effects of Artcure Diffusional Patch application on pain and functional status in lumbar disc herniation patients: a prospective randomized controlled study

Effects of Artcure Diffusional Patch application on pain and functional status in lumbar disc herniation patients: a prospective randomized controlled study

Histological composition of lumbar disc herniations related to the type of herniation and to the age

Spontaneously disappearing lumbar disc protrusion

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