Lumbar disc herniation and tight hamstrings syndrome in adolescence

Atalay, Ayçe; Akbay, Atilla; Atalay, Başar; Akalan, Nejat

doi:10.1007/s00381-003-0716-2

Cited by 12 publications

(5 citation statements)

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“…3 Differential diagnoses include tumour, infection, Schmorl's node, calcification of the posterior longitudinal ligament, calcification of the annulus, limbus fracture, and fracture of the posterior margin of a lumbar vertebral body. [9][10][11] In our cases there was a strong association of adolescent apophyseal ring fracture with a slipped capital femoral epiphysis and overweight/obesity. Being overweight puts persistent and excessive stress on the lumbar spine.…”

Section: Discussionsupporting

confidence: 47%

“…Other symptoms and signs include a limping gait due to listing, para-lumbar muscle spasm and tenderness, restricted back motion, tight hamstrings, a waddling gait with flexed knees, and neurological deficits caused by compressed nerve roots. 9 A systemic enquiry and complete neurological examination is mandatory. Cauda equina syndrome presenting with sphincter disturbance has been reported in apophyseal ring fracture.…”

Section: Discussionmentioning

confidence: 99%

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Posterior Lumbar Apophyseal Ring Fractures in Adolescents: A Report of Four Cases

Yen

Chan

et al. 2009

J Orthop Surg (Hong Kong)

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Posterior lumbar apophyseal ring fractures are rare in adolescents. We report 4 such cases in Chinese adolescents. Two of the patients had a slipped capital femoral epiphysis; 3 of them were overweight/obese. All presented with low back pain and radicular pain. Apophyseal fractures of the upper lumbar spine usually involve the lower end plate, whereas those of the lumbar sacral spine usually involve the upper end plate. The radiological features and pathophysiology are discussed. Two of the patients were treated with laminotomy and diskectomy after conservative treatment failed. All patients had complete resolution of their neurological deficits at a mean follow-up of 2 years. Despite its benign nature, long-term follow-up is necessary to define the natural course and prognosis of the disease. A high index of suspicion is needed to diagnose these fractures in adolescents.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Posterior Lumbar Apophyseal Ring Fractures in Adolescents: A Report of Four Cases

Yen

Chan

et al. 2009

J Orthop Surg (Hong Kong)

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“…Some authors previously suggested that a positive SLR test can result from "tight hamstring syndrome", characterized by the tightness of the lumbar and ischiocrural muscles. 28 Further studies should be conducted to obtain a more precise definition involving a cluster of signs, symptoms, and clinical parameters for predicting NP.…”

Section: Dovepressmentioning

confidence: 99%

<p>Female Overrepresentation in Low Back-Related Leg Pain: A Retrospective Study of the Autonomic Response to a Minimally Invasive Procedure</p>

Skorupska¹,

Jokiel²,

Rychlik³

et al. 2020

JPR

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Background The newly proposed low back pain treatment requires case classification according to the pain mechanism (nociceptive, neuropathic or nociplastic) to determine the most effective therapeutic approach. However, there is a lack of objective tools for distinguishing these pain mechanisms. The aim of the study was to identify which symptoms, signs, and standard diagnostic parameters would allow predicting the nociplastic pain (NP) subtype among low back leg pain (LBLP) patients. Methods A retrospective analysis of an LBLP case–control study database was carried out. The presence of NP was assumed if the patient presented with myofascial pain syndrome (MPS) and developed a short-term intensive vasodilatation reaction in the perceived lower leg pain area after provocation by a minimally invasive procedure. Clinical data and standard LBLP diagnostic parameters were analyzed to classify patients as NP (+) vs NP (-). Next, to predict NP probability, logistic regression analysis and a diagnostic classification tree were constructed. Results NP was confirmed in 43.75% of LBLP patients. Women represented 95.24% of all NP (+) patients. The diagnostic classification tree indicated that NP was highly probable if the LBLP subject was female and the result of a positive straight leg raise (SLR) test was lower than 45 degrees. If the SLR test result was greater than or equal to 45 degrees, a negative result on the Bragard test would have diagnostic value. This classification tree was approved to a certain extent in the logistic regression model (deviance residuals, min: −1.8519; 1Q: −0.5551; median: −0.1907; 3Q: 0.6565 and max: 2.1058) but should be verified in a larger group of subjects. Conclusion Female sex, but not clinical data or standard diagnostic parameters, is indicative of nociplastic pain in LBLP patients. More sophisticated statistical methods, based on directly measurable parameters, should be proposed to distinguish NP involvement in LBLP.

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“…SLRT can be utilized pre-operatively with diagnostic implications and intra-operatively/post-operatively to confirm the EPD [45,46]. There may be a component of hamstring tightness [47] which may remain; however, the characteristic radicular pain subsides [48]. It is important to note that this is a "passive" SLRT [49] to be performed by the surgeon only and not to be done by the patient on his own.…”

Section: Post-operative Assessmentmentioning

confidence: 99%

End-points of Decompression of in Lumbar Transforaminal Endoscopic Spine Surgery: A Narrative Review of Objective and Subjective Criteria to Prevent Failures

Krishnan

Marathe

Degulmadi

et al. 2022

J Minim Invasive Spine Surg Tech

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Objective: Executions of indications/extended indications are associated with higher than normal rates of symptomatic recurrences and treatment failures, especially for novice surgeons incorporating Percutaneous Transforaminal endoscopic lumbar discectomy/decompression (PTELD) techniques. Causes of failures can be manifold and can occur because of a residual or a complete fragment causing persistent compression or associated unaddressed stenosis. To prevent this problem, proper training, multiple instrument inventory, variable techniques are needed with progressive learning. Authors aim to suggest objective and subjective criteria to define end-points/adequacy of decompression (EPD).Methods: PubMed database search was limited to locate only adequacy of decompression of PTELD and thus included specific keywords: “ENDPOINT” OR “ADEQUATE” AND “DECOMPRESSION” AND “TRANSFORAMINAL” AND “ENDOSCOPY”. Authors added their experience to refine and define multiple EPD.Results: In the search we found 12 articles total. Upon reviewing these, we found 7 articles matching our criteria. Cross references of included articles were searched, 5 additional articles were included. EPD were described in only 9 articles. Author’s experience with other relevant references were added to complete the viewpoint (EPD, n=29). Direct observed/ provoked EPD and inferred EPD were defined separately. Videos, illustrations and descriptions of each EPD are illustrated to provide the ideation.Conclusion: EPD are variable and not all signs may be elicited in every case and may change with surgeon experience. The ability to recognize EPD is the crux for successful outcomes and maximum possible EPD’s should be aimed in every surgery to avoid failures.

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Lumbar disc herniation and tight hamstrings syndrome in adolescence

Cited by 12 publications

References 11 publications

Posterior Lumbar Apophyseal Ring Fractures in Adolescents: A Report of Four Cases

Posterior Lumbar Apophyseal Ring Fractures in Adolescents: A Report of Four Cases

<p>Female Overrepresentation in Low Back-Related Leg Pain: A Retrospective Study of the Autonomic Response to a Minimally Invasive Procedure</p>

End-points of Decompression of in Lumbar Transforaminal Endoscopic Spine Surgery: A Narrative Review of Objective and Subjective Criteria to Prevent Failures

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