Annals of Rehabilitation Medicine

"Disc herniation"

Original Articles

Effect of Aggressive Rehabilitative Treatment on Canalicular Sequestered Lumbar Disc Herniations : Long-term Follow-up Study.: Yang, Dong Seok , Ahn, Sang Ho , Lee, Dong Gyu , Park, Kyung A , Cho, Yun Woo , Jang, Sung Ho , Kim, Dong Gyu , Kang, Jae Hoon , Park, Hae Woon; J Korean Acad Rehabil Med 2006;30(6):584-589.

Abstract
PDF

Objective
To assess long term outcomes of aggressive rehabilitative treatment on canalicular sequestered lumbar disc herniations Method: Clinical outcomes of twenty four patients with sequestered disc herniation with symptomatic radicular pain were evaluated prospectively and longitudinally for one year. All patients received aggressive rehabilitative treatment including transforaminal epidural steroid injection, pelvic stabilization exercise, physical therapy, and back school. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry Disability Index (ODI) for back pain before treatment, posttreatment one, three, six, and twelve months. After twelve months, we categorized patients' satisfaction. Four patients were dropped out. Results: The averages of VAS for lower extremity and back pain reduced significantly from 6.6 and 5.8 at pretreatment to 0.7 and 0.9 at 12 months posttreatment, respectively (p＜0.001). The averages of ODI reduced significantly from 73.5% at pretreatment to 22.3% at posttreatment 12 months (p＜0.001). Sixteen of twenty patients (80.0%) were satisfied with their current status posttreatment 12 months. Conclusion: Sequestered disc herniations could be treated successfully by aggressive rehabilitative treatment. Clinical improvement was achieved from posttreatment one month and persisted for twelve months. Operation might be delayed until aggressive rehabilitation treatment fail to treat sequestered disc herniations. (J Korean Acad Rehab Med 2006; 30: 584-589)

2,138 View
11 Download

The Relationship between the Lower Lumbar Disc Herniation and the Morphology of the Iliolumbar Ligaments Using Magnetic Resonance Imaging.: Ahn, Kyung Hoi , Kim, Hee Sang , Yun, Dong Hwan , Hong, Jang Hyeok; J Korean Acad Rehabil Med 2002;26(4):439-444.

Abstract
PDF

Objective: This research aimed to define the relationship between the lower lumbar disc herniation and the morphology of the iliolumbar ligaments using magnetic resonance imaging.

Method: 24 male and 36 female patients were classified into two groups according to their disc herniation grade- those in whom the L5-S1 disc was less herniated than L4-5 disc, those in whom the L5-S1 disc was more herniated than the L4-L5 disc on magnetic resonance images. The lengths of iliolumbar ligaments were measured on T1- weighted coronal images. The angles of iliolumbar ligaments were measured on T1-weighted axial images.

Results: The length of iliolumbar ligament was not different between L4-L5 disc herniation and L5-S1 disc herniation. The degree of iliolumbar ligament angle difference (asymmetry of direction) at L5-S1 disc herniation was more deviated in paracentral disc herniation compared with central disc herniation.

Conclusion: The morphology of the iliolumbar ligament, especially its asymmetry of direction, may be a factor influencing the development of disc herniation at L5-S1. (J Korean Acad Rehab Med 2002; 26: 439-444)

1,952 View
12 Download

Follow-up Magnetic Resonance Imaging Study of Patients with Herniated Cervical Intervertebral Disc.: Park, Young Bum , Lee, Sang Chul , Yoo, Tae Won , Moon, Jae Ho , Cho, Soo Kyoung; J Korean Acad Rehabil Med 2006;30(4):357-361.

Abstract
PDF

Objective
To clarify the relationship between the morphologic changes of and the clinical course of conservatively treated herniated cervical disc patients Method: Follow-up magnetic resonance imaging (MRI) and clinical assessment by the visual analogue scale were performed in 21 patients at a mean interval of 22.7 months. Results: An average reduction ratio of herniation on the sagittal and axial images were 11.65% and 19.5%, respectively. The clinical features improved significantly and the degree of clinical improvement was unrelated to the reduction ratio of herniation. Conclusion: 8 out of 21 (38.09%) showed reduction of herniated mass on follow up MRI after conservative treatment. The patients with extruded and sequestered disc herniation showed more morphologic changes on MRI. There was no correlation between the clinical state and the morphological change of herniated cervical disc. (J Korean Acad Rehab Med 2006; 30: 357-361)

2,112 View
10 Download

Effect of Spinal Decompression Therapy Compared with Intermittent Mechanical Traction in Lumbosacral Disc Herniation.: Kim, Hee Sang , Yun, Dong Hwan , Huh, Ki Yun; J Korean Acad Rehabil Med 2008;32(3):319-323.

Abstract
PDF

Objective
To compare the effects of intermittent mechanical traction with spinal decompression therapy (SDT), using the newly introduced device DRX 3000^Ⱂ, in patients suffering from low back pain associated with lumbosacral disc herniation documented on MRI. Method: Thirty-five patients with low back pain with or without lower extremity radiating pain were prospectively enrolled in this study. They were all diagnosed with lumbosacral disc herniation according to physical examinations and MRI. Patients over age 60 years or those with previous spinal surgery, spondylolisthesis, severe osteoporosis, rheumatic diseases, hypertension, and other serious medical problems were excluded. Patients were randomly assigned to intermittent mechanical traction group (15 patients) or SDT group (20 patients) and compared visual analog pain scale (VAS) pre- and post-treatment. Results: There was a significant improvement in VAS in SDT group compared to intermittent mechanical traction group. The mean reduction in VAS for intermittent mechanical traction group equaled 1.93±0.83 (from 6.4±1.28 to 4.5±1.22) while the mean reduction in VAS in SDT group equaled 4.35±2.21 (from 6.9±1.86 to 2.6±1.43) (p=0.0006). Conclusion: Spinal decompression therapy can be used as an effective treatment for discogenic low back pain without serious complications. (J Korean Acad Rehab Med 2008; 32: 319-323)

3,595 View
143 Download

Follow-Up MRI of Lumbar Facet Joint Orientation in the Patients with Herniated Lumbar Intervertebral Disc Treated Operatively and Conservatively.: Min, Seong Ki , Kim, Hee Sang , Ahn, Kyung Hoi; J Korean Acad Rehabil Med 1999;23(1):140-147.

Abstract
PDF

Objective: The purposes of this study were to observe the radiographic changes of lumbar facet joints by magnetic resonance imaging (MRI) in conservatively and operatively treated groups of patients with herniated intervertebral disc, and to compare the biomechanical effects to lumbar facet joints according to the treatment methods

Method: The patients composed of 20 conservatively treated control group and 40 operatively treated group who had disc herniation at lower lumbar spine. Follow-up MRIs were performed in order to assess the radiographic changes of intervertebral disc and lumbar facet joints, such as disc degeneration, lumbar facet joint angle and tropism in either treatment groups individually.

Results: There are significant increase in lumbar facet joint angle in operatvely treated group at the level of both L4/5, right L5/S1 compared to that of conservately treated group, but the disc degeneration and facet joint tropism were not changed after treatment in both groups. There's no relationship between treatment period and each parameters.

Conclusion: The radiographic biomechanical lumbar facet joint changes on MRI seems to be related to degenerative change of lumbar facet joint in operatively treated group with a lumbar disc herniation. Therefore, careful selection of optimal operation time and criteria would be important.

1,896 View
9 Download

Correlation between Severity of Intervertebral Disc Herniation and Electrodiagnostic Findings in the S1 Radiculopathy.: Kim, Kyoung Yol , Hyun, Jung Keun , Lee, Seong Jae; J Korean Acad Rehabil Med 2008;32(2):194-199.

Abstract
PDF

Objective: To compare the results of electrodiagnostic studies with the severity of disc herniation, measured digitally by picture archiving and communication system (PACS) from the images of magnetic resonance imaging (MRI).

Method: MRI images were reviewed from thirty two patients who were diagnosed electrodiagnostically as unilateral S1 radiculopathy. Areas of herniated disc and spinal canal were measured and the ratio of disc herniation was calculated from the axial images stored and analyzed by PACS. The radiologic measurements were compared with the results of electrodiagnostic studies.

Results: The presence of abnormal spontaneous activities in needle EMG and no response in H reflex were associated with larger disc herniation (p＜0.05). There was no other single electrodiagnostic study that showed correlation with any of radiologic measurements. With increasing number of abnormal electrodiagnostic tests, area of disc herniation grew larger (p＜0.05). Area of spinal canal and the ratio of disc herniation did not show difference between normal and abnormal groups in most of electrodiagnostic studies.

Conclusion: There were limited correlations between electrodiagnostic results and severity of disc herniation. The size of disc herniation, regardless of the size of spinal canal, was associated with abnormal results of electrodiagnostic tests. (J Korean Acad Rehab Med 2008; 32: 194-199)

1,978 View
11 Download

Efficacy of Transforaminal Epidural Steroid Injections According to Nerve Root Enhancement.: Do, Sung Jin , Ahn, Sang Ho , Cho, Yun Woo , Shim, Dae Seop , Cho, Hee Kyung , Kim, Han Seon , Jang, Sung Ho; J Korean Acad Rehabil Med 2010;34(2):204-208.

Abstract
PDF

Objective
To determine the efficacy of transforaminal epidural steroid injections according to nerve root enhancement in lumbar disc herniations. Method: Twenty seven patients who had extruded or seques tered lumbar disc herniations on enhanced MR imaging were investigated: fifteen patients with corresponding nerve root enhancement (enhanced group), and twelve patients without enhancement (non-enhanced group). All patients received transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry disability index (ODI) before treatment and one month after injection. Results: The averages of VAS for lower extremity and back pain in both groups one month after injection significantly reduced compared to that of pretreatment, respectively (p＜0.001). The amount of decrease in pain in enhanced group was larger than that of non-enhanced group (p＜0.05). The averages of ODI in both group one month after injection significantly reduced compared to that of pretreatment (p＜0.0001), however, there was no difference between the two groups. Conclusion: The nerve root enhancement on contrast-enhanced MR imaging indicates the presence of severe inflammatory reaction of nerve root, which means well-responsiveness to anti-inflammatory treatment such as transforaminal epidural steroid injection, even if patients' symptom is very severe. (J Korean Acad Rehab Med 2010; 34: 204-208)

2,450 View
17 Download

The Relationship between Lumbar Shape and Lumbar Disc Herniation.: Kim, Ho Seong , Jang, Sung Ho , Lee, Kyung Hoon , Lee, Sung Yong , Lee, Yang Gyun; J Korean Acad Rehabil Med 2005;29(6):619-623.

Abstract
PDF

Objective
We designed this study to investigate the relationship among lumbar disc herniation, vertebral endplate area and shape, and lumbar and sacral parameters. Method: 78 experimental patients with low back pain and 27 controls were enrolled. Experimental patients were divided into group A with low back pain without trauma and lumbar disc herniation and group B with low back pain due to lumbar disc herniation without trauma. Controls had low back pain due to recent trauma but no previous history of back pain and lumbar disc herniation. We reviewed MRI (magnetic resonance image) films of these patients with anteroposterior and transverse diameter of endplates, lumbarlordosis angle, and sacral angle. The relationship of these data and sex, age, body weight, height, intervertebral disc herniation, low back pain were statistically studied. Results: Patients' sex, age, body weight, height, vertebral endplate area and shape, lumbar and sacral parameters were not related to disc herniation. But the more circular vertebral shape was, the larger lumbar lordosis angle was. And the larger lumbar lordosis angle was, the less sacral angle was. Conclusion: There were no relationships between the development of disc herniation at L4-5, L5-S1 and the shape of the vertebral body at the endplate level. (J Korean Acad Rehab Med 2005; 29: 619-623)

1,915 View
10 Download

Follow-up Magnetic Resonance Imaging Study of Patients with Herniated Lumbar Intervertebral Disc Who Were Treated Conservatively.: Kim, Eun Kyoung , Yang, Chang Sub , Min, Sung Ki , Jung, Byung Jun , Lee, Won Yung , Kwon, Jung Ho; J Korean Acad Rehabil Med 1998;22(3):587-594.

Abstract
PDF

Objective: To clarify the relationship between the morphologic changes of disc herniation and the clinical course of conservatively treated herniated lumbar disc patients.

Method: Follow-up MRIs and clinical assessments by the Visual Analogue Scale and Japanese Orthopaedic Association(JOA) Score were performed in 20 patients at a mean interval of 11.3 month.

Results: An average reduction ratio of herniation on the sagittal and axial images, were 21.4% and 20.8% respectively. The clinical features improved significantly and the degree of clinical improvement correlated with the reduction ratio of herniation, althougy 4 patients improved symptomatically despite increased or unchanged degree of herniation. Ten patients with extruded discs showed a higher reduction ratio of heniation with better clinical outcome than those with protruded discs.

Conclusion: The morphologic change verified on MRI of conservatively treated patients with a lumbar disc herniation is responsible for the clinical outcome although the anatomical factor alone is not enough to explain the outcome. The patients with extruded disc herniation shows more morphologic changes on MRI and better clinical outcomes than the patients with protruded discs.

1,881 View
4 Download

Effect of Intensive Conservative Treatment on Extraforaminal Lumbar Disc Herniations - 1 Year Prospective Follow-up Study.: Cho, Yun Woo; J Korean Acad Rehabil Med 2009;33(1):89-93.

Abstract
PDF

Objective
To evaluate the outcomes of intensive conservative treatment on extraforaminal lumbar disc herniations. Method: Twenty five patients with extraforaminal lumbar disc herniations with symptomatic radicular pain were included. Under fluoroscopic guidance, 40 mg of triamcinolone was infused around the nerve root after provocation of patient's usual radicular pain. Lumbosacral dynamic stabilization exercise, thermal and electrical therapy, and education of posture correction were added. The clinical outcomes were measured by visual analogue scale (VAS) and Oswestry disability index (ODI) before treatment, one, three, six, and twelve months after the treatment. After twelve months, patients' satisfaction was classified to four categories: excellent, good, fair, or poor. Four patients were dropped out. Results: Follow-up VAS and ODI significantly decreased since post-treatment one month (p＜0.0001). The average score of VAS for lower extremity and back pain reduced significantly from 6.6, 4.5 at pretreatment to 1.5, 1.9 at 12 months post-treatment, respectively (p＜0.0001). The averages of ODI reduced significantly from 65.4% at pretreatment to 25.4% at post-treatment 12 months (p＜0.0001). In patients' satisfaction, seventeen patients (81.0%) were recorded as excellent or good after post-treatment 12 months. Conclusion: Intensive conservative treatment was effective on patients who underwent extraforaminal lumbar disc herniation. Pain relief and functional improvement sustained for 12 months. (J Korean Acad Rehab Med 2009; 33: 89-93)

2,910 View
17 Download

Sequential Changes of CX3CR1 in Dorsal Root Ganglion in a Rat Model of Lumbar Disc Herniation.: Seo, Hye Jin , Rah, Ueon Woo , Yoon, Seung Hyun , Ahn, Sang Ho , Kim, Su Jeong , Choi, Gyu Sik , Park, Hea Woon , Jang, Sung Ho , Son, Su Min , Cho, Yun Woo; J Korean Acad Rehabil Med 2011;35(1):1-7.

Abstract
PDF

Objective
To investigate the pain-related behaviors and the changes of CX3CR1 expression in the dorsal root ganglion (DRG) in a rat model of lumbar disc herniation. Method A total of 90 male Sprague-Dawley rats were used. A laminectomy was performed to expose left L5 nerve roots and corresponding DRG. Autologous nucleus puplosus was implanted on the left L5 nerve root proximal to the DRG without mechanical compression. Sham operation was also done with the same procedure as mentioned above. Thermal hyperalgesia and mechanical allodynia were assessed at 1, 5, 10, 20 and 30 days after surgery. Real time PCR and immunohistochemistry after behavioral test were performed. Results In the lumbar disc herniation rats, significant reduction of thermal withdrawal latency indicating thermal hyperalgesia was shown on the ipsilateral hindpaw on postoperative day 1 (p＜0.01) and peaked on day 10 (p＜0.05) and maintained throughout day 30 (p＜0.05). The reduction of mechanical allodynia threshold, indicating mechanical allodynia, was observed on the ipsilateral hindpaw on postoperative day 1 (p＜0.01) and continued throughout day 30 (p＜0.01). Real time PCR showed the decrease in mRNA expression of CX3CR1 in the ipsilateral DRG on day 1 (p＜0.05) and the significant increase on day 20 (p＜0.05). The immunoreactivity for CX3CR1 was also increased in ipsilateral DRG on day 10 and 20. Conclusion These data suggest that lumbar disc herniation induces thermal hyperalgesia and mechanical allodynia and upregulates the expression of CX3CR1 in dorsal root ganglion. Expression of CX3CR1 might be associated with subacute neuropathic pain after intervertebral disc herniation.