Herniated disk

Abstract: Spontaneous regression of herniated nucleus pulposus has not been previously documented. Reported here are 11 patients in whom there was unequivocal regression or disappearance of a herniated lumbar disk on follow-up CT study. Two patients with herniated disks were without symptoms. In the nine patients with symptoms, those attributed to the original herniation disappeared or were diminished in all cases. The mechanism of regression of a disk herniation is unknown. Whether or not regression of herniated disk is a frequent occurrence in patients who recover with conservative therapy should be investigated by more frequent use of follow-up CT scans.

Abstract: Percutaneous endoscopic lumbar discectomy (PELD) is one of the surgical options for soft lumbar disk herniation, but the learning curve is perceived to be steep. The first 51 PELD cases performed for single-level intracanalicular lumbar disk herniation causing radiculopathy by the same surgeon were prospectively studied. The patients were divided into 3 groups of 17 patients, and the PELD learning curve was assessed by evaluating operating time, failure rate, complication rate, and 1-year reherniation rate. One-year clinical success rate was assessed by telephone interviews. The herniated disk was successfully removed by PELD in 47 patients. Four patients required subsequent open discectomy due to PELD failure. There were 2 minor complications. One year after surgery, clinical success was achieved in 42 of the 47 patients in whom PELD was initially successful, and reherniation developed in 5 patients. A significant reduction in operating time was observed after 17 patients had been treated (p = 0.0004). No significant differences were observed in terms of either failure rate or complication rate between the 3 groups. No significant differences were observed in terms of either the clinical success rate or the reherniation rate at 1 year after surgery. The PELD learning curve seems to be stable and acceptable with proper pre-PELD training.

Abstract: Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs. This impingement typically produces neck and radiating arm pain or numbness, sensory deficits, or motor dysfunction in the neck and upper extremities. Magnetic resonance imaging or computed tomographic myelography can confirm neurologic compression. The overall prognosis of persons with cervical radiculopathy is favorable. Most patients improve over time with a focused, nonoperative treatment course. There is little high-quality evidence on the best nonoperative therapy for cervical radiculopathy. Cervical collars may be used for a short period of immobilization, and traction may temporarily decompress nerve impingement. Medications may help alleviate pain and neuropathic symptoms. Physical therapy and manipulation may improve neck discomfort, and selective nerve blocks target nerve root pain. Although the effectiveness of individual treatments is controversial, a multimodal approach may benefit patients with cervical radiculopathy and associated neck pain.

Abstract: After 43 years of investigating the intervertebral disk, the long term results of the management of patients from the standpoint of pain are not significantly different than they were prior to the identification of the herniated disk nor do they seem to be significantly different than no treatment at all. This should at least suggest that the phenomena of low back pain is far more complex than can be accounted for on the basis of a simple mechanical-pressure theory of disk derangement. There is a significant volume of literature that would point to the neural tissues themselves as the most logical structures for future research that attempts to interfere with the natural history of this disease from the standpoint of pain. It seems most appropriate to attack lumbar disk disease from this standpoint because except in uncommon cases, the pathological process is benign and self limiting. It also seems logical that major advancements in the management of "diskogenic" back pain will depend upon an appreciation of the importance of controlling neural inflammation in the early phases of the disease rather than developing new techniques of managing irreversible neural lesions and their iatrogenetic or psychiatric sequelae.