Lumbar Disc Herniation Naneria Part 1

Lumbar disc herniation Management of free fragments Part 1 Vinod Naneria Consultant orthopaedic surgeon Choithram Hospital & Research Centre Indore, India

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Types of Disk Disease Disk Bulge Disk bulges into anterior epidural space without any area of focal-ness or out-pouching Disk Herniation General term used to describe different degrees of 'eccentric out-pouching' of IV disk. Protrusion contained herniation or sub-ligamentous herniation Extrusion non-contained herniation, or trans-ligamentous herniation Sequestration free fragment

Literature – Free Fragment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Migration ,[object Object],[object Object],[object Object],[object Object]

Composition of extruded material ,[object Object],[object Object],[object Object]

Pathophysiology of Absorption ,[object Object],[object Object],[object Object]

Absorption - Composition & Time ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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MRI – showing End-plate lesion, marrow signals Indicating a portion of end-plate avulsion in the extruded disc & Will take long time to absorbed or reduction in size. Early surgery may be contemplated.

Fate of Free Fragment – Complete absorption ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],More than 55% of absorption is clinically significant Follow up MRI – every 3 months for one year

Spontaneous changes on MRI & Clinical Correlation - 42 cases treated conservatively. Takada & Takahashi ,[object Object],[object Object],[object Object],[object Object],50% involution in 3 – 6 months J.of Orthopaedic Surgery 2001, 9(1): 1–7

Lateral Migration Case history – 2 - Monoradiculopathy L4 – L5 with loose fragment over L5 body EHL drop gr. 2 Complete relief 2 Yr FU

Why conservative? ,[object Object],[object Object],[object Object],[object Object]

R.K.- Absorption one month ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Absorption within 3 months ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complete absorption in three months.

N.K.- Complete absorption one year ,[object Object],[object Object],[object Object]

Case history – U.S. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Lumbar Disc Herniation Naneria Part 1

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