81. Www.chiro.org/chiro-list/newsfile/hnpl5lit.txt Dear Doctors, Have any of you had success in treating lumbar disk herniationwith manipulation? I am treating a 24 year old volunteer http://www.chiro.org/chiro-list/newsfile/hnpl5lit.txt

Dear Doctors, Have any of you had success in treating lumbar disk herniation with manipulation? I am treating a 24 year old volunteer fireman now with an L5-S1 medial herniation. He has positive nerve stretch signs in the left leg with pain into the calf, cannot toe walk on the left and has a weak extensor hallusis on the left. His reflexes have remained brisk and he has no changes in bowel or bladder functions. He is opposed to surgery and I agreed to a one month trial of therapy. We use a combination of flexion/distraction and gentle side posture manipulations. He has shown a 50% improvement in the past month using visual analog pain scale and Owestry Questionaire. The managed care company (Liberty Mutual) is pushing for surgery as a "less expensive alternative" to conservative care. For your info, I've attached studies I have supplied to the carrier to make my case for continued conservative therapy. Jerry Vonderharr, DC Evart Chiropractic Clinic vonder@netonecom.net fax: 616-734-6465 phone: 616-734-5891 MEDLINE SEARCH: LUMBAR DISK HERNIATION/ MANIPULATION Stern PJ; Cote P; Cassidy JD A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. Department of Orthopaedics, Royal University Hospital, Saskatoon, Saskatchewan, Canada. J Manipulative Physiol Ther 1995 Jul-Aug;18(6):335-42 Unique Identifier: MEDLINE 96020510 Abstract: OBJECTIVE: To report the clinical presentation and outcome of consecutive patients who received a course of nonoperative treatment, including manipulation, for low back and radiating leg pain. This review was conducted to generate hypotheses for a future clinical trial involving manipulation for the treatment of lumbar spine disk herniation. DESIGN: A case series of consecutive patients presenting to a postgraduate teaching chiropractic clinic between 1990 and 1993 was evaluated. Three thousand, five hundred and fifty-three charts were reviewed; in 71 of the cases, the patient had low back pain (LBP) with radiating leg pain clinically diagnosed as lumbar spine disk herniation. OUTCOME MEASURES: All outcome measures were extracted from the patients' charts. Subjective improvement reported by the patient, range of motion and nerve root tension signs were used to assess improvement. RESULTS: Of the 59 patients who received a course of treatment, 90% reported improvement of their complaint. A subgroup analysis indicated that 75% of the patients that reported improvement of their conditions had an increase in straight leg raising (SLR) and lumbar range of motion. The maximum complication rate associated with this treatment approach was estimated to be 5% or less. A previous history of low back surgery was a statistically significant predictor of poor outcome. CONCLUSION: Based on our results, we postulate that a course of nonoperative treatment including manipulation may be effective and safe for the treatment of back and radiating leg pain. This hypothesis remains to be tested in a prospective study. Mazanec DJ Back pain: medical evaluation and therapy. Center for the Spine, Cleveland Clinic Foundation, OH 44195, USA. REVIEW ARTICLE: 32 REFS. Cleve Clin J Med 1995 May-Jun;62(3):163-8 Unique Identifier: MEDLINE 95330861 Abstract: Most patients with acute low back pain or sciatica improve with appropriate conservative therapy, and most require no immediate diagnostic studies beyond a careful history and examination. In patients with red flags for visceral, malignant, or infectious causes or possible cauda equina syndrome, a more aggressive evaluation is mandatory. In patients whose pain does not respond to initial management or who have chronic symptoms, diagnostic re-evaluation is appropriate. Pustaver MR Mechanical low back pain: etiology and conservative management. Pustaver Chiropractic Care, Matthews, NC 28105. REVIEW ARTICLE: 83 REFS. J Manipulative Physiol Ther 1994 Jul-Aug;17(6):376-84 Unique Identifier: MEDLINE 95053420 Abstract: OBJECTIVE: To review literature pertaining to low back pain (including lumbar disk herniation) and its treatment by manipulative therapy and rehabilitative exercises. DATA SOURCES: A Medline literature search was performed. English and foreign language materials were reviewed. Key words included the following: manipulation, manipulative therapy, lumbar intervertebral disk herniation, lower back pain. STUDY SELECTION: The studies detailed the neurologic and biomechanical aspects of manipulative therapy, as well as the efficacy of manipulative and rehabilitative management of mechanical low back pain. Also included were studies detailing the etiology of mechanical low back pain. DATA SYNTHESIS: Recent studies have indicated there are certain activities that commonly precipitate lower back injuries. Several methods of treatment for these injuries are discussed. The review indicated the most effective form of treatment is manipulative therapy. The neurologic and biomechanical aspects of manipulation are discussed. CONCLUSION: Low back pain is a common cause of physical, emotional and financial distress. This paper concluded that manipulative therapy is an efficacious as well as cost-effective method of treatment in cases of mechanical low back pain. Schneider MJ Distraction manipulation reduction of an L5-S1 disk herniation [letter; comment] J Manipulative Physiol Ther 1993 Nov-Dec;16(9):618-20 Unique Identifier: MEDLINE 94180008 Comment on: J Manipulative Physiol Ther 1993 Jun;16(5):342-6 Cox JM; Hazen LJ; Mungovan M Distraction manipulation reduction of an L5-S1 disk herniation [see comments] J Manipulative Physiol Ther 1993 Jun;16(5):342-6 Unique Identifier: MEDLINE 93346925 Comment in: J Manipulative Physiol Ther 1993 Nov-Dec;16(9):618- 20;Comment in: J Manipulative Physiol Ther 1994 Jan;17(1):60-4 Abstract: OBJECTIVE: A computed tomography (CT)-confirmed L5-S1 disk protrusion is reported to be reduced following chiropractic adjustment, as seen on repeat CT scanning. Correlation of the CT reports with the patient's symptoms before and after manipulation is reported. CLINICAL FEATURES: A 38-yr-old female was treated for low back pain and right lower extremity first sacral dermatome sciatica. CT confirmed disk herniations at both the L4-L5 and L5-S1 levels were found. Motor weakness of the right gluteus maximus muscle was found and extremely tight hamstring muscles accompanying positive straight leg signs were elicited. A clinical and imaging diagnosis of an L5-S1 disk herniation was made. INTERVENTION AND OUTCOME: Distraction type chiropractic manipulation, electrical stimulation, exercises, nutrition advice and low back wellness class were administered with complete relief of sciatic pain and nearly complete relief of low back pain. CONCLUSIONS: Chiropractic distraction manipulation is an effective treatment of lumbar disk herniation, if the chiropractor is observant during its administration for patient tolerance to manipulation under distraction and any signs of neurological deficit demanding other types of care. Hession EF; Donald GD Treatment of multiple lumbar disk herniations in an adolescent athlete utilizing flexion distraction and rotational manipulation. Monmouth College Department of Sports Medicine, West Long Branch, NJ. REVIEW ARTICLE: 50 REFS. J Manipulative Physiol Ther 1993 Mar-Apr;16(3):185-92 Unique Identifier: MEDLINE 93260360 Abstract: An acute case of low back pain in a high school athlete is described. Onset of nonradicular back pain was related to squat-type weightlifting in preparation for high school football. Magnetic resonance images demonstrated central posterior disk herniations with thecal sac effacement of the lower three disk levels. Clinical and electrophysiological evaluation revealed no neurological deficits. Flexion distraction and rotational manipulation with adjunctive paraspinal muscle stimulation resulted in early improvement and apparent long-term resolution of this patient's symptoms. The effectiveness of flexion distraction and rotational manipulation in reducing subjective symptoms are compared utilizing visual analog pain scales. Literature review of the conservative treatment of lumbar disk herniations is discussed. Cassidy JD; Thiel HW; Kirkaldy-Willis WH Side posture manipulation for lumbar intervertebral disk herniation [see comments] Department of Orthopaedics, Royal University Hospital, Saskatoon, Saskatchewan, Canada. REVIEW ARTICLE: 41 REFS. J Manipulative Physiol Ther 1993 Feb;16(2):96-103 Unique Identifier: MEDLINE 93187577 Comment in: J Manipulative Physiol Ther 1994 May;17(4):258-62 Abstract: OBJECTIVES: The objective of this article is to review the status of side posture manipulation for lumbar intervertebral disk herniation. DATA SOURCES, STUDY SELECTION AND DATA EXTRACTION: The data presented in this article are from our Back Pain Clinic at the Royal University Hospital and the articles cited are those which we feel are important in reviewing this subject. CONCLUSIONS: The treatment of lumbar intervertebral disk herniation by side posture manipulation is both safe and effective. Further research is required to understand more fully the effects of this treatment on the intervertebral disk.

82. Virtual Hospital: Radiology Resident Case Of The Week: Document Title Radiology Resident Case of the Week. lumbar disk herniation and Conjoinednerve root sleeve (lumbar). May 15, 1997. Eric Fitzcharles http://www.janela1.com/vh/docs/v0001136.htm

Radiology Resident Case of the Week Lumbar disk herniation and Conjoined nerve root sleeve (lumbar). May 15, 1997 Eric Fitzcharles Peer Review Status: Not reviewed Clinical Sx: 53 year old male with several month history of increasing right lower extremity weakness and numbness. Etiology/Pathophysiology Disk degeneration is noticeable by the age of 20. The process consists of desiccation, or water loss in the nucleus pulposus and decreased tissue resiliency with decrease in the height of the disk space. With age, the initially soft and gelatinous nucleus pulposus is replace by fibrocartilage and the distinction between nucleus pulposus and annulus fibrosis becomes less distance. The annulus becomes fissured and negative pressures bring nitrogen out of solution causing vacuum phenomenon. Disk height loss leads to malalignment and all of these processes permit disk material to bulge and subsequently herniate. The second finding in this patient was a conjoined nerve root sleeve. This is a congenital anomaly which is considered a normal variant and is found in 1-3% of the population. Pathology: The terminology of disk disease is at times muddy, however the following definitions are helpful: bulge: concentric smooth circumferential expansion of softened disk material beyond the confines of endplates. protrusion = herniation: focal protrusion of disk material maintaining broad base with parent disk due to weakened or ruptured annulus fibrosus but intact posterior longitudinal ligament (herniation implies ruptured annulus fibrosus but protrusion doesnÕt necessarily). extrusion: prominent focal extrusion of disk material with only an isthmus of connection with the parent disk due to ruptured annulus and intact or ruptured posterior longitudinal ligament. free fragment: frank separation of disk material from parent disk (may migrate). There was no resected pathologic specimen from this patient.

83. Herniated Disc Hub Surgery in Patients with Herniated lumbar disk by Group Health Northwest. Surgicaldiscectomy is cost effective for certain patients with herniated discs. http://www.knowdeep.org/herniated/

Herniated disc, also known as ruptured disc, is when a portion of the intervertebral disc material bulges and sticks out into the neural canal. The herniated disc can press backwards onto the spinal cord or any of the nerves that come off of the spinal cord and go to your skin and muscles. On this hub page, you will find reviewed and categorized links about herniated disc. Acne Allergy Antibiotics Antioxidants ... Clinical Evaluation and Treatment Options for Herniated Lumbar Disc - by S. Craig Humphreys M.D., and Jason C. Eck, M.S., Chattanooga, Tennessee. Herniated Lumbar Disc - by North American Spine Society. Herniated nucleus pulposus (slipped disk) - by MEDLINEplus. A New Horizon for the Management of Herniated Disc of Cervical and Lumbar Spine - by S.M. Rezaian, M.D., Ph.D., L.R.C.P., M.R.C.P., F.R.C.S., California Orthopaedic Medical Clinic, Beverly Hills, California. Lumbar Disc Disease - by NYU Dept. of Neurosurgery. Herniated Cervical Disc - by North American Spine Society. Two-Level Thoracic Disc Herniation - by Niels Levi M.D. and Kjeld Dons M.D. Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Surgery in Patients with Herniated Lumbar Disk - by Group Health Northwest.

84. Lumbar (intervertebral) Disk Disorders DESCRIPTION Many patients with low back pain have lumbar disk disease andinvolvement of surrounding spinal ligaments, muscles and skeleton. http://www.5mcc.com/Assets/SUMMARY/0545.html

85. BackPainOConnor.com Sprain, Ligamentous Strain, Ligamentous Sprain, Lumbar Ligament Strain, LumbarLigament Sprain, Lumbar Disc Degeneration, (lumbar disk Degeneration), Low http://www.backache.md/bookorders.asp

THE BOOK CLICK HERE TO ORDER BOOK ... BOOK OR REFERRAL TO FRIEND TITLE: MAKING YOUR BAD BACK BETTER WITH THE O'CONNOR TECHNIQUE SUBTITLE: HOW YOU CAN BECOME YOUR OWN CHIROPRACTOR AUTHOR'S LAST NAME: O'Connor AUTHOR'S FIRST NAME: William AUTHOR'S MIDDLE NAME: Thomas, Jr., M.D. SYNOPSIS: MAKING YOUR BAD BACK BETTER WITH THE O'CONNOR TECHNIQUE (tm), HOW YOU CAN BECOME YOUR OWN CHIROPRACTOR The book and especially the self-administered physical therapy aspect was written to be read from a back pain sufferer's perspective, in lay language; however it was also intentionally written with sufficient technical detail so that a physical therapist, massage therapist, Chiropractor, or physician can apply the identical principles to patients in order to diagnose back pain or neck pain, relieve backache or neck ache, and prevent their back pain or neck pain from re-occurring. No other existing back pain therapy, backache therapy, or neck pain therapy offered by the medical establishment, or available to the public through any media, approaches the successfulness of The O'Connor Technique in its ability to not only address immediate, acute back pain or chronic backache; but, over the life of the individual, it teaches how the painful biological process of degenerative disc disease can be avoided and, this previously believed to be relentless process, prevented from advancing at the rate it otherwise might.

86. Cirugía Especializada 17.Disk cervical hernia ( Microsurgery ). 18.Disk cervical hernia with laser. 19.Lumbardisk hernia ( Microsurgery ). 20.lumbar disk hernia with laser tecnique. http://www.ciren.ws/icirugía.htm

An excellent service to elevate your life quality.The surgical services offered in our institution which are named hereafter, though other neurosurgical treatments are also offered. MOVEMENT DISORDERS AND NEURODEGENERATE CLINIC. NEUROMUSCULAR DISEASESAND MULTIPLE SCLEROSIS CLINIC. SPINAL CORD INJURY AND RELATED DISORDERS CLINIC. CLINIC FOR HEAD TRAUMA AND STROKE SEQUELS. ... CHILD NEUROLOGY CLINIC. Neurosurgical treatment in the Movement Disorders and Neurodegenerate Clinic. 1. VIM Thalamotomy. 2. Selective postventral pallidotomy. 3. Selective dorso-lateral subthalamotomy Neurosurgical treatment in the Child Neurology Clinic 4. Neuroendoscopy in Hidrocephaly ( premamidal ventriclostomomy ). 5. Neuroendoscopy ( Tumors ), endoscopic resection of tumors and intraventricular cysts. Neurosurgical treatment in the Spinal Cord Injury and Related Disorders Clinic 6. Surgery for stereotax for pain. 7.Syringomielia with microsurgery and evocative trans-operational potentials. 8.Syringomielia with microsurgery and neuroendoscopy and evocative trans-operational potentials. 9.Spondylitic myelopathies.

87. Lumbar Degenerative Disk Disease - DynoMed.com lumbar Degenerative disk Disease, What is “lumbar Degenerative disk Disease?”For most people with low back pain, an injury doesn't just happen. http://www.dynomed.com/encyclopedia/encyclopedia/spine/Lumbar_Degenerative_Disk_

Return Records Lumbar Degenerative Disk Disease Causes Symptoms Treatment A Quick Overview of the Spine: The cervical vertebrae are the seven vertebrae that form the upper part of your spine, between the skull and the chest. The thoracic vertebrae are the 12 bones between your neck and your lower back.  Thoracic vertebrae have cup-shaped surfaces called facets, in which the ribs rest and connect to the spine.  These ‘joints’ help the ribs to move up and down during breathing. The lumbar vertebrae are the five largest and strongest of all vertebrae.  They are found in your lower back between the chest and hips.  The strong muscles of the back are attached to the lumbar vertebrae. Your sacrum and coccyx are the bones found at the base of your spine.  The triangular sacrum—made up of five vertebrae fused together—supports the spine and connects it to the pelvis.  Your coccyx, or tailbone, is formed from four fused vertebrae and has little function. The vertebral foramen is the hollow part of the vertebrae where the spinal chord (nerve tissues) attaches to your brain and sends signals all over your body.

88. InteliHealth: If you have symptoms of lumbardisk herniation, your doctor also may ask you to performspecific maneuvers, such as walking on your toes, walking on your heels http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/31349/308996.html?d=dmtHealth

89. Health Library Find Information On Spinal Surgery - Lumbar At injured disks that bulge out (slipped disk) between the vertebrae; bone injuries(fractures); For the lower back (lumbar spine), an incision is made over the http://www.mercksource.com/pp/us/cns/cns_hl_adam.jspzQzpgzEzzSzppdocszSzuszSzcns

90. Journals : Endoscopic Discectomy,disk, Laser Discectomy,herniated Disc, Sciatica Especially about herniated disc, herniated disk, spine, laminectomy, back, leg,knee, neck pain, lumbar, pinched nerve, sciatica, neurosurgery, arthroscopic http://www.spineonline.com/published.html

The leader in herniated disc treatment! Home Incoming Patients Post Surgery Area Questions to Ask Your Doctor ... Out of Town Patients Tell A Friend Tell a friend about SpineOnline Questions Major surgery is not the only option for many patients with disc herniation. Call 800-956-6724. Send us a question Title : Endoscopic Transforaminal Lumbar Discectomy and Reconfiguration : A Posterolateral Approach into the Spinal Canal Surgical Neurology [An International Journal : 1998 Jun;49(6):588-97;] This study represents cases of working channel, transforaminal spinal endoscopy performed using an endoscope which, because of its small size and flexibility, can bend up to 90 degrees, and pass completely through the foramen into the spinal canal, to directly remove free fragments and reconfigure disc, relieving root and dural displacement at a lumbar levels. The percutaneous transforaminal endoscopic technique can be effective, safe approach for disc removal through the foramen, especially in cases where the disc presents itself for direct removal. Read This Article Any questions about this site, mail to

91. Lumbosacral Spine - Lumbosacral Disk Herniation - Tutorial Crossed straight leg raising is less sensitive, but more specific for lumbardisk herniations, particularly those with a central component. http://ortho.hyperguides.com/Tutorials/spine/lumbosacral/herniation/tutorial.asp

window.location="http://www.ortho.hyperguides.com/"; Lumbosacral Disk Herniation Edward N. Hanley Jr., MD Introduction Incidence and Epidemiology Clinical Features History and Physical Exam ... Surgical Options Introduction The prevalence of symptomatic lumbosacral disk herniation is relatively small. It is important to differentiate between the reasonably well-defined entity of sciatica resulting from a herniated intervertebral disk and the less well understood diagnosis of low-back pain. Sciatica is defined as pain radiating down the course of one or more of the roots of the sciatic nerve, extending down the nerve to a point below the knee in one or both legs. Sciatica is merely a symptom, not a specific disease or disorder. The history and physical exam are among the most important tools in differentiating this disease process. Incidence and Epidemiology A symptomatic herniated disk occurs during the lifetime of approximately 2% of the population. In most cases, sciatica improves spontaneously. When the prevalence of sciatica and the radiculopathy (10% to 25%) is taken into consideration, it is clear that surgical treatment should be entertained for less than 0.5% of the population. The intervertebral disk ages naturally from nuclear dehydration through a series of inevitable changes. With progressive degeneration, disk material may herniate, causing nerve root compression. Herniation generally occurs between the ages of 30 and 50 years. The exact cause of pain radiating down the leg is controversial. However, it appears that symptomatic lumbar radiculopathy is a result of mechanical contact between the disk and one or more nerve roots or a result of a combination of this contact and yet undetermined biomechanical and vascular factors. Almost 98% of clinically important disk herniations occur at the L5-S1 (most common) or L4-5 levels.

92. Akron General's Physical Therapy Department Can physical therapy relieve a bulging lumbar disc? The lumbar discs are locatedin the lower portion of the spine and absorb most of the weight of the body. http://www.agmc.org/pt/pt12.asp

Patient Education Rotator Cuff Tendinitis Lumbar ... Therapy Can physical therapy relieve a bulging lumbar disc? Discs are the cushions or shock absorbers located between each vertebra. The outer layer of the disc is made of fibrocartilage laid down in many layers to give the disc strength. The inner portion of the disc is made of a gel-like substance, which is mostly water. All discs will experience wear and tear as we get older. The lumbar discs are located in the lower portion of the spine and absorb most of the weight of the body. They are the most prone to wear-and-tear and injury. The discs can be injured by trauma, frequent repetitive movements like bending and twisting and prolonged static postures like sitting in a car or at a desk. The inner portion of the disc can push out on the injured part of the outer disc and cause the disc to swell or bulge. Bulging discs can cause local back pain and can even refer pain to one or both legs if the bulge is big enough. A bulging disc can also produce symptoms of numbness or weakness in the leg. An MRI or CAT scan can show the presence of a bulging disc. Most disc problems get better with a combination of time, rest and the proper treatment. The vast majority of bulging discs do not need surgery. This is where physical therapy can help.

93. New Study: Weightlifting Does Not Correlate With Degenerative Lumbar Disk Diseas New Study Weightlifting Does Not Correlate with Degenerative LumbarDisk Disease. A study published in the October 1997 issue of http://www.systoc.com/newscomments/news/january98/weightlif.htm

New Study: Weightlifting Does Not Correlate with Degenerative Lumbar Disk Disease A study published in the October 1997 issue of Medicine and Science in Sports and Exercise by T. Videman and associates from the Department of Health Sciences, University of Jyvaskyla, Finland examined the effect of lifetime exercise on MRI findings in monozygotic twins. The study examined: The effects of endurance exercise in 22 discordant twin pairs (mean lifetime frequencies of 3.9 vs 1.1 times/wk) The effects of power sports in 12 discordant pairs (2,300 vs 200 hours of weightlifting). The study found: No differences in MRI findings between co-twins discordant for endurance exercise at any of the spinal regions. Subjects with more power sport involvement had greater disk degeneration in the T6-T12 region (P <0.03), but similar findings were not present in the lumbar spine. The study concluded: No signs of beneficial or harmful effects of lifetime endurance exercise on disk degeneration were seen. Increased power sport participation was associated with slightly greater disk degeneration in the lower thoracic spine, but not in the lumbar spine. (Editor's Note: A common question for physicians at workers' compensation depositions is whether heavy lifting caused the employee's lumbar degenerative disk disease. This small but clever study would provide information that would argue against such causation. wln)

94. Known Spine Spine Cases by Diagnosis. http://www.mritutor.org/mriteach/spdiag.html

Spine Cases by Diagnosis Extruded Lumbar Disk Liposarcoma of Thoracic Spinal Canal Cervical Disk herniations Fatty Filum Terminale ... Back to MRI Teaching File Home Page Last modified January 17, 1997 URL: http://www.xray.ufl.edu/~rball/teach/spdiag.html

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