Lumbar Disc Herniation

J Manipulative Physiol Ther. 2008 Mar;31(3):191-8.

Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging.

Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S.

Department of Physical Medicine and Rehabilitation, Medical Faculty, Celal Bayar University, Manisa, Turkey. zelihaunlu@yahoo.com

Abstract

OBJECTIVE: This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH).

METHODS: A total of 60 patients were enrolled in this study and randomly assigned into 1 of 3 groups equally according to the therapies applied, either with traction, ultrasound, or LPL. Treatment consisted of 15 sessions over a period of 3 weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at 1 and 3 months after treatment.

RESULTS: There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the 3 treatment groups at any of the 4 interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups.

CONCLUSIONS: This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.

Photomed Laser Surg. 2007 Feb;25(1):40-4.

Percutaneous laser disc decompression for lumbar disc hernia: indications based on Lasegue’s Sign.

Iwatsuki K, Yoshimine T, Awazu K.

Department of Neurosurgery, Osaka University Medical School, Osaka, Japan. kiwatsuki@nsurg.med.osaka-u.ac.jp

Abstract

OBJECTIVE: The present study was conducted to establish reasonable indications of patient neurological manifestations for use of percutaneous laser disc decompression (PLDD).

BACKGROUND DATA: PLDD is a less invasive surgical procedure for lumbar disc hernia, whose indications have been described on the basis of radiographical findings.

METHODS: Sixty-five consecutive patients (45 men and 20 women) with lumbar disc hernia were treated with PLDD by applying a diode laser (wavelength 805 nm). A total of 450-1,205 joules (average, 805.5 joules) were delivered per disc. All patients suffered from radicular pain. They were divided based on the presence of Lasegue’s sign. The post-procedure results at 1 week and 1 year were compared between the groups.

RESULTS: PLDD was effective for patients with Lasegue’s sign (80.0%), but ineffective for those without the sign.

CONCLUSION: The present study suggests that Lasegue’s sign in patients is an indication of PLDD for lumbar disc hernia.

Neurol Res. 2005 Apr;27(3):319-23.

The effect of laser irradiation for nucleus pulposus: an experimental study.

Iwatsuki K, Yoshimine T, Sasaki M, Yasuda K, Akiyama C, Nakahira R.

Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. kiwatsuki@nsurg.med.osaka-u.ac.jp

Abstract

BACKGROUND: The radicular pain caused by disc herniation can be explained by two mechanisms: the compression of the nerve root by the herniated disc or the irritation of the nerve root due to chemical factors. Percutaneous laser disc decompression (PLDD) was introduced for the treatment of lumbar disc hernias in the 1980s. Decompression of the nerve root is assumed to be an effective therapeutic mechanism for PLDD. However, laser irradiation might reduce the chemical factors that cause nerve root irritation by altering intra-disc proteins. We used nerve conduction velocities (NCV) and levels of two chemical factors to evaluate the differences between the two groups in this in vivo study.

METHODS: All rabbits had the nerve root in contact with the leakage from the nucleus pulposus. One group underwent laser irradiation for the leaking nucleus pulposus including the incision site of the disc and nucleus pulposus itself. The levels of two chemical factors, prostaglandin E2 and phospholipase E2, in the intervertebral disc were measured before and after laser irradiation.

RESULTS: NCV in the laser-irradiated group was significantly faster than in the non-laser-irradiated group. The levels of chemical factors were significantly reduced after laser irradiation.

CONCLUSIONS: One of the mechanisms thought to be responsible for PLDD’s effectiveness is a decrease in the chemical factors through protein alteration in the intervertebral disc by laser irradiation.


Treatment of Low Back Pain
Kazuyoshi Zenba, the president of
Isehara Threrapeutic Institute

PHOTO:”Treatment of Low Back Pain”


Low back pain is said to be a characteristic illness to human beings who started to walk in the upright position. This is caused by the poor posture, the decline of muscular strength and the fatness. In case the conventional therapy such as medical treatments or physical therapies are not effective to a low back pain patient, the low power laser therapy is recomended to take up.
The low power laser can penetrate deep into the human body stimulates receptors of autonomous nervous system relieving the tension of sympathetic nerve and improves the blood circulation of entire body and affected part and mitigates the pain very quickly. Compared with conventional treatments, the effect of low power laser irradiation will continue for several hours and can be accumulated.
Points of irradiation are tender points or indurated parts, 20~30sec/point, 3~5 minutes in total, if possible daily irradiation is recomended or 3~4 days a week.
Recently, the radicular sciatica, which is difficult to be effected by low power laser has been found to be cured by the repoetition of very short time irradiation of high power laser. Please inform me through this association for more detaile information. (An example of laser treatment) The name of a disease: Protruded lumbar disc The birth day of the patient :October 10,1953, Sex: male
Development: On the following day when the patient went to dig bamboo shoots he tried to bring up a heavy goods from the floor. At that moment, he felt a strong pain at his back and became cannot move at all. He could not sleep through the night and was carried to our hospital. Laser treatment: Lying on his side we irradiated the low power laser to tender points of his low back 10~30 seconds at each point.Result of treatment: Soon after the first treatment, he became possible to keep sitting position and turn over while sleeping. After 4 time treatments, his pain was almost eliminated and started to drive his car.