Clinical Recognition Of Lumbar Disc Herniation In The Aged People

Background: Lowback and leg pain(LBLP)in the elderly has been increasingly focused nowadays alone with the faster approaching of the aging population in China.Lumbar Disc Herniation(LDH)is always one the most blamed pashomechanical diagnosis for the trouble.Clinically speaking,on the other hand,the radiological image of the herniated lumbar disc in the elderly during their suffering with LBLP may not reflectes the seriousness of their clinical manifestation.A complicated degeneration accompanied with LDH in the elderly might be of more clinical significance,which brings us some puzzling in the consideration of diagnosis and treatment on aged LDH patients.It will be of great cinical significance,therefore,to explore practically the pathomechanics of LDH related LBLP in the aged population.Objective: With quantified symptom and signs,measurement of herniated disc inside spinal canal by MRI image and dislocation of lumbar vertebrae by analyzing X-ray image,the study try to find the clinical significance of protruded nucleus pulposus in the aged LDH patient.The study also try to analyze the clinical significance of biomechanical compensation of lumbar spine in the patients,which will testify if the TCM spinal manipulative principle of correcting “Gu Cuo Feng(vertebra subluxation)” might be of clinical significance.Methods: 30 aged patients with LDH were collected from hospitalized patients in the PLA Spine Center of Manipulative Orthopedic of the General Air Force Hospital between December 2013 to December 2014 as study group.There were 16 male,14 female with the average age of 68yr(65-75yr).Anther group of asymptomatic LDH(ALDH)samples were also collected when they had been come for annual physical check up as a control.The samples in both group will be diagnosed by MRI for LDH assurance.The following indexes will be collected for all samples.1)the quantified evaluation of PNP occupation inside spinal canal.Based on our previous reports a relative occupation inside spinal canal by PNP(T value)is recorded,so does the invading effect on the nearby nerve root(AV angle).The study group will be measured and recorded twice before and after the therapy.2)quantified recording of biomechanical evaluation on the involved segments.All samples in both group were quantitively recorded the vertebral dislocation degree in rotation and tilt(VR and VT)at involved segment by X-ray analyzer produced by USA logan university.3)quantified evaluation of clinical manifestation.1.Oswestry Defensensy Index was recorded,indicating the interference of his daily life ability by the trouble before and after the therapy in the study group.2.general phsycical exam including the symptom standing for nerve root irritation(RS)and those standing for spinal column disorder(PS).The second follow up is about 1-3 month after the therapy.Statistics and results: the statistic analysis is conducted by SPSS19.0 software as following: 1.comparasion of T and AV between two groups(t test);2.comparison of T and AV befor and after the treatment in the study group(self t test);3.comparison of ODI,PS and RS between two groups(self pared t-test).4.correlation analysis between the clinical symptoms and vertebral dislocation degree including VR and VT(Spareman).5.comparison study of VR and VT between the control group and study group including before and after the therapy(t-test).Result: 1.the size and relative occupation inside spinal canal of PNP has not appeared any significant difference between two groups(T: t=1.591,p>0.05,AV: t=0.063,p>0.05);2.there has been no change at all after the therapy in the study group(T: t=0.941,p>0.05;AV: t=-1.944,p>0.05).3.clinical symptoms and signs has been significantly improved in the study group after the therapy(RS: t=7.151.,p<0.05;PS:t=15.557,p<0.05 ODI:t=10.362,p<0.05);4.the vertebral dislocation was also replaced significantly after the therapy in the study group at the involved segment(VR,VT);5.the improvement of clinical symptoms and signs is positively correlated with that of vertebral dislocation(RS/VR: rs=0.600,p<0.01;RS/VT: rs=0.431,P<0.05;PS/VR;rs=0.386,p<0.05;PS/VT: rs=0.408.P<0.05;ODI/VR:rs=0.814,p<0.01;RS/VT: rs=0.567,P<0.05).6.the degree of vertebral dislocation in the study group is significantly different compared with that of the control group before the therapy(VR: t=13.154,p<0.05;VT: t=4.785,p<0.05);but 7.it is also different after the therapy(VR: t=3.581,p<0.05;VT: t=0.282,p>0.05),though,the difference is narrowed.Conclusion: 1.The PNP size and relative occupation inside spinal canal has not yet any obvious difference between symptomatic and asymptomatic LDH samples of aged population,indicating the symptom and signs of the aged LDH is not clinically related to PNP.2.Even the patients have their symptom subsided after conservative therapy the PNP has not yet changed for most of time,which reflect that the PNP is not the key point in conservative treatment to the aged LDH patients.The focus of the therapy is not on the regression of PNP.3.Uncompensated spinal column biomechanical disturbances is the key point for the aged LDH patients.firstly,there have been no obvious difference of PNP in the size and spinal cannal occupation between the samples of LDH and those of ALDH.But the biomechanical instability of involved vertebrae is significantely existed in LDH group than that of ALDH samples recorded by logan X-ray analyzer.Secondly,the “vertebral subluxation” could be compensated or nearly comensated after the spinal manipulative therapy,though the.PNP is not all changed.Furthermore,the compensation is closely related to the improving of the clinical symptoms and signs of the patient.That will explain the effective results of FSM therapy focused on correcting vertebral subluxation.All in all,The study indicates that compensation of the dislocated vertebral body might be of great clinical significance in the aged patients with LDH.On the other hand,the protruded neuclus pulposus radiologically imaged may not be the most important pathomechanical reason to be focused.