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| Evaluation function of CT examination to traction therapy to lumbar disc protrustion |
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| DING Chang-wei, LIU Li-jun, LIN Nan, WANG Tian-jun (third Affiliated Hospital of China Medical University, Shenyang 110022, China) | |||||||||||||||||||||||||||||||
| Abstract: Objective To investigate whether there is morphological change at intervertebral disc after traction therapy to lumbar disc protrusion. Methods We observed 58 lumbar disc protrusion cases diagnosed by CT and treated with traction therapy with CT again, and compared morphological change of intervertebral disc on CT image before and after treatment. Result Effective rate of traction therapy to lumbar disc protrusion was 84.48%, there was no apparent difference in degree of lumbar disc protrusion, anterior-posterior diameter of vertebral canal and lateral crypt width between before and after treatment. Conclusion Traction can relieve effectively clinical symptoms of lumbar disc protrusion, but can't make great change in shape of protruded intervertebral disc. Key words: lumbar disc protrusion; traction; X-ray computer; CT |
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| There are many kinds of therapies to Lumbar disc protrusion (LDP), in which traction is one kind of effective non-operative method; CT is effective and preferred examination method to diagnose LDP. We analyzed clinical manifestations and CT images of 8 lumbar disc protrusion cases that were diagnosed by CT and treated with traction therapy before and after treatment and assessed function of traction therapy to LDP. 1 Subject and Method 1.1 Subject We collected 58 LDP cases that treated with traction therapy from October 1997 to June 2001, including 35 males and 23 females, ages 23-58, average 46.6, disease course 3 days to 15 years. 1.2 Methods Pelvis traction: the first stage lasted 15 days, 2 times per day, 1 hour per time; 3 days later, began the second stage, which lasted 15 days, 1 time per day, 1 hour per time. Weight of traction body is 2/3 of patients' body weight. Patients slept on hard bed in the course of therapy. We scored and evaluated effects according to curative score of Japanese reparative surgery association lumbar vertebral diseases. Patients received CT examinations on lumbar intervertebral discs with Japanese SCT5000T CT scanner before and after treatment: supine position, layer thick 2 mm, interlayer space 2 mm, we compared and analyzed vertebral canal, anterior and posterior intervertebral disc shape, results of which tested by t test. 2 Result Curative effects of 58 LDP cases: 10 excellent cases (17.24%), 39 good cases (67.24%; 6 normal cases (10.34%); 3 bad cases (5.17%), good rate was 84.48%. There was no apparent difference in degree of lumbar disc protrusion and anterior-posterior diamater of vertebral canal between before and after treatment.
3 Discussion LDP is common orthopedic disease and is main reason to |
lumbago and scelalgia. Main reason to pain is protruded nucleus pulposus compress dural sac and / or nerve root. LDP have 5 pathological types: lumbar disc degenerations, bulge, protrusion, prolapse, nucleus pulposus dissociation; according to protrusion position, LDP can be classified into center type, collateral type, posterior type etc. CT can gain high density resolution 2-D cross image and can show clearly direction, degree intervertebral disc bulge, protrusion or prolapse and compress state of dural sac and nerve root. CT can diagnose LDP accurately, which is preferred image method to diagnose LDP and effective method to observe shape change after treatment. Traction is widely used in clinical treatment because it can relieve and promote clinical symptoms of LDP, but there is divergence on whether it can make protruded nucleus pulposus back to normal place(1, 2). This research showed that traction can relieve effectively clinical symptoms of lumbar disc protrusion, but can't make great change in shape of protruded intervertebral disc. This result is consistent with Keqi's results(3). But they adopted CT scan with 4 mm layer thick and 4 mm interlayer space, which is easy to lead to measurement errors and easy to be influenced by partial volume effect. We adopted thinner scan, which gained more reliable results. Mechanism of traction therapy to LDP is not related to back of nucleus pulposus, it is related to edema regression of compressed nerve root, absorption of inflammatory exudation and adhesion relief(4). Traction can relax tension and spasm of paravertebral muscles, decrease intervertebral disc pressure and change spatial position relationship of protrusion body and nerve root. It increases spatial volume around suffered nerve root, relaxes adhesion of small jount and root, corrects uncoordinated dynamic relationship and relieves symptoms. So traction has confirmed curative effects on relief LDP symptoms, is an effective method to treat LDP. But it can't make great change in shape protruded intervertebral disc. References:
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