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谷代, 弘三; Yashiro, Kouzou (1989)
Publisher: 新潟医学会
Journal: 新潟医学会雑誌
Languages: Japanese
Types: Research
Subjects: Lumbar disc hernia, 診断, Neurological findings, 腰椎椎間板ヘルニア, Diagnosis, 神経学的所見

Classified by OpenAIRE into

mesheuropmc: surgical procedures, operative, stomatognathic diseases, digestive system diseases
Real neurological findings in 177 cases of lumbar disc hernia, the levels of which were operatively proved were compared with those described as corresponding to a certain level of hernia in books hitherto published. Sensory change in Keegan's L5 dermatome was accordant with L4-5 hernia only in 41%, that in S1 dermatome with L5-S1 hernia in 44%, and that in L4 dermatome with L3-4 hernia in 67%. Weakness of an entire lower limb or of lliopsoas was proved in accordance with L1-2 or L2-3 hernia. However, weakness of extensor hallucis longus with L4-5 hernia only in 65%, that of flexor hallucis longus with L5-S1 hernia in 37%, and that of quadriceps with L3-4 hernia in 44%. Patellar tendon reflex was diminished in 67% of L3-4 hernia, in 10% of L4-5 hernia, and in 6% of L5-S1 hernia. However, since the incidence of L4-5 hernia was much higher than L3-4 hernia, this finding was encountered in L4-5 hernia as often as in L3-4 hernia. By the same reason, diminished Achilles tendon reflex was encountered in L4-5 hernia as often as in L5-S1 hernia. Findings above described together with consideration that the positional deviation of a disc hernia at a certain lumbar intervertebral level did not cause simultaneous compression on a nerve root which branched at the level of herniation and one which branched one level above it, disclosed an individual difference in motor and sensory innervation was so great that a lumbar disc hernia at a certain level coincided with hitherto described neurological findings only in 40 to 60%. Results of this study led to the conclusion that the level of lumbar disc hernia could not be determined only with neurological findings but with myelography and other figure analyses.

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