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36also known as contusion. 37 Nicoll,EA (1949) Fractures of the dorso-lumbar spine. J. Bone Joint Surg [Br] 31B:376-394. 38Figure 28: Protrusion - herniation of the nucleus through the torn inner layers of the annulus with bulging of the intact outer layers. Figure 28(2): Extrusion - complete tear of the annulus with extrusion of the nucleus. The extruded portion still remains in continuity with the part inside the disc. Figure 28(3): Sequestration - the extruded fragment of the nucleus looses contact with the disc and moves upwards or downwards. 39 Russel T (1989) Thoracic intervertebral disc protrusion: experience of 67 cases and review of literature. Br. J. Neurosurg 3:153-160. 40 Love JG and Schorn VG (1965) Thoracic disc protrusions. J Am Med Assoc. 191:627-631. 41 The importance of cauda-equina syndrome is that this is a rare but definite indication of immediate MRI scan and surgical decompression of the cauda-equina, in terms of hours than days. Even more than a few hours delay may preclude any possible recovery of the loss of sphincter function. 42 Alexander RH and Proctor HJ (1993) ATLS student manual 5th eds. American College of Surgeons, Committee on Trauma. Chicago, IL. 43 White AA and Panjabi MM (1990) Clinical biomechanics of the lumbar spine 2nd eds. Lippincott, Philadelphia p278 defined clinical instability as failure to maintain morphology (anatomical alignment of its structures) and neurology (status of any neurological deficit) under physiological load (normal activities of daily life). 44 Essea SI and Reitman C (1995) Nonoperative care of the spine in Text book of Spinal Disorders. Lippincott. Philadelphia p145. 45 osteophytes are small beads of new bones which form spontaneously around a degenerated joint from the margin of bone, in response to the degenerative process. |
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