Disc Herniation Associated to Other Conditions

  • F. Postacchini
  • G. Cinotti


The clinical presentation of central stenosis associated with marked annular bulging or disc herniation is extremely variable. In some cases, signs and symptoms differ from those typical of lumbar stenosis: chronic symptoms with a predominance of radicular disturbances with respect to low back pain; bilateral radicular symptoms, even if often predominant on one side; no symptoms at rest; sensory, astenic or, less commonly, painful intermittent claudication; and negative nerve-root tension tests. A clinical presentation typical of stenosis is usually observed when the disc condition is represented by slight annular bulging. In the presence of a herniated disc, signs and symptoms are more often those typical of disc herniation: recent onset or exacerbation of symptoms; predominance of radicular pain with respect to sensory and motor dysfunction; unilateral radicular symptoms; pain at rest; no or essentially painful intermittent claudication; and positive nerve-root tension tests. The latter, however, tend to be slightly positive, particularly in elderly patients, who are those most frequently presenting stenosis.


Spinal Canal Disc Herniation Interbody Fusion Lumbar Spinal Stenosis Lumbar Disc Herniation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Abumi K. A., Panjabi M. M., Kramer K. M. et al.: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15: 1142–1147, 1990.PubMedCrossRefGoogle Scholar
  2. 2.
    Aebi M.: Correction of degenerative scoliosis of the lumbar spine. Clin. Orthop. 232: 80–86, 1988.PubMedGoogle Scholar
  3. 3.
    Andersson G. B. J.: Surgical aspects on lateral spinal stenosis. Indications and principles. Acta Orthop. Scand. (Suppl. 251) 64: 74–75, 1993.Google Scholar
  4. 4.
    Apel D. M., Lorenz M. A., Zindrick M. R.: Symptomatic spondylolisthesis in adults: four decades later. Spine 14: 345–348, 1989.PubMedCrossRefGoogle Scholar
  5. 5.
    Beckers L.: Buck’s operation for treatment of spondylolysis and spondylolisthesis. Acta Orthop. Belg. 52: 819–823, 1986.PubMedGoogle Scholar
  6. 6.
    Bell G. R.: Spondylolisthesis. In: Lumbar disc disease. Second Edition. Hardy R. W. Jr. Ed., Raven Press, New York, 1993.Google Scholar
  7. 7.
    Boccanera L., Laus M.: Cauda equina syndrome following lumbar spinal stenosis surgery. Spine 12: 712–715, 1987.PubMedCrossRefGoogle Scholar
  8. 8.
    Bradford D. S.: Spondylolysis and spondylolisthesis. In: Moe’s textbook of scoliosis and other spinal deformities. Third Edition. Lonstein J. E., Bradford D. S., Winter R. B., Ogilvie J. W. Eds., W. B. Saunders Co., Philadelphia, 1994.Google Scholar
  9. 9.
    Bradford D. S., Iza J.: Repair of the defect in spondylolysis or minimal degrees of spondylolisthesis by segmental wire fixation and bone grafting. Spine 10: 673–679, 1985.PubMedCrossRefGoogle Scholar
  10. 10.
    Branch C. L., Branch C. L. Jr.: Posterior lumbar interbody fusion with the keystone graft: technique and results. Surg. Neurol. 27: 449–454, 1987.PubMedCrossRefGoogle Scholar
  11. 11.
    Branch C. L. Jr.: Posterior lumbar interbody fusion. In: Lumbar disc disease. Second Edition. R. W. Hardy Jr. Ed., Raven Press, New York, 1993.Google Scholar
  12. 12.
    Bridwell K. H., Sedgewick T. A., O’Brien M. F. et al.: The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J. Spinal Disord. 6: 461–472, 1993.PubMedCrossRefGoogle Scholar
  13. 13.
    Briggs H., Milligan P. R.: Chip fusion of the low back following exploration of the spinal canal. J. Bone Joint Surg. 26-A: 125–130, 1944.Google Scholar
  14. 14.
    Brodsky A. E., Hendricks R. L., Khalil M. A. et al.: Segmental (“floating”) lumbar spine fusions. Spine 14: 447–450, 1989.PubMedCrossRefGoogle Scholar
  15. 15.
    Buck J. E.: Direct repair of the defect in spondylolisthesis. J. Bone Joint Surg. 52-B: 432–437, 1970.Google Scholar
  16. 16.
    Buck J. E.: Further thoughts on direct repair of the defect in spondylolysis. J. Bone Joint Surg. 61-B: 123, 1979.Google Scholar
  17. 17.
    Cauchoix J., Benoist M., Chassaing V.: Degenerative spondylolisthesis. Clin. Orthop. 115: 122–129, 1976.PubMedGoogle Scholar
  18. 18.
    Chang K. W., McAfee P. C.: Degenerative spondylolisthesis and degenerative scoliosis treated with a combination segmental rod-plate and transpedicular screw instrumentation system: a preliminary report. J. Spinal Disord. 1: 247–256, 1989.Google Scholar
  19. 19.
    Cinotti G., Gumina S., Perugia D. et al.: La fissazione mono-laterale nella patologia lombare mediante sistema Compact CD. Progr. Chir. Vert. 18: 243–250, 1995.Google Scholar
  20. 20.
    Cinotti G., Postacchini F.: Spondilolistesi degenerativa. Indicazioni all’artrodesi. Progr. Chir. Vert. 17: 121–128, 1994.Google Scholar
  21. 21.
    Cloward R. M.: Posterior lumbar interbody fusion (PLIF). Surgical techniques. Randolph, M. A., Codman, 1990.Google Scholar
  22. 22.
    Dake M. D., Jacobs R. P., Margolin F. R.: Computed tomography of posterior lumbar apophyseal ring fractures. J. Comput. Assist. Tomogr. 9: 730–732, 1985.PubMedCrossRefGoogle Scholar
  23. 23.
    Dall B. E., Rowe D. E.: Degenerative spondylolisthesis. Spine 10: 668–672, 1985.PubMedCrossRefGoogle Scholar
  24. 24.
    Deburge A., Bex M., Lassale B. et al.: Technique chirurgicale dans le traitement des stenoses du canal lombaire. Acta Orthop. Belg. 53: 412–419, 1987.PubMedGoogle Scholar
  25. 25.
    Deutman R.: Chemonucleolysis in lytic spondylolisthesis. Proc. 2nd Annual Meeting, European Spine Society, Roma, 1991.Google Scholar
  26. 26.
    Deutman R.: Chemonucleolysis in spondylolisthesis. Proc. 20th SICOT Meeting, Amsterdam, 1996.Google Scholar
  27. 27.
    Epstein J. A., Epstein B. S., Lavine L.: Surgical treatment of nerve root compression caused by scoliosis of the lumbar spine. J. Neurosurg. 41: 449–454, 1974.PubMedCrossRefGoogle Scholar
  28. 28.
    Epstein N. E., Epstein J. A, Carras R. et al.: Degenerative spondylolisthesis with an intact neural arch: a review of 60 cases with an analysis of clinical findings and the development of surgical management. Neurosurgery 13: 555–561, 1983.PubMedCrossRefGoogle Scholar
  29. 29.
    Epstein N. E., Epstein J. F., Mauri T.: Treatment of fractures of the vertebral limbus and spinal stenosis in five adolescents and five adults. Neurosurgery 24: 595–604, 1989.PubMedCrossRefGoogle Scholar
  30. 30.
    Feffer H. L., Wiesel S. W., Cuckler J. M. et al.: Degenerative spondylolisthesis. To fuse or not to fuse. Spine 10: 287–289, 1985.PubMedCrossRefGoogle Scholar
  31. 31.
    Fitzgerald J. A. W., Newman P. H.: Degenerative spondylolisthesis. J. Bone Joint Surg. 58-B: 184–192, 1976.Google Scholar
  32. 32.
    Fredrickson B. E., Baker D., McMolick W. J. et al.: The natural history of spondylolysis and spondylolisthesis. J. Bone Joint Surg. 66-A: 669–707, 1984.Google Scholar
  33. 33.
    Frennered K.: Isthmic spondylolisthesis among patients receiving disability pension under the diagnosis of chronic low back pain syndromes. Spine 19: 2766–2769, 1994.PubMedCrossRefGoogle Scholar
  34. 34.
    Goel V. K., Goyal S., Clark C. et al.: Kinematics of the whole lumbar spine. Effect of discectomy. Spine 10: 543–554, 1985.PubMedCrossRefGoogle Scholar
  35. 35.
    Goel V. K., Nye T. A., Clark C. R. et al.: A technique to evaluate an internal spinal device by use of the selpot system: an application to Luque closed loop. Spine 12: 150–159, 1987.PubMedCrossRefGoogle Scholar
  36. 36.
    Grabias S.: The treatment of spinal stenosis: current concept review. J. Bone Joint Surg. 62-A: 308–313, 1980.Google Scholar
  37. 37.
    Grobler L. J., Novotny J. E., Wilder D. G. et al.: L4-L5 isthmic spondylolisthesis. A biomechanical analysis comparing stability in L4-L5 and L5-S1 isthmic spondylolisthesis. Spine 19: 222–227, 1994.PubMedCrossRefGoogle Scholar
  38. 38.
    Grubb S. A., Lipscomb H. J., Coonrad R. W.: Degenerative adult onset scoliosis. Spine 13: 241–245, 1988.PubMedCrossRefGoogle Scholar
  39. 39.
    Hanley E. N.: Decompression and distraction-derotation arthrodesis for degenerative spondylolisthesis. Spine 11: 269–276, 1986.PubMedCrossRefGoogle Scholar
  40. 40.
    Harris I., Weinstein S.: Long-term follow-up of spondylolisthesis. J. Bone Joint Surg. 69–A: 960–969, 1987.Google Scholar
  41. 41.
    Hensinger R. N.: Spondylolysis and spondylolisthesis in children and adolescents: Current concept review. J. Bone Joint Surg. 71-A: 1098–1107, 1989.Google Scholar
  42. 42.
    Herkowitz H. N., Kurz L. T.: Degenerative spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J. Bone Joint Surg. 73-A: 802–808, 1991.Google Scholar
  43. 43.
    Herron L. D., Trippi A. C.: Degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion. Spine 14: 534–538, 1989.PubMedCrossRefGoogle Scholar
  44. 44.
    Iida Y., Kataoka O., Sho T. et al.: Postoperative lumbar spinal instability occurring or progressing secondary to laminectomy. Spine 15: 1186–1189, 1990.PubMedCrossRefGoogle Scholar
  45. 45.
    Johnson G. V., Thompson A. G.: The Scott wiring technique for direct repair of lumbar spondylolysis. J. Bone Joint Surg. 74-B: 426–430, 1992.Google Scholar
  46. 46.
    Johnsson K. E., Udèn A., Rosèn I.: The effect of decompression on the natural course of spinal stenosis. A comparison of surgically treated and untreated patients. Spine 16: 615–619, 1991.PubMedCrossRefGoogle Scholar
  47. 47.
    Kabins M. B., Weinstein J. N., Spratt K. F. et al.: Isolated L4-L5 fusions using the variable screw placement system: unilateral versus bilateral. J. Spinal Disord. 5: 39–49, 1992.PubMedCrossRefGoogle Scholar
  48. 48.
    Kamioka Y., Yamamoto H.: Lumbar trapezoid plate for lumbar spondylolisthesis. A clinical study on preoperative and postoperative instability. Spine 15: 1198–1203, 1990.PubMedCrossRefGoogle Scholar
  49. 49.
    Kaneda K., Kazama H., Satoh S. et al.: Follow-up study of medial facetectomies and posterolateral fusion with instrumentation in unstable degenerative spondylolisthesis. Clin. Orthop. 203: 159–167, 1986.PubMedGoogle Scholar
  50. 50.
    Knox B. D., Harvell J. C., Nelson P. B. et al.: Decompression and Luque rectangle fusion for degenerative spondylolisthesis. J. Spinal Disord. 2: 223–228, 1989.PubMedCrossRefGoogle Scholar
  51. 51.
    Kurz L. T., Garfin S. R., Unger A. S. et al.: Intraspinal synovial cyst causing sciatica. J. Bone Joint Surg. 67-A: 865–871, 1985Google Scholar
  52. 52.
    Lee C. K.: Lumbar spinal instability (olisthesis) after extensive posterior spinal decompression. Spine 8: 429–433, 1983.PubMedCrossRefGoogle Scholar
  53. 53.
    Lombardi J. S., Wiltse L. L., Reynolds J. et al.: Treatment of degenerative spondylolisthesis. Spine 10: 821–827, 1985.PubMedCrossRefGoogle Scholar
  54. 54.
    Marchesi D. G., Aebi M.: Pedicle fixation devices in the treatment of adult lumbar scoliosis. Spine 17: S 304–309, 1992.CrossRefGoogle Scholar
  55. 55.
    Marchetti P. G., Bartolozzi P.: Le spondilolistesi. A. Gaggi, 1985.Google Scholar
  56. 56.
    Mayerding H. W.: Spondylolisthesis. Surg. Gynecol. Obstet. 54: 371–377, 1932.Google Scholar
  57. 57.
    Mayerding H. W.: Low backache and sciatic pain associated with spondylolisthesis and protruded intervertebral disc. J. Bone Joint Surg. 23: 461–469, 1941.Google Scholar
  58. 58.
    McGuire R. A., Amundson G. M.: The use of primary internal fixation in spondylolisthesis. Spine 18: 1662–1672, 1993.PubMedCrossRefGoogle Scholar
  59. 59.
    Morscher E., Gerber B., Fasel J.: Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Acta Orthop. Trauma Surg. 103: 175–178, 1984.CrossRefGoogle Scholar
  60. 60.
    Nazarian S.: Spondylolysis and spondylolytic spondylolisthesis. A review on current concepts on pathogenesis, natural history, clinical symptoms, imaging, and therapeutic management. Eur. Spine J. 1: 62–83, 1992.PubMedCrossRefGoogle Scholar
  61. 61.
    Newman P. H.: Stenosis of the lumbar spine in spondylolisthesis. Clin. Orthop. 117: 112–120, 1976.Google Scholar
  62. 62.
    Nicol R. O., Scott J. H. S.: Lytic spondylolysis: repair by wiring. Spine 11: 1027–1030, 1986.PubMedCrossRefGoogle Scholar
  63. 63.
    Nixon J. E.: Surgical management. In: Spinal stenosis. J. E. Nixon Ed., E. Arnold, London, 1991.Google Scholar
  64. 64.
    Nordby E. J.: Eight-to 13-year follow-up evaluation of chemonucleolysis patients. Clin. Orthop. 206: 18–23, 1986.PubMedGoogle Scholar
  65. 65.
    Pedersen A. K., Hagen R.: Spondylolysis and spondylolisthesis: treatment by internal fixation and bone-grafting of the defect. J. Bone Joint Surg. 70-A: 15–24, 1988.Google Scholar
  66. 66.
    Pipino F., De Giorgi G., Bancale R.: Valutazione clinica, radio-grafica ed evoluzione spontanea della spondilolistesi. Progr. Patol. Vert. 6: 17–35, 1984.Google Scholar
  67. 67.
    Postacchini F.: Lumbar spinal stenosis and pseudostenosis. Definition and classification of pathology. Ital. J. Orthop. Traumat. 9: 339–350, 1983.Google Scholar
  68. 68.
    Postacchini F.: Lumbar spinal stenosis. Springer-Verlag, Wien New York, 1989.CrossRefGoogle Scholar
  69. 69.
    Postacchini F.: The evolution of spondylolysis into spondylolisthesis during adult age. Ital. J. Orthop. Traumatol. 15: 210–216, 1989.PubMedGoogle Scholar
  70. 70.
    Postacchini F.: Management of lumbar spinal stenosis. J. Bone Joint Surg. 78-B: 154–164, 1996.Google Scholar
  71. 71.
    Postacchini F.: Lumbar spinal stenosis. Long-term results. In: The Lumbar Spine. Second Edition. Weinstein J. N., Wiesel S. W. Eds., Saunders Co., Philadelphia, 1996.Google Scholar
  72. 72.
    Postacchini F., Cinotti G., Perugia D.: Degenerative lumbar spondylolisthesis. Ital. J. Orthop. Traumat. 17: 467–477, 1991.Google Scholar
  73. 73.
    Postacchini F., Cinotti G., Perugia D.: Microdiscectomy in treatment of herniated lumbar disc. Ital. J. Orthop. Traumat. 18: 5–16, 1992.Google Scholar
  74. 74.
    Postacchini F., Cinotti G., Gumina S. et al.: Long-term results of surgery in lumbar stenosis. 8-year review of 64 patients. Acta Orthop. Scand. (Suppl. 251) 64: 78–80, 1993.Google Scholar
  75. 75.
    Postacchini F., Cinotti G., Perugia D. et al.: The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J. Bone Joint Surg. 75-B: 386–392, 1993.Google Scholar
  76. 76.
    Rosenberg N. J.: Degenerative spondylolisthesis. Surgical treatment. Clin. Orthop. 117: 112–120, 1976.Google Scholar
  77. 77.
    Rothman S. L. G., Glenn W. V. Jr.: CT multiplanar reconstruction in 253 cases of lumbar spondylolysis. AJNR 5: 81–90, 1984.PubMedGoogle Scholar
  78. 78.
    Salib R. M., Pettine K. A.: Modified repair of a defect in spondylolysis or minimal spondylolisthesis by pedicle screw, segmental wire fixation, and bone grafting. Spine 18: 440–443, 1993.PubMedGoogle Scholar
  79. 79.
    Sanderson P. L., Wood P. L. R.: Surgery for lumbar spinal stenosis in old people. J. Bone Joint Surg. 75-B: 393–397, 1993.Google Scholar
  80. 80.
    Saraste H.: Symptoms in relation to level of spondylolysis. Int. Orthop (SICOT). 10: 183–185, 1986.Google Scholar
  81. 81.
    Saraste H.: Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis. J. Pediatr. Orthop. 7: 631–638, 1987.PubMedGoogle Scholar
  82. 82.
    Schlenzka D., Poussa M., Seitsalo S. et al.: Intervertebral disc changes in adolescents with isthmic spondylolisthesis. J. Spinal Disord. 4: 344–352, 1991.PubMedCrossRefGoogle Scholar
  83. 83.
    Schlenzka D., Seitsalo S., Poussa M. et al.: Operative treatment of symptomatic lumbar spondylolysis and mild isthmic spondylolisthesis in young patients: direct repair of the defect or segmental spinal fusion? Eur. Spine J. 2: 104–112, 1993.PubMedCrossRefGoogle Scholar
  84. 84.
    Sienkiewicz P. J., Flatley T. J.: Postoperative spondylolisthesis. Clin. Orthop. 221: 172–180, 1987.PubMedGoogle Scholar
  85. 85.
    Simmons J. W.: Posterior lumbar interbody fusion with posterior elements as chip grafts. Clin. Orthop. 193: 85–89, 1985.PubMedGoogle Scholar
  86. 86.
    Steffee A. D.: The variable screw placement system with posterior lumbar interbody fusion. In: Lumbar interbody fusion. Lin P. M., Gill K. Eds., Aspen, Rockville, 1989.Google Scholar
  87. 87.
    Suh P. B., Esses S. I., Kostuik J. P.: Repair of pars interarticularis defect. The prognostic value of pars infiltration. Spine 16: S 445–448, 1991.CrossRefGoogle Scholar
  88. 88.
    Surin V., Hedelin E., Smith L.: Degenerative lumbar spinal stenosis. Results of operative treatment. Acta Orthop. Scand. 53: 79–85, 1982.PubMedCrossRefGoogle Scholar
  89. 89.
    Szypryt E. P., Twining P., Mulholland R. C. et al.: The prevalence of disc degeneration associated with neural arch defects of the lumbar spine assessed by magnetic resonance imaging. Spine 14: 977–981, 1989.PubMedCrossRefGoogle Scholar
  90. 90.
    Takahashi K., Kitahara H., Yamagata M. et al.: Long-term results of anterior interbody fusion for treatment of degenerative spondylolisthesis. Spine 15: 1211–1215, 1990.PubMedCrossRefGoogle Scholar
  91. 91.
    Takata K., Inoue S., Takahashi K. et al.: Fracture of the posterior margin of a lumbar vertebral body. J. Bone Joint Surg. 70-A: 589–594, 1988.Google Scholar
  92. 92.
    Van der Werf G. J., Tonino A. J., Zeegers W. S.: Direct repair of lumbar spondylolysis. Acta Orthop. Scand. 56: 378–379, 1985.PubMedCrossRefGoogle Scholar
  93. 93.
    Vebostad A.: Spondylolisthesis. A review of 71 patients. Acta Orthop. Scand. 45: 711–723, 1974.PubMedCrossRefGoogle Scholar
  94. 94.
    Verbiest H.: Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. A review of twenty-seven years experience. J. Bone Joint Surg. 59-B: 181–188, 1977.Google Scholar
  95. 95.
    Virta L., Osterman K.: Radiographic correlations in adult symptomatic spondylolisthesis: a long-term follow-up study. J. Spinal Disord. 7: 41–48, 1994.PubMedCrossRefGoogle Scholar
  96. 96.
    Virta L., Ronnemaa T.: The association of mild-moderate isthmic lumbar spondylolisthesis and low back pain in middle-aged patients is weak and it only occurs in women. Spine 18: 1496–1503, 1993.PubMedGoogle Scholar
  97. 97.
    Wiltse L. L.: The effect of the common anomalies of the lumbar spine upon disc degeneration and low-back pain. Orthop. Clin. North Am. 2: 569–582, 1971.PubMedGoogle Scholar
  98. 98.
    Wiltse L. L., Kirkaldy-Willis W. H., Mclvor G. W. D.: The treatment of spinal stenosis. Clin. Orthop. 115: 83–91, 1976.PubMedGoogle Scholar
  99. 99.
    Young S., Veerapen R., O’Laoire S. A.: Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Neurosurgery 23: 628–633, 1988.PubMedCrossRefGoogle Scholar
  100. 100.
    Yuh W. C., Drew J. M., Weinstein J. N. et al.: Intraspinal synovial cysts: magnetic resonance evaluation. Spine 16: 740–745, 1991.PubMedCrossRefGoogle Scholar
  101. 101.
    Zdeblick T. A.: A prospective randomized study of lumbar fusion. Preliminary results. In: Instrumented spinal fusion. Preoperative evaluation, indications and techniques. Wittenberg R. H. Ed., G. Thieme Verlag, Stuttgart, 1994.Google Scholar

Copyright information

© Springer-Verlag Wien 1999

Authors and Affiliations

  • F. Postacchini
  • G. Cinotti

There are no affiliations available

Personalised recommendations