title: [Observation of CT three-dimensional reconstruction in the treatment of standard manipulation for lumbar intervertebral disc herniation].
abstract: OBJECTIVE
  To observe the morphological change of prominence through CT three-dimensional reconstruction before and after manipulative treatment and in order to investigate biomechanical effect of manipulation in treating lumbar intervertebral disc herniation (LIDH).
  
  
  METHODS
  From December 2009 to May 2010, 24 patients with LIDH (32 herniated discs) with the unilateral typing,which were treated with manipulation (on alternate day one time and every time about 20 min, 3 weeks as a course of treatment). There were 10 males and 14 females, ranging in age from 25 to 54 years with an average of 36.2 years, in course of disease from 2 days to 10 years with an average of 6.9 years. Protrusible 12 discs were in L4,5 and 20 discs were in L5S1. According to typing of distance between prominence and zygapophysial joint or vertebral plate (ligamentum flavum), 5 cases were type I, 13 cases were type II and 6 cases were type III. After a course of treatment,the morphological changes of prominences were analyzed in the same level of CT three-dimensional reconstruction, including contour map of nerve root sheath side distance (TD), the distance between prominence and zygapophysial joint or vertebral plate (ligamentum flavum), the deviated angle of prominence (AN value) and the sagittal index (SI value).
  
  
  RESULTS
  From the contour map of TD, 19 patients (79.2% of the total) can be identified morphological changes after the treatment; from the distance between prominence and zygapophysial joint or vertebral plate (ligamentum flavum), 7 cases with type II turned into type I and 2 cases with type III turned into type II after treatment; AN value increased after treatment (P<0.05),it showed prominence occurred morphological change toward deviated direction of intervertebral foramina; there was no significant difference in SI value between before and after treatment (P>0.05).
  
  
  CONCLUSIONS
  Standard manipulation can make prominence change, the prominence and nerve roots release, and mutual position improve,which can provide imaging evidence for the study in biomechanical effects.
authors.affiliation: Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China. 84042347@163.com
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Lei
authors.initials: L
authors.lastname: Han
authors.forename: Xue
authors.initials: X
authors.lastname: Han
authors.forename: Jie
authors.initials: J
authors.lastname: Tang
authors.forename: Jin-hong
authors.initials: JH
authors.lastname: Wang
authors.forename: Quan-ming
authors.initials: QM
authors.lastname: Jiao
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000628:therapy*; D008159:Lumbar Vertebrae; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*