Abstract Magnetic resonance imaging (MRI) provides methods to study the microstructure and functional properties of tissues that can be utilized to acquire information about the degenerative processes in the spine. The purpose of the current study was to evaluate the value of diffusion-weighted MRI and quantification of delayed gadolinium enhancement in assessing intervertebral disc degeneration. An experimental degeneration model was used to evaluate the sensitivity of diffusion-weighted MRI and T2 relaxation time measurements in detecting early degenerative changes in the disc. In six pigs, an annular disc lesion was induced surgically, after which the discs were repeatedly MR imaged for up to eight weeks. T2 relaxation time of the lesioned discs decreased postoperatively, whereas apparent diffusion coefficient (ADC) initially increased, but at eight weeks decreased when compared to the control discs. The value of ADC in degeneration of human discs was evaluated by imaging 228 voluntary middle-aged men. ADC values of the three lowest lumbar intervertebral discs were measured and disc degeneration was visually graded. The reduction in ADC between visually normal and moderately degenerated discs was 4%, whereas severely degenerated discs showed 5% higher ADC values than normal discs. T2 signal intensity of the discs was significantly correlated with the ADC values. Because of a considerable overlap between ADC values of normal and degenerated discs the clinical relevance of the ADC measurements of lumbar intervertebral discs remains questionable. A method to quantify delayed enhancement of the nucleus pulposus after intravenous gadolinium contrast agent injection was developed to evaluate the diffusion of small solutes into the disc. Twenty male volunteers were imaged in order to correlate the measured change in the T1 relaxation rate with visually evaluated degenerative changes. The percentual change of T1 relaxation rate for individual discs was up to 126%, and a positive trend was observed between the delayed enhancement and the disc degeneration grades. In order to study the factors that determine the intensity of delayed enhancement, T1 relaxation rate measurements were further correlated with lumbar artery stenosis, bone marrow changes adjacent to endplates, endplate defects, and ADC of the disc. Lumbar artery stenosis and ADC values of the discs were not correlated with enhancement, while disc space narrowing and the presence of degenerative endplate changes had a strong correlation, suggesting an important role for the endplate in maintaining the integrity of the disc.

Abstract The purpose of this study was to evaluate the role of diminished arterial blood flow in painful disc degeneration. Diffusion in intervertebral discs of 37 asymptomatic adults measured by magnetic resonance imaging (MRI) and their lumbar arterial blood supply measured by magnetic resonance angiography (MRA) correlated significantly. End plate degeneration in intervertebral discs evaluated with MRI was analysed with reference to disc distress evaluated with computed tomography (CT) discography, and a significant correlation between end plate degeneration and disc degeneration was found among 36 low back pain patients. Intradiscal pain caused by discography did not correlate with end plate degeneration. There were significantly more atheromatous plaques in the abdominal aorta among 29 chronic low back pain patients compared to 52 asymptomatic people, especially in the age group under 50 years. Occlusion of lumbar arteries in MRA correlated significantly with disc degeneration in MRI among 113 sciatica patients. Furthermore, the disc degeneration and the occlusion of lumbar arteries were severe among 41 sciatica patients and 41 asymptomatic people. During a three-year follow-up, the occlusion of lumbar arteries in MRA correlated significantly with physical and mental ability measured by a self-efficacy questionnaire at every assessment point (1,2,3 years). Furthermore, the intensity of back pain at 1 year and leg pain at 2 years correlated with the occlusion of lumbar arteries. Re-stenosis of lumbar arteries within 3 years correlated significantly with medical consultations for low back pain, prolonged low back pain and prolonged sciatica during one year before the baseline assessment.

Abstract Low back pain (LBP) is the leading cause of years lived with disabilities worldwide. Intervertebral disc (IVD) degeneration is a strong contributing factor to LBP. Recent studies have shown that genetic determinants contribute markedly to IVD degeneration but knowledge about the actual genes involved as well as their roles is still limited. The aim of this thesis work was to study genetic factors that may predispose to IVD degeneration. Using both family and case-control association study designs, variants in five genes showed association with IVD degeneration on magnetic resonance imaging (MRI) in a population-based sample and among patients with sciatica due to lumbar disc herniation (LDH). We performed a candidate gene association study of the known variants implicated in IVD degeneration in a Finnish cohort of 538 young individuals with a moderate degree of lumbar IVD degeneration on MRI. We were able to confirm the associations of variants in the IL6, SKT, and CILP genes, which provides further evidence for true associations. Based on our earlier linkage study in Finnish sciatica families, we performed a candidate gene analysis and identified IL17F as a potential candidate gene. To the best of our knowledge this is the first study to observe an association between this gene and discogenic sciatica. Both IL-6 and IL-17 are pro-inflammatory cytokines with elevated expression levels in herniated tissues, which suggest a role in IVD degeneration. Study of the role of genes coding for inflammatory mediators is of interest as it may contribute to the understanding of the overall inflammatory response of the disc. In addition, we reported on the involvement of SKT in the etiology of lumbar disc herniation (LDH) both in Japanese and Finnish case-control samples. Experimental studies in mice have shown that Skt homozygous mutants exhibit disc abnormalities resulting in a kinky tale phenotype. We hypothesized that the human homolog SKT could have long-term importance in the onset of IVD degeneration by making the discs more vulnerable. Finally, through linkage studies and in the subsequent association analyses, the role of CHST3 as a novel risk factor for IVD degeneration was identified. CHST3 encodes an enzyme that catalyzes the sulfation of chondroitin, and mutations in this gene are associated with spondylepiphyseal dysplasia and humerospinal dysostosis. In our study, we identified this gene using genome –wide linkage based on data from a Southern Chinese family and speculated that mild CHST3 reduction caused by the reported susceptibility SNP could result in disc degeneration in adults in conjunction with other risk factors. This thesis provides new information about the genetic background of IVD degeneration and new insights into the etiology of the disease. The specific roles of these genes in the IVD function and pathogenesis of sciatica are not clear however, and need to be elucidated. / Tiivistelmä Alaselkäkipu on yksi yleisimmistä sairauksista ja johtava syy työkyvyttömyyteen. Välilevyrappeuma myötävaikuttaa merkittävästi alaselän kipuun. Vaikka aiemmat tutkimukset ovat osoittaneet, että perintötekijöillä on vahva osuus välilevyrappeumaan, altistavat geenit ja niiden rooli tunnetaan huonosti. Tämän tutkimuksen tavoitteena oli arvioida tiettyjen perintötekijöiden osuutta välilevyrappeumassa ja tunnistaa taudille altistava geeni perheaineistossa aiemmin havaitulta kromosomialueelta. Aineistoina tutkimuksessa olivat perheaineistot sekä laajat potilas-kontrolliaineistot suomalaisesta ja aasialaisista väestöistä. Tutkimuksessa osoitimme, että perimän vaihtelut viidessä tutkitussa geenissä altistivat erilaisille välilevyrappeuman taudin muodoille. Tutkimus, jossa analysoimme aiemmin tunnistettuja alttiusgeenejä, vahvisti IL6, SKT ja CILP geenien vaihteluiden osuuden taudin alttiustekijöinä. Tutkimusaineistona oli pohjoissuomalainen syntymäkohortti, jossa välilevyrappeuma oli määritetty magneettikuvauksella (MRI). Suomalaisessa perheaineistossa tehdyn kokogenomin laajuisen kartoituksen pohjalta analysoimme IL17F geenin mahdollisena uutena alttiusgeeninä oireiselle välilevytaudille. Kahdesta geenin variantista koostuva haplotyyppi assosioitui tautiin merkitsevästi. Lisäksi osoitimme, että SKT-geenin tietty muutos altistaa välilevyn pullistumille sekä japanilaisessa että suomalaisessa potilasaineistossa. Hiirikokeissa on havainnoitu, että SKT-geenin homotsygootti mutaatio johtaa välilevy-poikkeamaan, joka edelleen aiheuttaa hiiren poikkeavan häntäilmiasun-. Hypoteesimme oli, että ihmisen SKT -geeni voi myötävaikuttaa välilevypullistuman kehittymiseen altistamalla välilevyt rappeumalle. Edelleen, laajassa usean populaation aineiston käsittävässä tutkimuksessa osoitimme CHST3-geenin muutoksen altistavan välilevyrappeumalle. Peittyvästi periytyvät muutokset tässä geenissä aiheuttavat perinnöllisiä harvinaisia luusairauksia. Tämä väitöstutkimus tarjoaa uutta tietoa välilevyrappeuman geneettisestä taustasta ja auttaa taudin syiden tutkintaa. Geenien rooli välilevyn toiminnassa ja muutosten vaikutus taudin kulkuun vaativat kuitenkin vielä lisätutkimuksia.

Title: Physical activity of patients after surgical treatment of the lumbar spine. Aim: Main aim of the diploma thesis is to investigate which physiotherapeutic intervention for patients after spinal surgery is the most effective one and offer optimal activity immediately after the surgery and in a long term phase. Investigate questions: 1. Which physiotherapeutic intervention is the most effective one? 2. Which type of physical activity is the most optimal one? Methods: A systematic review on the topic. Results: The review answers the questions about physiotherapy after lumbar surgery in acute and long term phase after surgery and shows current trends and unique approaches in this study area. Keywords: Lumbar spine, intervertebral disc herniation, microdiscectomy, physiotherapy, physical activity.

The degenerative and traumatic injuries of a spine are very frequent. In those cases it is necessary to stabilize the corresponding spine segment using a spine implant. The spinal implants are rigid or flexible, the latter known as dynamic ones in medical practice. In this thesis, the problems of the physiological spinal segment and the segment with implant were solved using the computational modelling (finite element method). Computational model consists of 4 lumbar vertebrae L2 – L5, intervertebral discs, joints and spinal implants. The spinal segment was loaded by the force 400N and 200N, than by force 200N together with bending moments 2,5Nm and 5Nm depending of the motion. The displacement of the whole system, contact pressure of cartilages, equivalent strain in cancellous bone and equivalent stress in the implant were analyzed. The deformation of the physiological model and the model with the implant are comparable, but the bone tissue of the model with the implant is dramatically more loaded in vicinity of the screws.

Einleitung: Der Verdacht, dass Hunde mit einem Bandscheibenvorfall eine Prädisposition für die Entstehung einer Pankreatitis haben könnten, wurde in der Veterinärmedizin bereits in den frühen 1980er Jahren diskutiert. Trotz dieser bereits vor vielen Jahren erhobenen Vermutungen, wurde der Zusammenhang zwischen der Entstehung einer Pankreatitis und einem zeitgleich vorliegenden Bandscheibenvorfall auch im Hinblick auf mögliche Risikofaktoren wie dem Einfluss der Narkose oder dem Einsatz von Medikamenten (v. a. Glukokortikoide und nichtsteroidale Antiphlogistika) bisher nicht näher untersucht. Ziele der Untersuchungen: Im Rahmen der vorliegenden prospektiven Studie sollte untersucht werden, ob Bandscheibenvorfälle ein Risikofaktor für die Entstehung einer Pankreatitis beim Hund darstellen. Ferner sollte geklärt werden, ob die Narkose und die Gabe von Glukokortikoiden und/oder nichtsteroidalen Antiphlogistika zusätzlich das Risiko der Entstehung einer Pankreatitis bei Hunden mit einem Bandscheibenvorfall erhöhen. Material und Methoden: Insgesamt wurden 106 Hunde, bei denen aufgrund der klinischen Symptome der Verdacht einer Rückenmarksläsion bestand, an fünf aufeinander folgenden Tagen klinisch untersucht. Besonderes Augenmerk wurde hierbei auf Symptome gelegt, welche typischerweise bei Pankreatitiden zu beobachten sind (reduziertes Allgemeinbefinden, Schwäche, Anorexie, dolentes Abdomen, Vomitus, Regurgitieren, Diarrhoe, Fieber, Dehydratation). Ferner wurde am Tag 0 und Tag 4 der stationären Aufnahme die Konzentration der caninen pankreasspezifischen Lipase im Serum gemessen (Spec cPL und Snap cPL). Am Tag 0 wurde von dem Vorliegen einer Pankreatitis ausgegangen, wenn klinische Befunde im Sinne einer Pankreatitis sowie eine abnorm erhöhte Konzentration der caninen pankreasspezifischen Lipase im Serum (>400 μg/L) auffällig waren. Am Tag 4 erfolgte zudem eine sonographische Untersuchung des Abdomens. Somit basierte die Diagnosestellung einer Pankreatitis an diesem Tag auf dem Vorliegen von zwei der folgenden drei Kriterien: klinische Befunde im Sinne einer Pankreatitis, abnorm erhöhte Konzentration der caninen pankreasspezifischen Lipase im Serum, sonographische Hinweise für das Vorliegen einer Pankreatitis. Im Rahmen der statistischen Auswertung wurden zudem auch Patienten erfasst, welche in einem oder in mehreren der oben genannten Kriterien ein fragliches Ergebnis aufwiesen. Entsprechend ihrer neurologischen Ausfallserscheinungen sowie der Befunde im Rahmen der bildgebenden Diagnostik (Myelographie, Computertomographie, Kernspintomographie) wurden die Patienten in eine der folgenden drei Untersuchungsgruppen eingeteilt: 1. Hunde mit einem chirurgisch versorgten Bandscheibenvorfall (n = 71) 2. Hunde mit einem konservativ therapierten Bandscheibenvorfall (n = 20) und 3. Hunde mit einer akuten intramedullären Läsion (n = 15). Die statistische Auswerte erfolgte aufgrund der geringen Stichprobengrößen vorwiegend deskriptiv. Die Daten wurden mittels des Shapiro-Wilk-Tests auf Normalverteilung überprüft, die durchgeführten Gruppenvergleiche erfolgten unter Verwendung des Kruskal-Wallis und Mann-Whitney-U-Tests. Zudem wurden die betrachteten Merkmale mit dem Fisher Test und dem Chi-Quadrat-Test auf Unabhängigkeit überprüft. Das Signifikanzniveau wurde für alle Tests mit p < 0,05 festgelegt. Ergebnisse: Basierend auf den klinischen Symptomen und der Konzentration der caninen pankreasspezifischen Lipase im Serum konnte insgesamt am Tag 0 bei vier Hunden (3,8 %) eine Pankreatitis diagnostiziert werden. Am Tag 4 waren es, basierend auf den drei Kriterien, welche für die Diagnosestellung einer Pankreatitis herangezogen werden, insgesamt acht Patienten (7,5 %). Hunde mit einem Bandscheibenvorfall (chirurgisch beziehungsweise konservativ therapiert) wiesen am Tag 0 beziehungsweise Tag 4 in 4,3 % (n = 4) beziehungsweise 7,7 % (n = 7) der Fälle eine Pankreatitis auf. Aufgrund der geringen Häufigkeiten in den einzelnen Untersuchungsgruppen, war eine Berechnung eines signifikanten Unterschieds zwischen den Gruppen nicht möglich. Hinsichtlich einer möglichen Korrelation zwischen einer Narkose und der Entstehung einer Pankreatitis bei Hunden mit einer Rückenmarksläsion konnte kein signifikanter Zusammenhang festgestellt werden. Auch die Gabe von Glukokortikoiden und/oder nichtsteroidalen Antiphlogistika hatte hier keinen signifikanten Einfluss auf die Entstehung einer Pankreatitis. Schlussfolgerung: Vergleicht man die Ergebnisse der vorliegenden Studie mit der in der Literatur angegebenen Prävalenz für akute Pankreatitiden beim Hund (0,7-3,5 %), so kann geschlussfolgert werden, dass eine Rückenmarksläsion, insbesondere ein Bandscheibenvorfall, als Risikofaktor für die Entstehung einer akuten Pankreatitis beim Hund in Betracht gezogen werden muss. Demgegenüber erhöhen weder die Narkose noch die Gabe von Glukokortikoiden und/oder nichtsteroidalen Antiphlogistika zusätzlich das Risiko der Entstehung einer Pankreatitis bei Hunden mit einer Rückenmarksläsion. / Objective: The suspicion that dogs with intervertebral disc disease are at greater risk of developing pancreatitis is being discussed in veterinary medicine since the early 1980s. So far no study has been published examining the correlation between intervertebral disk disease and the development of pancreatitis in dogs, especially in combination with general anaesthesia and anti-inflammatory medication (glucocorticoids and/or nonsteroidal anti-inflammatory drugs). The aim of this study was therefore 1) to evaluate intervertebral disk disease as possible risk factor of pancreatitis and 2) to ascertain if general anaesthesia and the administration of glucocorticoids and/or nonsteroidal anti-inflammatory drugs further increase the risk of pancreatitis in dogs with intervertebral disk disease. Material and methods: One hundred and six dogs with symptoms associated with spinal cord injury were clinically examined over a period of five days. Special attention was payed to symptoms usually seen with pancreatitis such as anorexia, vomitus and abdominal pain. Furthermore the concentration of canine pancreatic lipase in the blood serum was measured with Spec cPL and Snap cPL at day 0 and day 4 after admission. At day 0 the diagnosis of pancreatitis was based on clinical symptoms associated with pancreatitis in combination with an increased concentration of canine pancreatic lipase in the blood serum (>400 μg/L). A sonography of the pancreas was performed at day 4 to evaluate the organ itself and the surrounding tissue for lesions associated with pancreatitis. Therefore the diagnosis of pancreatitis at day 4 was based on positive results in at least two of the three following criteria: symptoms associated with pancreatitis, elevation of the concentration of canine pancreatic lipase in the blood serum, sonographic changes of the pancreas parenchyma and the surrounding tissue associated with pancreatitis. For statistical analysis questionable results in one or more of these criteria were also documented. According to the neurologic symptoms and the findings of diagnostic imaging (myelography, computed tomography and magnetic resonance imaging), dogs were categorized in one of the following groups: 1. dogs with surgically treated intervertebral disk disease (n = 71), 2. dogs with medically treated intervertebral disk disease (n = 20), 3. dogs with an acute intramedullary lesion (n = 15). Due to the small sample size, statistics were primarily performed descriptively. Data were tested for normal distribution using the Shapiro-Wilk test. If Group comparisons were feasible, they were performed using the Kruskal-Wallis test and the Mann-Whitney-U test. Fisher test and the Chi-Square test were used to test for association between group affiliation and possible risk factors for the development of pancreatitis. A value of P < 0.5 was considered significant for all analysis. Results: Based on clinical symptoms and an elevated concentration of the canine pancreatic lipase (> 400μg/l) at day 0, four dogs (3.8 %) were diagnosed with pancreatitis. According to the clinical symptoms, the concentration of the canine pancreatic lipase and sonographic changes, a total number of eight dogs (7.5 %) were diagnosed with pancreatitis at day 4. Considering only the dogs with intervertebral disk disease (surgically and medically treated) 4.3 % (n = 4) and 7.7 % (n = 7) were diagnosed with pancreatitis at day 0 and day 4, respectively. Due to the small sample size, the calculation of significant differences between the three subgroups was not feasible. There was no significant correlation between general anaesthesia and the development of pancreatitis. Furthermore, the administration of glucocorticoids and/or nonsteroidal anti-inflammatory drugs is not significantly associated with the genesis of pancreatitis.

Degenerated intervertebral discs (IVDs) were treated with autologous adipose-derived stem cells (ASC) loaded into an injectable collagen scaffold in a sheep model to investigate the implant's therapeutic potential regarding the progression of degeneration of previously damaged discs. In this study, 18 merino sheep were subjected to a 3-step minimally invasive injury and treatment model, which consisted of surgically induced disc degeneration, treatment of IVDs with an ASC-loaded collagen hydrogel 6 weeks post-operatively, and assessment of the implant's influence on degenerative tissue changes after 6 and 12 months of grazing. Autologous ASCs were extracted from subcutaneous adipose tissue and cultivated in vitro. At the end of the experiment, disc heights were determined by µ-CT measurements and morphological tissue changes were histologically examined.Histological investigations show that, after treatment with the ASC-loaded collagen hydrogel implant, degeneration-specific features were observed less frequently. Quantitative studies of the degree of degeneration did not demonstrate a significant influence on potential tissue regeneration with treatment. Regarding disc height analysis, at both 6 and 12 months after treatment with the ASC-loaded collagen hydrogel implant a stabilization of the disc height can be seen. A complete restoration of the intervertebral disc heights however could not be achieved.The reported injection procedure describes in a preclinical model a translational therapeutic approach for degenerative disc diseases based on adipose-derived stem cells in a collagen hydrogel scaffold. Further investigations are planned with the use of a different injectable scaffold material using the same test model.

La dégénérescence discale est généralement considérée comme le résultat de l'insuffisance chronique de la nutrition de ses cellules due à un déficit du renouvellement de la matrice extra-cellulaire. Des chargements mécanique excessifs et répétés sont parmi les principales causes créant des lésions dans les disques et à terme précipitent la dégénérescence discale. En modélisant le fonctionnement multi-physique du disque par un modèle quadriphasique couplé à un modèle métabolique des cellules, l'objectif de ce travail est d'aider à une meilleure compréhension du fonctionnement discal. Puis par une approche numérique, le lien entre sollicitation mécanique, nutrition et dégénérescence est étudié. Dans un premier temps, le disque a été représenté en 2D. L'effet d'un cycle nycthéméral simplifié sur les paramètres osmotico-mécaniques et nutritionnels du disque lombaire d'un sujet de corpulence normale et d'un sujet en surpoids ou portant des charges a alors été analysé. Dans un second temps, à travers une approche 3D, l'influence sur la fonction discale de mouvements rapides associés à la vie quotidienne, telles qu'une flexion, une flexion latérale et une rotation axiale, a été quantifiée. En outre, pour ces deux approches, une étude comparative a été réalisée afin d'étudier l'influence réelle de la convection par rapport à la diffusion dans le transport des nutriments. Ainsi, ce travail constitue une contribution à une meilleure compréhension de l'évolution spatiale et temporelle des nutriments et des paramètres osmotico- mécaniques du disque intervertébral, lorsque ce dernier est soumis à différents types de chargements. / Disc degeneration is generally regarded as the result of chronic insufficiency of cell nutrition due to a lack of renewal of the extracellular matrix. Excessive and repeated mechanical loads are among the leading causes of injury in the disc and eventually precipitate disc degeneration. By modeling the multi-physics functioning of the disc by a quadriphasic model coupled with a metabolic model, the aim of this work is to contribute to a better understanding of the disc functions. With a numerical approach, the relationship between mechanical stress, nutrition and degeneration is studied. The disc was first represented in 2D. The effect of a simplified circadian cycle on the osmotico-mechanical and nutritional parameters of lumbar disc of a normal weight and overweight (or carrying loads) subjects was then analyzed. After that, through a 3D approach, the influence of the disc function towards rapid movements such as bending, lateral bending and axial rotation was quantified. In addition to these two approaches, a comparative study was conducted to investigate the real influence of convection compared to diffusion in the transport of nutrients. This work contributed to a better understanding of the spatial and temporal evolution of nutrients and osmotico-mechanical parameters of the intervertebral disc when it is subjected to different loadings.

Eight out of ten people in the United States will have problems with low back pain at some point in their life. The most significant surgical treatments for low back pain can be distributed into two main groups of solutions: arthrodesis and arthroplasty. Spinal arthrodesis consists of the fusion of a degenerated functional spine unit (FSU) to alleviate pain and prevent mechanical instability. Spinal arthroplasty consists of the implantation of an artificial disc to restore the functionality of the degenerated FSU. The objective of this study is to analyze and compare the alteration of the biomechanics of the lumbar spine treated either by arthrodesis or arthroplasty. A three-dimensional finite element model of a ligamentous lumbar motion segment, constituted of two FSUs, was built and simulated through a static analysis with the finite element software ABAQUS. It was shown that the mobility of the segment treated by arthrodesis was reduced in all rotational degrees of freedom by an average of approximately 44%, relative to the healthy model. Conversely, the mobility of the segment treated by arthroplasty was increased in all rotational degrees of freedom by an average of approximately 52%. The FSU implanted with the artificial disc showed a high risk of instability and further degeneration. The mobility and the stresses in the healthy FSU, adjacent to the restored FSU in the segment treated by arthroplasty, were also increased. In conclusion, the simulation of the arthroplasty model showed more risks of instability and further degeneration, on the treated level as well as on the adjacent levels, than in the arthrodesis model.

Tyrimo objektas: pacientų funkcinės būklės kitimas, taikant skirtingas kineziterapijos programas, esant juosmeninėms disko išvaržoms. Tyrimo tikslas: nustatyti skirtingų kineziterapijos programų poveikį pacientų funkcinei būklei gydant juosmeninės stuburo dalies tarpslankstelines disko išvaržas. Tyrimo uždaviniai: 1. Nustatyti skirtingų grupių tiriamųjų tiesios kojos kėlimo kampą, ties kuriuo juntamas skausmas, pilvo ir nugaros raumenų ištvermę prieš ir po kineziterapijos. 2. Nustatyti skirtingų grupių tiriamųjų juosmeninės stuburo dalies skausmą, negalios laipsnį ir gyvenimo kokybę prieš ir po kineziterapijos. 3. Palyginti skirtingų kineziterapijos programų poveikį gydant juosmeninės stuburo dalies tarpslankstelines disko išvaržas. Tyrimas buvo atliktas 2008-2009 m. UAB „Palangos linas“ viešbutyje-reabilitacijos centre. Tyrime dalyvavo 40 tiriamųjų (19 vyrų ir 21 moteris). Sudarytos 2 grupės: I grupė (n=20) pacientai, kuriems buvo taikyta 20 IDD terapijos procedūrų. II grupė (n=20) ambulatorinės reabilitacijos pacientai. Jiems buvo taikyta 10 kineziterapijos procedūrų vertikalioje vonioje. Tiriamieji buvo vertinami prieš ir po kineziterapijos procedūrų kurso. Tyrimo metodai: Lasego mėginys, skausmo vertinimas, Oswestry negalios indeksas, nugaros raumenų ištvermės testas, pilvo raumenų ištvermės testas, SF – 36 klausimynas. Išvados: 1. Taikant tarpslankstelinę diferencinę dinaminę terapiją ir kineziterapiją vertikalioje vonioje statistiškai reikšmingai (p<0,05) padidėjo... [toliau žr. visą tekstą] / Research object: the changes patients’ functional state when applying different physiotherapy programs in cases of lumbar disc herniation. Research aim: to evaluate the influence of different physiotherapy programs on patients’ functional state after intervertebral disc herniation. Research tasks: 1. Assess the participants’ of different group’s elevation angle of straight leg, at the point of which the pain is suffered, endurance of abdominal and spinal muscles before and after physiotherapy. 2. Assess the participants’ of different group’s low back pain, degree of disability and life quality before and after physiotherapy. 3. Compare effect of different physiotherapy programs when treating lumbar intervertebral disc herniation. The research was carried out in 2008-2009 at JSC “Palangos linas” hotel – rehabilitation center. 40 (19 men and 21 women) participants took part in research. Participants were divided into 2 groups: 1st group (n=20) patients, they received 20 IDD therapy procedures. 2nd group (n=20) ambulant rehabilitation patients, they received 10 physiotherapy procedures in a vertical bath. The participants were tested before and after the physiotherapy procedures . Methods: Straight leg raise test, pain evaluation, Oswestry disability index, endurance test of spinal muscles, endurance test of abdominal muscles, SF – 36 questionnaire. Conclusions: 1. After applying intervertebral differential dynamics therapy and physiotherapy in a vertical bath, straight... [to full text]