腰椎间盘突出英文幻灯

WhycalledherniateddiscWhyspecialfocusforlumbarIncidenceandsocialfactorMorphalogyMostcommonMostdisturbingIntroductionObjectivesIdentifytheanatomyofthelowerback

Understandthetypesoftraumathatcancauseaherniateddisc

Identifythesignsofaherniateddisc

Beabletoevaluatepatientswithpotentialherniateddiscs

AlsoabletofollowatypicaltreatmentprogramforlumbarherniateddiscsLumbarAnatomyThelumbarsectionofthespineismadeupofthelower5vertebraeCommonlyreferredtoasL1toL5L5connectstothetopofthesacrumAnatomyofLumbarVerebraThevertebralbodyisathinringofdenseboneConsistingofthebody,pediclesandliminaeVertebralforamenisawholeinvertebralbodythatspinalcordrunsthroughGellikeTissuebetweeneachvertebrafibrocartilaginouscushionsserveasthespine'sshockabsorbingsystemprotectthevertebrae,brain,andotherstructuresThediscsallowsomevertebralmotionextensionandflexion.DiscsfunctionThediscismadeupof3structurestheNucleuspulposus,gelatinouscenterAnnulusFibrosus.ItsjobistocontainthenucleusVertebralendplatesthatattachthedisctothevertebraeDiscsstructureHerniateddiskOccurwhenthereisenoughpressurefromthevertebraeaboveandbelowThiscanforcenucleuspulposusthroughaweakenedortornpartoftheannulusfibrosus.Therupturednucleuswilloftencomeincontactwithandpressonnervesnearthedisc.HerniateddisksareoneofthemostcommoncausesofbackpainMechanismofinjuryAged----------diskshaveworndownovertimeoverweight------------extrapressureontheintervertebraldisksImproperliftingform,Twistingviolently------suddenstrainthatcouldpossibleherniateadiskSymptomsLowerbackpain,sharpandshootingpaintherunsdownlowback,buttocksanddownthethighPain,weakness,numbnessortinglinginthelegs,buttocksandfeetProblemswithbowel,bladderorerectilefunction,inseverecasesHowcanwerecognizeaherniateddisk?SignsLumbarcurvatureisflattenedorevenkyphoticSidebendingtowardtheoppositesideofthepainusuallyrelievesthepainThestraightleg-raising(SLR)testwithradiatingpainbelowkneelevelseemsreasonablyassociatedtodischerniationObviouslyneurologicsignsalteredsensibility,reflexes,musclestrength,andmuscleatrophyshouldbetested.NeurologicsignsLocatednerverootandinvolvedsegmentNeurologicsignsQuads/TibialisAnteriorPatellarreflexSensoryGreattoeandmediallegL4NeurologicsignsL5StrengthofAnkleandgreattoedorsiflexionExtensorHallucisLongusSensorytodorsumoffootNeurologicsignsS1AnklereflexesandsensationofposteriorcalfandlateralfootPeroneals/GastrocAchillesreflexSensorytolateralandplantarfootDiagnosisGenerallyisbasedonthesymptomsoflowerbackpain.examineyoursensation,reflexes,gaitandstrengthX-ray--High-energyradiationisusedtotakepicturesofthespine.MagneticResonanceImaging(MRI)

--AnMRIprovidesdetailedpicturesofthespinethatareproducedwithapowerfulmagnetlinkedtoacomputer.ComputedTomography(CT)Scan--ACTscanusesathinX-raybeamthatrotatesaroundthespinearea.Acomputerprocessesdatatoconstructathree-dimensional,cross-sectionalimage.Electromyography(EMG)--Thistestmeasuresmuscleresponsetonervousstimulation.MRIMAGEDiagnosisHerniatedDisc(“slippeddisc”)TypesofherniationDegeneration:

chemicalchangesassociatedwithagingcausedehydrated,collapsedandweak,butwithoutafrankherniation.Prolapse:

thediscbulgesandmaycauseslightnarrowingofthespinalcanal,alsoknownasbulgeorprotrusion.Extrusion:

nucleuspulposusrupturesthroughtheannulusfibrosusbutremainswithinthedisc.Sequestration:

nucleuspulposussqueezedout,liesoutsidethediscandwithinthespinalcanal.L4vertebraL5vertebraL4exitsaboveherniationL5&lowerarecompressedL4/L5discherniationTypesofherniationCentralPosterlateralLateralDifferenciationCategoriesofLowBackPain（CAMPBELL’S）ExtrinsiclesionsUrogenitalsystem,gastrointestinalsystem,vascularsystem,endocrinesystem,nervoussystemnotlocalizedtothespine,extrinsicmusculoskeletalsystemInfections,tumors,metabolicdisturbances,congenitalabnormalities,associateddiseasesofagingIntrinsiclesionsSpinalmusculoskeletalsystem,localhematopoieticsystem,localneurologicsystemTrauma,tumors,infections,diseasesofaging,immunediseasesDifferentialDiagnosisofLowBackPain

Diseaseorcondition

Patientage(years)

Backstrain

20to40discherniation

30to50

Osteoarthritisorspinalstenosis

>50

Spondylolisthesis

Anyage

Ankylosingspondylitis

15to40

Infection

Anyage

Malignancy

>50

ATULT.PATEL,ABNAA.OGLE.DiagnosisandManagementofAcuteLowBackPain[J].AAFP,Vol.61/No.6(March15,2000).

DifferentialDiagnosisofLowBackPain

Diseaseorcondition

Locationofpain

Backstrain

Lowback,buttock,posteriorthigh

discherniation

Lowbacktolowerleg

Osteoarthritisorspinalstenosis

Lowbacktolowerleg;oftenbilateral

Spondylolisthesis

Back,posteriorthigh

Ankylosingspondylitis

Sacroiliacjoints,lumbarspine

Infection

Lumbarspine,sacrum

Malignancy

Affectedbone(s)

DifferentialDiagnosisofLowBackPain

Diseaseorcondition

AggravatingorrelievingfactorsBackstrain

Increasedwithactivityorbendingdischerniation

Decreasedwithstanding;increasedwithbendingorsitting

Osteoarthritisorspinalstenosis

Increasedwithwalking,especiallyupanincline;decreasedwithsittingSpondylolisthesis

IncreasedwithactivityorbendingAnkylosingspondylitis

MorningstiffnessInfection

Varies

Malignancy

Increasedwithrecumbencyorcough

ATULT.PATEL,ABNAA.OGLE.DiagnosisandManagementofAcuteLowBackPain[J].AAFP,Vol.61/No.6(March15,2000).DifferentialDiagnosisofLowBackPain

Diseaseorcondition

Signs

Backstrain

Localtenderness,limitedspinalmotiondischerniation

Positivestraightlegraisetest,weakness,asymmetricreflexesOsteoarthritisorspinalstenosis

Milddecreaseinextensionofspine;mayhaveweaknessorasymmetricreflexesSpondylolisthesis

Exaggerationofthelumbarcurve,palpable"stepoff"(defectbetweenspinousprocesses),tighthamstringsAnkylosingspondylitis

Decreasedbackmotion,tendernessoversacroiliacjointsInfection

Fever,percussivetenderness;mayhaveneurologicabnormalitiesordecreasedmotion

Malignancy

Mayhavelocalizedtenderness,neurologicsignsorfeverTreatmentConservativetreatmentoflowerdiscpainusuallyissuccessfulovertime,includes:Painmedicationorpaintherapiessuchasultrasound,massageortranscutaneouselectricalnervestimulationAnti-inflammatorymedicationsuchasaspirin,ibuprofenandacetaminophenPhysicaltherapyEducationinproperstretchingandpostureRestAlthoughperformingphysicalTherapydoesnotdirectlyhelpthedisks,itdoesstrengthenthemusclesaroundit,soastoincreasestability,whichcanhelppreventherniateddisksinthefuturePhysicalTherapyTreatmentPhysicalTherapyExercisesExercise#1whilelyingonyourbackbendyourleftkneeup.Clenchabsandbutt,keepingbackinneutralposition.Raiseyourotherlegabout12inofffloor,whilekneeisstraightHoldthepositionfor3secondsThenlowerleg,dofor10repsRepeatthesamewithyourotherlegEB-CMERehabilitationHerniateddiskscanvaryinseverityandtherehabilitationplancanvarydependingontheseverityofthesymptoms;Phase#1Rest-Lastfrom2daysupto2monthsdependingonthenatureoftheinjury,typicallytheolderthepatientthelongertherestperiod.Phase#2Aftersymptomssubsided,anywherefrom10daystoafewmonthsexercisesshouldbedonetostrengthenmusclesaroundspinalcolumntohelppreventanotherhernia.TheseexercisesmaybedonewithsomeslightlowerbackpainRehabilitationHamstringstretchLaydownfaceupwithonelegindoorwayotherlegonwallThisstretchesoutligamentsandtendonsthatconnectfromlegtolowerbackCatandCamelOnyourhandandknees,allowyourbacktosagfor5seconds,thenarchyourbackfor5secondsRepeatfor10repsRehabilitationReturntoplayPatientsthathassustainedaherniateddisktoreturntoplayhe/shemusthaveclearancefromtheirdoctorThiswillnotusuallyhappenuntilallpain,andnumbnesshasgonecompletelySurgerySurgeryisveryrarelyrequiredforherniateddisksNonoperativetreatmentisalmostalwaysdonepriortosurgeryGenerallyifsymptoms,suchaspainandnumbnessgrowworseovertimesurgeryisrequiredIfherniateddiskinterfereswithbladderandbowlmovements,surgeryisalsore