Low Back pain. Lumbar disc herniation, causes ,diagnosis ,symptoms and treatment скачать в хорошем качестве

Low Back pain. Lumbar disc herniation, causes ,diagnosis ,symptoms and treatment

Low Back pain. Lumbar disc herniation, causes ,diagnosis ,symptoms and treatment check my book on Amazon https://www.amazon.com/dp/B0C51X2CWB?... Low back pain and disc herniation. The spine consists of bony vertebrae and intervertebral discs. These structures include the bony vertebrae and the intervertebral discs. Within the spinal canal are neural structures. The spinal cord ends approximately at the T12-L1 vertebral level. The conus medullaris is the terminal portion of the spinal cord. Below this, beginning at the level of L1, lies the cauda equina, which consists of multiple nerve roots. Low back pain can result from various conditions affecting the lumbar spine, including disc herniation. The lumbar spine comprises five vertebrae numbered from L1 to L5. These vertebrae articulate inferiorly with the sacrum. The lumbosacral junction is the articulation between the L5 vertebra and the sacrum, which forms the tailbone. Intervertebral discs, which lie between vertebrae, are rounded cushioning pads designed to absorb shock and resist compression. A normal disc comprises two layers: an inner soft gelatinous nucleus pulposus and an outer strong fibrous annulus fibrosus. Posterior to the disc lie the spinal nerve roots and the cauda equina. Herniation of a lumbar or lumbosacral disc may affect these nerve roots. Most cases of disc herniation involve the L4-L5 and L5-S1 levels. Typically, herniation of the L4-L5 disc affects the L5 nerve root, while herniation of the L5-S1 disc affects the S1 nerve root. Disc herniations are categorized into three types. The first type is disc protrusion or bulge, characterized by a bulging disc with intact annular fibers and intact posterior longitudinal ligament fibers, representing a minor disc bulge. The second type involves disruption of the annular fibers with a tail of disc material extending partially or fully into the disc space. The third type, known as a sequestered disc, involves a free disc fragment without a tail extending into the disc space; this fragment may spontaneously reabsorb. Disc herniations can occur in various locations. The most common location, known as posterolateral herniation, typically affects one nerve root—the lower traversing root. For example, a posterolateral herniation at the L4-L5 level involves the L5 nerve root. The second location is foraminal herniation, accounting for approximately 8% to 10% of cases, affecting the exiting nerve root. An L4-L5 foraminal disc herniation involves the L4 nerve root, which exits at this level. This is distinct from a posterolateral herniation at the same level, which involves the traversing L5 nerve root. The third location is central disc herniation, a rare condition affecting multiple nerve roots of the cauda equina. This condition predominantly causes low back pain more than leg pain and may lead to bladder and bowel incontinence. Central disc herniation requires urgent diagnosis and immediate surgical intervention. Early recognition of central disc herniation and cauda equina syndrome can be challenging due to subtle initial symptoms. Therefore, clinicians must maintain a high index of suspicion, specifically inquiring about bladder or bowel symptoms, performing a digital rectal exam, assessing perianal sensation, and obtaining an emergent MRI if suspected. Emergency surgical intervention is typically required, and the timing of surgery significantly impacts outcomes. Early surgical treatment has the best prognosis for recovering bladder and bowel function. Lastly, discogenic back pain, or internal disc disruption, represents early disc degeneration characterized by annular tears. Patients typically experience worsening pain with spinal flexion and prolonged sitting, and some improvement with spinal extension. Clinical examination reveals limited forward flexion without radicular symptoms. Quizzes 1. What type of disc herniation involves a free fragment detached from the disc space? A) Disc bulge B) Protrusion C) Sequestered disc D) Annular tear Answer: C) Sequestered disc 2. The most common location for lumbar disc herniation is: A) Central B) Posterolateral C) Foraminal D) Anterior Answer: B) Posterolateral Explanation: Posterolateral disc herniations are the most common and typically affect the traversing nerve root. 3. A foraminal disc herniation at L4-L5 affects which nerve root? A) L3 B) L4 C) L5 D) S1 Answer: B) L4 Explanation: A foraminal herniation at L4-L5 involves the exiting L4 nerve root. 4. Which type of disc herniation affects multiple nerve roots and may cause bladder incontinence? A) Posterolateral herniation B) Foraminal herniation C) Central herniation D) Lateral herniation Answer: C) Central herniation Explanation: Central disc herniation affects multiple nerve roots causing symptoms such as bladder and bowel dysfunction. 5. Which diagnostic imaging is urgent in suspected cauda equina syndrome? A) CT scan B) Ultrasound C) MRI D) X-ray Answer: C) MRI