Lumbar Disc Herniation Causes, Symptoms and Treatment скачать в хорошем качестве

Lumbar Disc Herniation Causes, Symptoms and Treatment

Low back pain, lumbar disc herniation. The spine has bony vertebrae and discs. These are the bony vertebrae, and these are the discs. Inside the spinal canal lie the neural structures. You find the spinal cord, which ends at the level of T12-L1. The conus medullaris is the lower end of the spinal cord. The cauda equina begins at the level of L1 and contains a lot of nerve roots. Low back pain is caused by different conditions of the lumbar spine, including disc herniation. The lumbar spine has five lumbar vertebrae, from L1 to L5. As you can see, these are the five vertebrae, and they are numbered. These vertebrae are attached to the sacrum at the lower end of the spine. The lumbosacral spine is the junction between the lumbar spine and the sacrum, between L5 and the sacrum, which is the tailbone. The discs between the vertebrae are round cushioning pads that absorb the shock and resist compression. The normal disc is composed of two layers. The inner layer is soft gelatinous tissue called the nucleus pulposus, and the outer layer is called the annulus fibrosus, which is strong and thick. Behind the disc lies the spinal nerve root and the cauda equina. A lumbar or lumbosacral disc herniation could affect the nerve roots. In the majority of cases of disc herniation, the L4-L5 and L5-S1 disc levels are involved. Typical herniation of L4-L5 disc will affect the L5 nerve root. Typical herniation of L5-S1 disc will affect the S1 nerve root. What are the types of disc herniation? The patient may have a protrusion or bulge. A bulging disc with intact annular and posterior longitudinal ligament fibers. So, that's a small disc bulge. The second type is disruption of the annular fibers with the tail of disc material extending into the disc space, either partially or totally. The third type is a sequestered disc. It's a free fragment without a tail extending into the disc space. The fragment may be reabsorbed spontaneously. What are the locations of disc herniation? The most common location, which is a typical location of disc herniation, is posterolateral, and you can see from the diagram that it affects the nerve root. It is the usual location, most commonly involving one nerve root, the lower one. For example, an L4 and L5 posterolateral disc herniation will involve the L5 nerve root. The second location of disc herniation is foraminal. It occurs in about 8 % to 10% of cases and involves the exiting nerve root. For example, an L4-L5 foraminal disc herniation will involve L4 nerve root, the nerve root that will exit the L4. Different than posterolateral disc herniation, which involves the traversing nerve root. In the case of L4-L5, the posterolateral disc herniation will involve the L5 nerve root, the traversing nerve root. Central disc herniation. It is a rare condition. It affects multiple nerve roots. The cauda equina predominantly causes lower back pain more than leg pain. It may cause incontinence of the bladder and bowel. Urgent diagnosis and urgent surgical treatment is necessary. The early diagnosis of central disc herniation and cauda equina syndrome is challenging. The initial signs and symptoms are usually subtle. It is important that you suspect this condition and ask the patient if the patient has any bladder or bowel symptoms. Do a digital exam on the patient, test the perianal sensation, and get an emergency MRI if you suspect it. Treatment, usually emergency surgery. Timing of the surgery decides the outcome. Early surgery has the best prognosis for recovery of bladder and bowel function. How about discogenic back pain, which is internal disc disruption? So, there is an early disc degeneration. The patient will have annular tears. Pain is worse with flexion and sitting and slightly better with extension. The forward flexion is limited on exam and the patient does not have radicular symptoms. quizzes 1. At which vertebral level does the spinal cord typically end? A) L2-L3 B) T10-T11 C) T12-L1 D) L3-L4 Answer: C) T12-L1 Explanation: The spinal cord typically terminates at the T12-L1 level, forming the conus medullaris. 2. What neural structure begins at the level of L1? A) Conus medullaris B) Filum terminale C) Cauda equina D) Spinal cord Answer: C) Cauda equina Explanation: The cauda equina starts at the L1 level and contains multiple nerve roots descending below the spinal cord. 3. What is the soft gelatinous inner layer of the intervertebral disc ? A) Annulus fibrosus B) Nucleus pulposus C) Ligamentum flavum D) Posterior longitudinal ligament Answer: B) Nucleus pulposus Explanation: The nucleus pulposus is the inner soft gelatinous layer of an intervertebral disc. 4. Which nerve root is typically affected by an L4-L5 posterolateral disc herniation? A) L4 B) S1 C) L5 D) S2 Answer: C) L5 Explanation: L4-L5 posterolateral disc herniation commonly affects the traversing nerve root, which is L5. 5. Which nerve root is usually affected by an L5-S1 disc herniation? A) L5 B) L4 C) S2 D) S1 Answer: D) S1