腰椎间盘突出英文幻灯ppt课件.pptx

Why called herniated discWhy special focus for lumbarIncidence and social factor,Morphalogy,Most common,Most disturbing,Introduction,Objectives,Identify the anatomy of the lower back Understand the types of trauma that can cause a herniated disc Identify the signs of a herniated disc Be able to evaluate patients with potential herniated discs Also able to follow a typical treatment program for lumbar herniated discs,Lumbar Anatomy,The lumbar section of the spine is made up of the lower 5 vertebraeCommonly referred to as L1 to L5L5 connects to the top of the sacrum,Anatomy of Lumbar Verebra,The vertebral body is a thin ring of dense boneConsisting of the body, pedicles and liminaeVertebral foramen is a whole in vertebral body that spinal cord runs through,Gel like Tissue between each vertebrafibro cartilaginous cushionsserve as the spines shock absorbing systemprotect the vertebrae, brain, and other structuresThe discs allow some vertebral motion extension and flexion.,Discs function,The disc is made up of 3 structures the Nucleus pulposus, gelatinous centerAnnulus Fibrosus. Its job is to contain the nucleusVertebral end plates that attach the disc to the vertebrae,Discs structure,Herniated disk,Occur when there is enough pressure from the vertebrae above and belowThis can force nucleus pulposus through a weakened or torn part of the annulus fibrosus. The ruptured nucleus will often come incontact with and press on nerves near the disc.Herniated disks are one of the most common causes of back pain,Mechanism of injury,Aged -disks have worn down over timeoverweight -extra pressure on the intervertebral disksImproper lifting form, Twisting violently -sudden strain that could possible herniate a disk,Symptoms,Lower back pain,sharp and shooting pain the runs down low back, buttocks and down the thighPain, weakness, numbness or tingling in the legs, buttocks and feet Problems with bowel, bladder or erectile function, in severe cases,How can we recognize a herniated disk?,Signs,Lumbar curvature is flattened or even kyphotic Side bending toward the opposite side of the pain usually relieves the painThe straight leg-raising (SLR) test with radiating pain below knee level seems reasonably associated to disc herniation,Obviously neurologic signs altered sensibility, reflexes, muscle strength, and muscle atrophy should be tested .,Neurologic signs,Located nerve root and involved segment,Neurologic signs,Quads/Tibialis AnteriorPatellar reflexSensory Great toe and medial leg,L4,Neurologic signs,L5,Strength of Ankle and great toe dorsiflexionExtensor Hallucis LongusSensory to dorsum of foot,Neurologic signs,S1,Ankle reflexes and sensation of posterior calf and lateral footPeroneals/GastrocAchilles reflexSensory to lateral and plantar foot,Diagnosis,Generally is based on the symptoms of lower back pain.examine your sensation, reflexes, gait and strengthX-ray - High-energy radiation is used to take pictures of the spine.Magnetic Resonance Imaging (MRI) - An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.Computed Tomography (CT) Scan - A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.Electromyography (EMG) - This test measures muscle response to nervous stimulation.,MR IMAGE Diagnosis,Herniated Disc(“slipped disc”),Types of herniation,Degeneration:chemical changes associated with aging cause dehydrated, collapsed and weak, but without a frank herniation. Prolapse:the disc bulges and may cause slight narrowing of the spinal canal ,also known as bulge or protrusion.Extrusion:nucleus pulposus ruptures through the annulus fibrosus but remains within the disc.Sequestration:nucleus pulposus squeezed out,lies outside the disc and within the spinal canal.,Types of herniation,Central,Posterlateral,Lateral,Differenciation,Categories of Low Back Pain （ CAMPBELLS ）,Extrinsic lesionsUrogenital system, gastrointestinal system, vascular system, endocrine system, nervous system not localized to the spine, extrinsic musculoskeletal systemInfections, tumors, metabolic disturbances, congenital abnormalities, associated diseases of agingIntrinsic lesionsSpinal musculoskeletal system, local hematopoietic system, local neurologic systemTrauma, tumors, infections, diseases of aging, immune diseases,Differential Diagnosis of Low Back Pain,ATUL T. PATEL, ABNA A. OGLE .Diagnosis and Management of Acute Low Back PainJ.AAFP, Vol. 61/No. 6 (March 15, 2000).,Differential Diagnosis of Low Back Pain,Differential Diagnosis of Low Back Pain,ATUL T. PATEL, ABNA A. OGLE .Diagnosis and Management of Acute Low Back PainJ.AAFP, Vol. 61/No. 6 (March 15, 2000).,Differential Diagnosis of Low Back Pain,Treatment,Conservative treatment of lower disc pain usually is successful over time, includes:Pain medication or pain therapies such as ultrasound, massage or transcutaneous electrical nerve stimulation Anti-inflammatory medication such as aspirin, ibuprofen and acetaminophen Physical therapy Education in proper stretching and posture Rest,Although performing physical Therapy does not directly help the disks, it does strengthen the muscles around it, so as to increase stability, which can help prevent herniated disks in the future,Physical Therapy,Treatment,Physical Therapy Exercises,Exercise #1 while lying on your back bend your left knee up. Clench abs and butt, keeping back in neutral position. Raise your other leg about 12in off floor, while knee is straightHold the position for 3 secondsThen lower leg, do for 10 reps Repeat the same with your other leg,EB-CME,Rehabilitation,Herniated disks can vary in severity and the rehabilitation plan can vary depending on the severity of the symptoms;Phase #1 Rest- Last from 2 days up to 2 months depending on the nature of the injury, typically the older the patient the longer the rest period.,Phase #2 After symptoms subsided, anywhere from 10days to a few months exercises should be done to strengthen muscles around spinal column to help prevent another hernia. These exercises may be done with some slight lower back pain,Rehabilitation,Hamstring stretchLay down face up with one leg in door way other leg on wall This stretches out ligaments and tendons that connect from leg to lower back,Cat and CamelOn your hand and knees, allow your back to sag for 5 seconds, then arch your back for 5 secondsRepeat for 10 reps,Rehabilitation,Return to play,Patientsthat has sustained a herniated disk to return to play he/she must have clearance from their doctorThis will not usually happen until all pain, and numbness has gone completely,Surgery,Surgery is very rarely required for herniated disksNon operative treatment is almost always done prior to surgeryGenerally if symptoms, such as pain and numbness grow worse over time surgery is requiredIf herniated disk interferes with bladder and bowl movements, surgery is also required,34,Jeffrey H. Oppenheimer,etal. Minimally invasive spine technology and minimally invasivespine surgery: a historical review. Neurosurg Focus 27 (3):E9, 2009,Milestone in spine using traditional and MAST,Lumbar laminectomy for discectomy (Smith) Lumbar fusion (Albee,Hibbs) Lumbar artificial disc replacement (Fermstrom) Lumbar microdiscectomy (Yasargil)1975 Percutaneous Nucleotomy (Hijikata) Transforaminal interbody fusion TLIF (Harms)1987 Lumbar arthroscopic discectomy (Kambin) Microendoscopic discectomy-Med (Foley)2006 Mis-TLIF (Foley),Classical -discectomy,Surgery,Lumbar arthroscopic discectomy,Surgery,Lumbar tunnel MED discectomy,Surgery,Surgery,Tunnel fusion and percutaneous fixation,Prevention,The stretches and exercises listed previously can strengthen the muscles around the discs, which can increase the stability of the discsTeaching and practicing proper lifting form is essential in preventing these injuries,Thanks !,