Lumbar Disc Herniation LIAO Hui MD Tongji Hospital, HUST 2012.11.21

Low back pain strain of the muscles ligaments and tendons Herniation of lumbar disc sciatica Various other conditions

Spine "S"-like curve Cervical spine 7 vertebrae Thoracic spine 12 vertebrae Lumbar spine 5 vertebrae Sacrum "S"-like curve

Anatomy

Etiology of Disc Degeneration In the normal, healthy disc, the nucleus distributes the load equally throughout the anulus As the disc undergoes degeneration, the nucleus loses some of its cushioning ability and transmits the load unequally to the anulus In the severely degenerated disc, the nucleus has lost all of its ability to cushion the load, which can lead to disc herniation

Degeneration Prolapse Extrusion Sqeuestration A herniated disc occurs when the intervertebral disc's outer fibers (the annulus) are damaged and the soft inner material of the nucleus pulposus, under extreme pressure, bulges out through the annulus fibrosus ring. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal.

Causes

Which kind of position is right when you to lift something heavily form the ground. First squat and then stand up is the correct method.

Symptoms Pain Numbness Muscle weakness Loss of the reflexes

Signs Skin sensation Muscle power Reflexes

SCIATICA S1 nerve root

L5 nerve root

L4 nerve root

Diagnosis Complete history of the problem Physical examination. Diagnostic tests

complete history Did you have an injury? Where is the pain? Do you have any numbness? Where? Do you have any weakness? Where? Have you had this problem or something like it before? Have you had any weight loss, fevers, or illnesses recently?

Cauda Equina Syndrome Most serious complication Ruptured disc material may press on the nerves that control the bowels and bladder It can cause permanent damage lead to lose the ability to control bowels and bladder Surgery immediately is recommend

physical examination Motion of Spine Weakness Pain Sensory Changes Reflex changes Motor skills Special signs

Localizing Neurologic Levels

straight-leg-raise test

diagnostic tests X-Ray

X-ray

MRI Scan

Imaging of the Herniated Disc

Treatment Conservative Treatment Surgical Treatment Purpose: to relieve pain and nerve root irritation Surgical Treatment purpose : to relieve nerve root compression from herniated disk material.

Conservative Treatment Observation Rest and physiotherapy Orthosis or brace

Conservative Treatment Pain medications Epidural Steroid Injection (ESI)

Surgical Treatment Laminotomy and Discectomy

Microdiscectomy

Endoscopic Discectomy Many surgical procedures have been revolutionized by the use of special TV cameras. The procedure is still the same, but even smaller incisions (1/4 inch) are made to insert a special magnified TV camera into the spinal canal so that the surgeon can actually see the disc material. Through these small incisions, the camera and several other surgical instruments are inserted. Rather than look through a microscope, he watches the TV screen while he directs the specially designed instruments to remove the disc material. The notion is that if microdiscectomy can do less damage because of a smaller incision, endoscopic discectomy could do even less damage. This surgical procedure is still evolving and is not yet widely used. This procedure has the benefit that it does even less damage to the normal tissues around the spine during the operation. This can lead to a still faster recovery and less complications.

Indication progressive neurologic deficit profound neurologic deficit cauda equina syndrome progressive neurologic deficit profound neurologic deficit severe and disabling pain refractory to four to six weeks of conservative treatment

Rehabilitation

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