1、Lower back pain,1st hospital of Xinjiang Medical University,Objective,1. The mechanism of Lower back pain. 2. The clinical presentations and Orthopedic Examination of the Lumbar Disk Herniation. 3. The differential diagnoses. 4. The principles of precaution and therapy.,Content,1. The lumbar anatomy
2、 and its physiological movement, lumbar disk anatomy and its physiological functions. 2. The mechanism of Lumbar Disk Herniation.and its precaution. 3. The clinical presentations. 4. The differential diagnoses. 5. Operative therapy and operative indications.,Causes of Back pain,Lumber disc herniatio
3、n Infection Trauma Neoplasia Congenital abnormalities Miscellaneous conditions,Lumber Disc Herniation,Lumber Disc Herniation,Difinationnucleus pulpous breaks through the annulus fibrosis of an intervertebral disc most often at the L4-L5 and L5-S1 levels,History,460357 BC Hippocrates (Greece) 9801077
4、 Avicenna (Arab) 1934 Mixter and Barr (USA) 1946 Xianzhe Fang (China),Anatomy Review,The disk is composed of two parts, a soft center called the nucleus and a tough outer band called the annulus,Lumber disc function,Click Please,Itiology,Degeneration of the disk Trauma Congenital,Pathology,(1) disc
5、protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc,Pathophysiology,Direct pressure on the nerve rootBreakdown products from nucleus pulposusAutoimmune reaction,Clinical findings,Symptomsback pain (91%)sciatica (97%)bladder and rectal function involvement occasionally,Sciatica,Scia
6、tica is pain radiating down the posterior aspect of the leg in the distribution of the sciatic nerve andit may be associated with symptomsof paresthesia or weakness,Sciatica,Clinical findings,SignsScoliosis Mobility limmited Sensory loss Weakness of muscle Straight leg-raising test (positive)Depress
7、ed or absent of tendon reflex,Neurology of the lower extremity,COMARISON PRINCIPLE,X-ray,1.Indirectly reveal degenerative disc changes , can not confirmthe diagnosis 2.Rule out any other diseases,CT (computed tomography),CT scans are generally helpful when MRI scans cannot be obtained, but it can gi
8、ve better detail of the bone,MRI(magnetic resonance image),An excellent way to evaluate the compromise of neural structures,Differential diagnosis,Tumors within the spinal canal Neurofibromata in the root canal Ependymoma Ankylosing spondylitis Spinal stenosis Vertebral tumors Tuberculosis,Spine ste
9、nosis Click please,Standand Of Diagnosis,history physical examination Observation and Regional Back ExaminationCheck for limping; guarding of lumbar motion; vertebral point tenderness 2. Neurologic Screening Sensory Examination Testing for muscle strengthReflexesClinical tests for sciatic tension SL
10、R X-ray imaging ,CT, MRI ,EMG,Treatment,Conservative TreatmentSurgical Treatment,Conservative Treatment,Bed rest Physical therapy Nonsteroidal medication Epidural corticosteroids analgesics,Surgical treatment,Indication1.Conservative treatment unsuccessful2.Sciatica is severe and disabling and lessi
11、ons signs are positive (1 month)3.LDH with stenosis4.Bladder or bowel involvement,Surgical treatment,Standard discectomy (85% success) Microdiscectomy Percutaneous automated discectomy Chemonucleolysis Laser discectomy,Operation,Complication of surgery,Dural tear Wrong level exploration Infection He
12、morrhage Nerve deficit,Epidemiological and clinical studies show that most lumbar disc prolapses resolve naturally with the passage of time and conservative management without surgery,Evidence-based medicine(EBM),There is considerable evidence that surgical discectomy provides effective clinical rel
13、ief for carefully selected patients with sciatica due to lumbar disc prolapse that fails to resolve with conservative management .,Evidence-based medicine(EBM),The quality of surgical RCTs still needs to be improved, particularly on the issues of adequate randomisation, blinding, duration of follow-
14、up and better clinical outcome measures.,Evidence-based medicine(EBM),There is no evidence that patients need to have their activities restricted after first time lumbar surgery,Evidence-based medicine(EBM),There is strong evidence that intensive exercise programs are more effective on functional st
15、atus and faster return to work (short-term follow-up) and there is strong evidence that on long term follow up there is no difference between both interventions with regard to overall improvement.,Evidence-based medicine(EBM),Case report,Age 35 History Low back pain Findings 1. CT L5/S1 Posterior bulge of L5/S1 disc with thecal indentation, compressing the right S1 nerve root and asymmetry of fat in the lateral recesses .,Thank,
