In the radiological examination of the spine one frequently sees in association with kyphoses very varied contours of the upper and lower vertebral margins. Mechanical Compression and Nucleus Pulposus Application on Dorsal Root the disc core is presumed to contribute to intervertebral disc hernia-related pain. This report examines 18 surgically proven L3/4 herniated nucleus pulposus ( HNP), all having myelogram, CT and adequate neurological evaluation. It will focus.
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Spinal disc herniation is an injury to the cushioning and connective tissue between vertebraeusually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRIand treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including posture.
When a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings, the disc is said to be herniated. Disc herniation is frequently associated with age-related degeneration of the outer ring, known as the anulus fibrosusbut is normally triggered by trauma or straining by lifting or twisting.
Tears are almost always postero-lateral on the back of the sides owing to the presence of the posterior longitudinal ligament in the spinal canal. Disc herniation is normally a further development of a previously existing disc protrusionin which the outermost layers of the anulus fibrosus are still intact, but can bulge when the disc is under pressure.
In contrast to a herniation, none of the central portion escapes beyond the outer layers. Most minor herniations heal within several weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear are generally effective. Severe herniations may not heal of their own accord and may require surgery. The condition may be referred to as a slipped discbut this term is not accurate as the spinal discs are firmly attached between the vertebrae and cannot “slip” out of place.
Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue involved. They can range from little or no pain, if the disc is the only tissue injured, to severe and unrelenting neck pain or low back pain that radiates into regions served by nerve roots which have been herrnia or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as patients present with undefined pains in the thighs, knees, or feet.
Symptoms may include sensory changes such as numbness, tingling, paresthesiaand motor changes such hermia muscular weakness, paralysis, and affection of reflexes. If the herniated disc is in the lumbar region, the patient may also experience sciatica due to irritation of one of the nerve roots of the sciatic nerve. Unlike a pulsating pain or pain that comes and goes, which can be caused by muscle spasm, pain from a herniated disc is usually continuous or at least continuous in a specific position of the body.
It is possible to have a herniated disc without pain or noticeable symptoms if the extruded nucleus pulposus material doesn’t press on soft tissues or nerves. A herniated disc in the hernnia spine may cause radiating nerve nuukleus in the lower extremities hernka groin area and may sometimes be associated with bowel or bladder incontinence.
Typically, symptoms are experienced only on one side of the body, but if a herniation is very large and nukleua on the nerves on both sides within the spinal column or the cauda equinaboth sides of the body may be affected, often with serious consequences.
Compression of the cauda equina can cause permanent nerve damage or paralysis which can result in loss of bowel and bladder control and sexual dysfunction. This disorder is called cauda equina syndrome. Other complications include chronic pain.
When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs.
While sitting or bending to lift, internal pressure on a disc can move from 17 psi lying down to over psi lifting with a rounded back. Herniation of the contents of the disc into the spinal canal often occurs when the anterior side stomach side of the disc is compressed while sitting or bending forward, and the contents nucleus pulposus get pressed against the tightly stretched and thinned membrane anulus fibrosus on the posterior side back side of the disc.
The combination of membrane-thinning from stretching and increased internal pressure to psi results in the rupture of the confining membrane.
The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, which may produce intense and potentially disabling pain and other symptoms. Some authors favour degeneration of the intervertebral disc as the major cause of spinal disc herniation and cite trauma as a minor cause. Specifically, the nucleus becomes fibrous and stiff and less able to bear load. Excess load is transferred to the anuluswhich may then develop fissures as a result.
If the fissures reach the periphery of the anulusthe nuclear material can pass through as a disc herniation. Several genes have been implicated in intervertebral disc degeneration. Probable candidate genes include type I collagen sp1 sitetype IX collagenvitamin D receptoraggrecanasporinMMP3interleukin-1and interleukin-6 polymorphisms. Disc herniations can result from general wear and tear, such as constant sitting or squatting, driving, or a sedentary lifestyle.
Professional athletes, especially those playing contact sports such as American football, are known to be prone to disc herniations. Herniations usually occur postero-laterally, at the points where the anulus fibrosus is relatively thin and is not reinforced by the posterior or anterior longitudinal ligament. The rest of the spinal cord, however, is oriented differently, so a symptomatic postero-lateral herniation between two vertebrae will impinge on the nerve exiting at the next intervertebral level down.
Lumbar disc herniations occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica. The femoral nerve can also be affected and cause the patient to experience a numb, tingling feeling throughout one or both legs and even feet or a burning feeling in the hips and legs.
Thus, a herniation of the L4—5 disc compresses the L5 nerve root. Cervical disc herniations occur in the neck, most often between the fifth and sixth C5—6 and the sixth and seventh C6—7 cervical vertebral bodies. Intradural disc herniation is a rare form of disc herniation with an incidence of 0. Pre-operative imaging can be helpful for diagnosis, but intra-operative findings are required for confirmation.
It is increasingly recognized that back pain resulting from disc herniation is not always due solely due to compression of the spinal cord or nerve roots, but may also be caused by chemical inflammation. Terms commonly used to describe the condition include herniated discprolapsed discruptured discand slipped disc.
Other conditions that are closely related include disc protrusionradiculopathy pinched nervesciaticadisc disease, disc degeneration, degenerative disc diseaseand black disc a totally degenerated spinal disc. The popular term slipped disc is a misnomer, as the intervertebral discs are tightly sandwiched between two vertebrae to which they are attached, and cannot actually “slip”, or even get out of place. The disc is actually grown together with the adjacent vertebrae and can be squeezed, stretched and twisted, all in small degrees.
It can also be torn, ripped, herniated, and degenerated, but it cannot “slip”. Nucleus herniating through tear in anulus with MRI . Diagnosis of spinal disc herniation is made by a practitioner on the basis of a patient’s history and symptoms, and by physical examination.
Nucleus pulposus | Radiology Reference Article |
During an evaluation, tests may be performed to confirm or rule out ;ulposus possible nuleus with similar symptoms — spondylolisthesis, degeneration, tumorsmetastases and space-occupying lesionsfor instance — as well as to evaluate the efficacy of potential treatment options.
The straight leg raise is often nulkeus as a preliminary test for possible disc herniation in heria lumbar region. A variation is to lift the leg while the patient is sitting. Narrowed space between L5 and S1 vertebrae, indicating probable prolapsed intervertebral disc – a classic picture.
Example of a herniated disc at L5—S1 in the lumbar spine. Tests may be required to distinguish spinal disc herniations from other conditions with similar symptoms. Initial treatment usually consists of nonsteroidal anti-inflammatory drugs NSAIDsbut long-term use of NSAIDs for people with persistent back pain is complicated by their possible cardiovascular and gastrointestinal toxicity. Epidural corticosteroid injections provide a slight and questionable short-term improvement for those with sciatica, but are of no long-term benefit.
Non-surgical methods of treatment are usually attempted first.
Pain medications may be prescribed to alleviate acute pain and allow the patient to begin exercising and stretching. There are a number of non-surgical methods used in attempts to relieve the condition. They are considered indicatedcontraindicatedrelatively contraindicated, or inconclusive, depending on the safety profile of their risk—benefit ratio and on whether they may or may not help:. Surgery may be useful when a herniated disc is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control.
Regarding the role of surgery for failed medical therapy in people without a significant neurological deficit, a Cochrane review concluded that “limited evidence is now available to support some aspects of surgical practice”. Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation.
The former is the most common, causing low back pain lumbago and often leg pain as pulpsus, in which case it is commonly referred to as sciatica.
Lumbar disc herniation occurs 15 times more often than cervical neck disc herniation, and it is pulpowus of the most common causes of low back pain.
Lateral L3/4 herniated nucleus pulposus: clinical and imaging considerations.
Uplposus following locations have no discs and are therefore exempt from the risk of disc herniation: Most disc herniations occur when a person is in their thirties or forties when the nucleus pulposus is still a gelatin-like substance.
With age the nucleus pulposus changes “dries out” and the risk of herniation is greatly reduced. After age 50 or 60, osteoarthritic degeneration spondylosis or spinal stenosis are more likely causes of low back mukleus or leg pain. Because there are various causes of back injuries, prevention must be comprehensive. Back injuries are predominant in manual nukelusso the majority of low back pain nuklsus methods have been applied primarily toward biomechanics.
Education should emphasize not lifting beyond one’s capabilities and giving the body a rest after strenuous effort. Over time, poor posture can cause the intervertebral disc to tear or become damaged. Striving to maintain proper posture and body alignment will aid in preventing disc degradation. Exercises that enhance back strength may also be used to prevent back injuries.
Back exercises include the prone press-ups, upper back extension, transverse abdominis bracing, and floor bridges. If pain is present in the back, it can mean that the stabilization muscles of the back are weak and a person needs to train the trunk musculature.
Lateral L3/4 herniated nucleus pulposus: clinical and imaging considerations.
Other preventative measures are to lose weight and not to work oneself past fatigue. Signs of fatigue include shakingpoor coordination, muscle burning, and loss of the transverse abdominal brace. Heavy lifting should be done with the legs performing the work, and not the back. Swimming is a common tool used in strength training. The usage of lumbar-sacral support belts may restrict movement at the spine and support the back pulpoosus lifting. Future treatments may include stem cell therapy. From Wikipedia, the free encyclopedia.
For other uses, see Slipped disc disambiguation. Illustration depicting herniated disc and spinal nerve compression. MRI scan of large herniation on the right pulposu the disc between L4 and L5 vertebrae. From Occiput to Coccyx”. Degenerated intervertebral disc prolapse and its association of collagen I alpha 1 Oulposus gene polymorphism: A preliminary case control study of Indian population.
Indian J Orthop ; American Journal of Human Genetics.