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Everything About Herniated Disc and Back Pain

Discussion in 'Orthopedics' started by Egyptian Doctor, Aug 23, 2019.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    A herniated disc is the output of the disc contents (nucleus pulposus) within the spinal canal or the intervertebral foramen where the spinal nerves emerge, causing compression of these structures, producing reflex contracture of the muscles of the area, and as a result, generating back pain. Herniation of the intervertebral disc occurs towards the most weakened part of the fibrous annulus, usually posteriorly or posterolaterally.

    Incidence

    The prevalence of herniated disc is around 2% in patients with back pain. This pain affects many people in the world. back pain is a serious social and health problem, causing high labor absenteeism, being the most frequent cause of incapacity to work in people under 45 years of age. The herniated disc primarily affects the population group whose age is between 30 and 50 years, this is due to the high proportion of physical activity that is done in these ages, which coexists with the progressive degeneration of the intervertebral disc.

    Causes

    During the aging process the disks of the spine lose flexibility and elasticity due to the loss of their liquid content, which leads to a process of disc degeneration. The ligaments around the discs become brittle and tear more easily.

    Risk factors

    The main risk factors are repeated microtrauma in the back (vibrations), repetitive movements of flexion-extension of the trunk, carrying weights and continuous rotational movements.

    Being overweight adds pressure to the discs of your lower back.

    Driving vehicles for long time.

    Sedentary lifestyle.

    Smoking decreases the oxygen supply to the disc and causes faster degeneration.

    Symptomatology

    Most cases of herniated disc are preceded by episodes of low back pain, whose duration differs from one patient to another. However, it should be noted that not all herniated disc causes symptoms. In a typical herniated disc, there is a root compression whose characteristics depend on the root that is affected.

    The nerve root compression causes pain, loss of strength and tingling sensation, which can affect certain muscles groups. The upper and lower limbs may be affected depending on the nerve root that is compressed.

    Spinal cord compression causes muscle paralysis or spasm, tingling sensation and loss of sensitivity, affecting the body area that is below the level of compression. Sometimes it is possible to find in the patient an abnormal posture due to contracture of the muscles of the back.

    Diagnosis

    The diagnosis is based on an adequate clinical history and a full physical examination. The targeted medical examination will help rule out systemic diseases that may debut with low back pain. Imaging studies are very helpful to corroborate the diagnosis.

    · Radiography: conventional radiology should be performed as the first diagnostic test. The advantages of simple radiology include its accessibility and the detection of bone and disc degenerative phenomena that are associated with possible herniated disc.

    · Computed axial tomography (CAT): the main advantages of the CAT scan are the possibility of directly observing the boundaries bone and soft tissue of the spinal canal. It is also an excellent technique for the demonstration of bone alterations associated with disc degeneration.

    · Magnetic resonance imaging (MRI): MRI is the procedure that allows a better view of the soft tissues, that is, all components of the spine which are not bone, such as the intervertebral disc, spinal cord, nerve roots or the eventual existence of post-surgical fibrosis. Although it also allows you to see the bone, it looks better with the CAT scan. It has a high resolution and allows differentiating the excluded disk and the adjacent root.

    · Electromyography (EMG): this imaging test involves collecting the electrical activity of the muscles. The contraction of a muscle is the response to the electrical discharge of the nerve that controls it. If there is involvement of said nerve, its operation is compromised. The EMG evaluates the state of the nerves, muscle contracture and allows detecting with extreme precision the degree of compression or suffering of the nerves.

    Medical treatment

    Initially, if there is no significant motor or sensory deficit, the treatment should be conservative, with rest and drugs such as anti-inflammatories, analgesics and muscle relaxants. In fact, most patients with herniated disc who undergo conservative treatment respond well, requiring surgery only 7% of those affected. Bed rest is not recommended beyond the first 24 hours.

    Surgical treatment

    Microdiskectomy is the surgical technique of choice, which produces satisfactory results in more than 80% of patients. The absolute indications for surgical treatment are the following:

    · Disc prolapse compressing the cauda equine.

    · Motor deficit for the extension of the foot and the first finger.

    · Lumbar pain irradiated to the sciatic territory with neurological, motor and sensitive deficit.

    · Root claudication (increased pain with walking).

    · Motor deficit and paresthesia in the sciatic territory.

    · Young patients with repeated sprouts of low back and sciatic pain.

    · Failure of medical treatment.

    Other therapeutic options

    The therapeutic options for a herniated disc also include physiotherapy and rehabilitation. In this sense, it is especially important to perform exercises that strengthen the muscles of the back. Other therapies equally indicated are acupuncture and ozone therapy.

    The ozone therapy used for medical purposes is based on the application of ozone to treat ailments, producing the least possible aggression. The infiltration of ozone is indicated in the treatment of the herniated disc, as well as in other pathologies of the locomotor system.

    The principle that justifies the therapeutic application of ozone is based on the fact that ozone acts on the nucleus pulposus of the intervertebral disc, causing different biochemical and antioxidant reactions that diminishes its volume, and therefore, the pain disappears or diminishes.

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    This is an original post written by FacMedicine team
     

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