Skip to main content

Back Pain ...Disc Hernation ..part 1




Lumbar backache is one of the most common causes of chronic debility in the world  .

Acute lumbar disc prolapse or chronic degeneration with disc-space narrowingat L4/5 or L5/S1 are the most common pathologies.

 In acute prolapse, the disc may bulge beneath the posterior longitudinal ligament in the mid line (central disc) or posterolaterally with consequent distortion of the spinal canal or nerve-rootcompression.

Local edema may exacerbate the problem.

Symptoms result from distortion of the posterior longitudinal ligament (chronic pain), pressure on the nerve-root sheath(sciatica) and compression of the nerve itself (muscle weakness, numbness and paraesthesia).

Cauda equina compression may cause urinary retention, but is relatively uncommon.

 Management may include rest, analgesia and physiotherapy, but the prolapsed disc can be treated effectively only by bed rest, disc reduction (including epidural injection or chemonucleolysis) or surgical discectomy.

Cervical disc prolapse may be precipitated by sudden unexpected flexion or rotational movements.

In most cases, there is probably a pre-existing disc abnormality.

The most common levels for prolapse are C5/6 and C6/7, and symptoms are similar to those of lumbar disc prolapse.

Treatment of the prolapse may be effected by rest, reduction using bed rest and traction, or surgical removal, if the symptoms are severe
Labels:

Comments

Post a Comment

Popular posts from this blog

Falling from Height...The Prognostic factors

Falls from Height is Knwon to cause major morbidities and mortalities.  There are several prognostic factors for survival that have been identified: Height Age Type of surface Body part that touches the ground first Two other factors are important, but do not have a significant effect on mortality: Circumstances of the fall (suicide, accident, escape) Initial impact with an object before impacting the ground Height . Overall, about half of victims die at the scene, and a total of 70% die before they reach the hospital . The median height leading to death is about 49 feet, or about 4 to 5 storeys. 100% of victims die after falling 85 feet, or about 8 storeys. Age . Mortality increases with age due to pre-existing medical conditions and decreased physiologic reserve. Type of surface . The type of surface struck (i.e. grass, water, construction debris) can also have an effect on secondary injuries and survival. Mortality after striking a hard surface is nearly doubl...
Post a Comment
Read more

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is  caffeine  prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg,  dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...
1 comment
Read more