腰腿痛课件_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 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 herniation Infection Trauma Neoplasia Congenital abnormalities Miscellaneous conditions,Lumber Disc Herniation,Lumber Disc Herniation,Difination nucleus 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 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 protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc,Pathophysiology,Direct pressure on the nerve root Breakdown products from nucleus pulposus Autoimmune reaction,Clinical findings,Symptoms back pain (91%) sciatica (97%) bladder and rectal function involvement occasionally,Sciatica,Sciatica is pain radiating down the posterior aspect of the leg in the distribution of the sciatic nerve and it may be associated with symptoms of paresthesia or weakness,Sciatica,Clinical findings,Signs Scoliosis Mobility limmited Sensory loss Weakness of muscle Straight leg-raising test (positive) Depressed or absent of tendon reflex,Neurology of the lower extremity,COMARISON PRINCIPLE,X-ray,1.Indirectly reveal degenerative disc changes , can not confirm the diagnosis 2.Rule out any other diseases,CT (computed tomography),CT scans are generally helpful when MRI scans cannot be obtained, but it can give 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 stenosis Click please,Standand Of Diagnosis,history physical examination Observation and Regional Back Examination Check for limping; guarding of lumbar motion; vertebral point tenderness 2. Neurologic Screening Sensory Examination Testing for muscle strength Reflexes Clinical tests for sciatic tension SLR X-ray imaging ,CT, MRI ,EMG,Treatment,Conservative Treatment Surgical Treatment,Conservative Treatment,Bed rest Physical therapy Nonsteroidal medication Epidural corticosteroids analgesics,Surgical treatment,Indication 1.Conservative treatment unsuccessful 2.Sciatica is severe and disabling and lessions signs are positive (1 month) 3.LDH with stenosis 4.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 Hemorrhage 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 relief 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-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 status 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.,Evi