Sie sind auf Seite 1von 22

Intervertebral disc involment

RAKHMAD ROSADI,. MPT.


Statistics for lumbal disc disease
• 80% of the population will experience low
back pain
• 7% to 14% will have symtomps longer 2 weeks
• 1% to 2 % will undergo surgery
• This involves a change in the architecture of
the disc with a typical loss in the gelatinous
stucture (nucleus puposus) or a fibrotic disc
with amyloid and lipofucin deposits.
• The first manifestation of the degerative
process involves tears in the center of the disc,
which gradually increase and progress to the
anulus fibrosus.
• The most common manifestation of
degerative nvolvment includes osteophytes on
the adjacent vertebral bodies which are
oriented primarily in horizontal direction.
• Ostephytes grow first on the anterior and,
later, posterior edge of the vertebral body.
Bulging disc
• Symmetrical disc bulge beyond the vertebral
body
Disc herniation (protution, prolaps)
• Central subtance of the nulceus puposus
escapes toward the defect in the anulus
fibrosus and focal protution of the disc
beyond the perimeter of the vertebra occurs
Disc exterusion
• Nucleus puposus penetrates trought the
external layer of the annulus fibrosus, but
remains connected to the rest of the nucleus
substance
Extrution with sequestration of the
disc
• The posterior longitudinal ligament is
perforated and one more free fragments of
the nulceus pulposus migrate within epidural
space, but not into the spinal canal
Predictive value of clinical and surgical findings in
patients with lumbago-sciatica (Kosteljanetz,1984)

• In a prospective, consecutive study of patients


with lumbar back pain and sciatica, various
clinical features and surgical findings were
evaluated in order to analyse the predictive
value regarding (1) level of diseased
interspace (2) presence and type of lesion
responsible for root compression (3) outcome
after surgery.
• One hundred patients underwent surgery
solely on clinical grounds. Fifty-eight had disc
herniation. The level of disc herniation was
correctly predicted in three quarters of
patients with aprolapsed disc. The outcome
after surgery was good in 77 patients.
• Only few clinical features, namely male sex
and scoliosis were predictors of a good
outcome. Lasegue's sign was indicative of root
compression in 90%, but only two-thirds had
disc herniation. Conversely one-third had disc
herniation in spite of a “negative” test.
Lasegue's sign was not superior to other
clinical tests in predicting outcome
• The most important indicator of a good
outcome was the presence of disc herniation
at surgery. Patients with disc pathology other
than true disc herniation fared equally with
patients, who had normal discs disclosed at
surgery.
• Myelography was undertaken in all patients
prior to surgery, the results of which are
analysed in the following paper
• It is known fact that the clinical significance of
a disc hernitiation can be confirmed in
approximatly 20%-30% of examinations (CT or
MRI) in healthy inividuals.
• These hernitiations are neurogycally
asymtomatic and are not accompanied by any
problems.
• However, they are never asymtomatic
funtionally, meanning they are always lingked
to functional reactive changes inthe muscle
and soft tissue.
• According to Allat (1994), disc herniation is
found in 39% of individuals who report no
problems.
• During radiculopaty, allat showed a disc
protusion in 50% of cases and a disc
herniation in 24% of the cases.
• As result of compensatory mechanisms, a disc
herniation may not be source of neurological
signs or even subsjecyive findings.
• A demonstrated disc herniation always needs
to be observed in aclinical picture and in
functional context.
• In a number of cases, low back pain preceds
pain radiating into the lower extremities.
• This is also why disc herniation needs to be
considered as acause of not only spinal root
syndromes, but also of low back pain.
• At the same time, back pain develops and
progresses to the lower extremities similiarly
to nerve root irritation but without the
presence of neurogical findings.

Das könnte Ihnen auch gefallen