{"id":2627,"date":"2019-07-06T09:13:08","date_gmt":"2019-07-06T10:13:08","guid":{"rendered":"https:\/\/turanuslu.net\/?p=2627"},"modified":"2021-12-22T09:35:39","modified_gmt":"2021-12-22T09:35:39","slug":"bel-agrisi-ve-dejeneratif-disk-hastaligi","status":"publish","type":"post","link":"https:\/\/turanuslu.net\/en\/bel-agrisi-ve-dejeneratif-disk-hastaligi\/","title":{"rendered":"Low Back Pain and Degenerative Disc Disease"},"content":{"rendered":"

Low Back Pain and Degenerative Disc Disease<\/h3>\n

Low Back Pain<\/h3>\n

Low Back Pain and Degenerative Disc Disease , Low Back Pain<\/strong> son derece yayg\u0131nd\u0131r ve insanlar\u0131 hekime g\u00f6t\u00fcren en \u00f6nemli hastal\u0131klar\u0131n ikincisidir. \u0130\u015f g\u00fcc\u00fc kay\u0131plar\u0131n\u0131n en s\u0131k rastlanan sebeplerinden biridir. \u00d6m\u00fcr boyu g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 %60-80 aras\u0131nda de\u011fi\u015fir. %1-3\u2019\u00fc cerrahi giri\u015fim gerektirir. B\u00fcy\u00fck \u00e7o\u011funlu\u011fu 2-3 hafta i\u00e7inde iyile\u015fir. Nas\u0131l tedavi edilirse edilsin hastalar\u0131n %70 inde tekrarlar. Low back pain<\/strong> The prognosis is good in most cases and recovery usually occurs with little or no medical intervention. It occurs in all ages and genders.<\/p>\n

Definitions<\/h3>\n

Radiculopathy<\/h4>\n

Any pressure or damage to the nerve roots coming out of the spinal cord nerve root<\/strong> It is the presence of symptoms such as pain, tingling, numbness, loss of sensation and strength in the distribution area of the nerve as a result of damage for any reason.<\/p>\n

Sciatica<\/h4>\n

It is a lesion of the thickest and longest nerve in the body, resulting from radiculopathy of a nerve root (L4, L5 or S1) that joins the sciatic nerve. Radiculopathy symptoms extending along the back and side of the lower extremity to the foot and ankle.<\/p>\n

Mechanical low back pain<\/h4>\n

Spinal circumference your muscles<\/strong> and\/or strain on ligaments, irritation of facet joints low back pain<\/strong>It is the most common form of low back pain, excluding anatomically determinable causes (e.g. tumor, disc herniation).<\/p>\n

Radiological evaluation<\/h3>\n

Direct graphs<\/h4>\n

A variety of clinically significant congenital anomalies may be detected (e.g. spina bifida occulta). Spinal malignancy, infection, inflammatory spondylitis, or clinical<\/strong> It is useful for patients who are likely to have significant fractures. Surgical indications for disc herniation and spinal stenosis cannot be made from plain radiographs.<\/p>\n

Findings supporting disc disease (flattening of lordosis, scoliosis, decrease in intervertebral disc height) may be seen. It is useful in showing movement instability. It may not give any findings of disc disease.<\/p>\n

MRI : <\/strong>The structure of the intervertebral disc and the width of the spinal canal provide valuable information about spinal tumors. The cauda equina is evaluated in sagittal images. It provides better information than CT about tissues outside the spinal canal (e.g. extraforaminal disc herniation, tumors<\/strong>…).<\/p>\n

BT : <\/strong>If technically sufficient images are obtained, they may be sufficient to recognize most spinal pathologies. They provide better information about the bone structure.<\/p>\n

Lumbar Disc Herniation (Lumbar Disc Herniation)<\/h3>\n

Anatomy<\/strong>: The intervertebral disc is located between two vertebral bodies and acts as a shock absorber. is texture<\/strong>It is bordered by the soft, gelatinous nucleus pulposus in the middle, the hard annulus fibrosus around it, and the cartilaginous end plate on the surface facing the vertebral body.<\/p>\n

Anulus fibrosusun d\u0131\u015f yaprak\u00e7\u0131klar\u0131ndaki lifler omur cisminin epifizine direkt olarak yap\u0131\u015f\u0131r. Bunlar Sharpey lifleri olarak bilinir. \u0130\u00e7 lamellerdeki fibriller direkt olarak kartilaginoz end platelere yap\u0131\u015f\u0131r. N\u00fckleus pulposus intervertebral diskin hacminin %40\u2019\u0131n\u0131 olu\u015fturur. Eri\u015fkin diski damars\u0131zd\u0131r. End plate ler ve anulus etraf\u0131ndaki kapillerlerden diff\u00fczyonla beslenir.<\/p>\n

Nucleus pulposus<\/strong>; kollajen lifler, proteoglycan ve su (\u00e7ocukluk \u00e7a\u011f\u0131nda %80) i\u00e7erir. Diskin normal hidrasyonu; proteoglycan matriks taraf\u0131ndan osmotik olarak sa\u011flan\u0131r (chondroitin sulfat ve daha az oranda keratin sulfat\u0131n hydrophilic zincirleriyle). Ya\u015f\u0131n artmas\u0131yla; chondroitin sulfat\u0131n keratin sulfata oran\u0131 azal\u0131r. Bu da diskin s\u0131v\u0131 i\u00e7eri\u011finin azalmas\u0131na neden olur.<\/p>\n

Annulus fibrosus<\/strong>; It is composed of collagen fibers in layers.<\/p>\n

End plate (contact surface between the disc and the vertebra)<\/strong>; composed of hyaline cartilage.<\/p>\n

Innervation<\/strong>: Sinovertebral nerves; innervate annular fibers, posterior part of disc, dura, post. long. ligament. Primary dorsal ramus; innervate facet joints, paraspinous muscle and interspinous ligament. Gray ramus; innervate anterior part of disc, ant. long. ligament.<\/p>\n

Disc herniation (herniation)<\/strong> : the escape of the nucleus pulposus into or out of the tears in the annulus fibrosus. This is either a traumatic event or a structural and age-related
\nrelated degeneration. Intervertebral disc Up to 18 years old<\/strong> It is fed by arterial blood. At the end of the 20s and the beginning of the 30s, the entire nucleus pulposus and most of the peripheral part of the annulus fibrosus cease to receive vascular nutrition. After this age, it is fed by diffusion from the environment.<\/p>\n

The water content of the nucleus pulposus decreases and the natural elasticity of the disc is impaired. Thus, it transmits forces in a non-linear and asymmetrical manner. The annulus becomes brittle and vulnerable over time and the nucleus loses water Fragments<\/strong> fragmentation facilitates herniation. For this reason, disc herniation is more common in middle ages (40-50 years old). It is rare before the age of 20.<\/p>\n

Risk factors<\/strong>; obesity, smoking and poor physical conditions.<\/p>\n

Moving and not moving<\/strong> The transition zone between the zones is subjected to greater pressure during movement. Thus, degenerative changes are more common in the lower cervical and lower lumbar intervertebral discs in humans.<\/p>\n

There are 3 phases of disc degeneration<\/h3>\n

First phase<\/strong>\u00a0 : (dysfunctional phase): Various degrees of acute injury occur in the disc.<\/p>\n

Second phase:<\/strong> (unstable phase): The disc space narrows and the ligaments loosen. As a result, the posterior joints of the spine (facet joints) become loosened, and the facet capsule and ligamentum flavum hypertrophy occur.<\/p>\n

Third phase:<\/strong> (stabilization phase): Movement decreases.<\/p>\n

\"\"The nucleus pulposus can herniate in any direction out of its normal configuration. Because the nucleus pulposus is located partly posteriorly, and the annulus fibrosus has fewer lamellae posteriorly, and because the posterior longitudinal ligament strengthens the annulus fibrosus in the posterior midline, most disc herniations occur in the posterolateral direction. Central, foraminal, and, much less frequently, extraforaminal (%7-12) herniations may occur.<\/p>\n

If it herniates from the cartilaginous plate to the adjacent vertebral body in the upper and lower directions, it is called Schmorl's nodule. It can generally be found incidentally in radiological examinations or autopsy, and has no clinical significance. Most patients with lumbar degenerative disc disease have back pain as the first symptom. This pain syndrome occurs when the annulus balloons due to the pressure of the nucleus pulposus, causing pressure on the sinovertebral sensory nerves located posteriorly. It causes radicular pain and motor and\/or sensory changes by compressing the nerve root. Inflammation in the nerve root increases symptoms.<\/p>\n

Posterolateral disc protrusion or disc extrusion often compresses the nerve root exiting the dural sac at the same distance. Left L4-5 disc herniation compresses the left L5 nerve root, and left L5-S1 disc herniation compresses the left S1 nerve root. Rarely, an upper or lower nerve root may be compressed.<\/p>\n

Posterolateral disc protrusion or disc extrusion often compresses the nerve root exiting the dural sac at the same distance. Left L4-5 disc herniation compresses the left L5 nerve root, and left L5-S1 disc herniation compresses the left S1 nerve root. Rarely, an upper or lower nerve root may be compressed.<\/p>\n

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Classification of disc herniations<\/h3>\n

Bulging disk<\/strong>: Slightly convex image extending beyond the adjacent vertebral disc edges. Annulus fibrosus and Sharpey's fibers located in the periphery are intact.<\/p>\n

Prolapsed disc<\/strong>: Posterior herniation of the disc through a partial defect in the annulus fibrosus. Only the most peripheral or posterior annulus fibers (Sharpey's fibers) are intact. Herniated or prolapsed disc is associated with the non-herniated portion.<\/p>\n

Extruded (burst) disc<\/strong>: Posterior herniation of the disc through a defect in the annulus fibrosus.<\/p>\n

Sequestrated disc (free fragment)<\/strong>: Extrusion of the nucleus pulposus from a defect in the annulus fibrosus, and the absence of communication between this extruded fragment and the unherniated disc. The fragment may be anterior or posterior to the post. long. lig.a, superior or inferior to the disc space, or rarely intradural.<\/p>\n

\"\"As degeneration (disc degeneration) progresses, the nucleus of the disc loses its water content and hardens, the intervertebral disc space narrows, spinal movements decrease, and the distribution of forces applied to the annulus fibrosis located on the outer part of the disc is completely disrupted. The shock absorption and load-carrying ability of the disc decreases. Ossification occurs in the disc itself and new bone formation occurs in the vertebrae.<\/p>\n

The vertebrae are integrated with each other. For this reason, disc herniation is very rare in the elderly (after the age of 60). In those with degenerative disc disease, excessive forceful movements can cause calcification in the annulus fibers.
\nThis is called spondylosis. This often occurs on the back of the spine. Spondylosis is more common with increasing age. Similarly, as the disc space narrows, excessive loads on the facet joints lead to degeneration in these joints.<\/p>\n

The resulting narrowing of the disc space and facet joint hypertrophy causes narrowing of the spinal canal and lateral canals (spinal stenosis) and\/or mechanical instability (loss of spinal stability), which may lead to nerve root irritation.<\/p>\n

Asymmetric loss of lumbar disc height can progress to asymmetric deformation of the spine. If this lateral bending (scoliosis deformity) occurs and progresses, it is together with rotation of the spine. As a result, degenerative scoliosis is seen in advanced ages as a result of severe degenerative changes or due to previous surgeries.<\/p>\n

Low Back Pain and Degenerative Disc Disease Symptoms<\/h3>\n

Low back and leg pain<\/h3>\n

Remaining in any one position (sitting, standing, or lying down) for too long typically increases pain, requiring frequent position changes. Cough<\/strong>, sneeze<\/strong> or straining<\/strong> Pain is aggravated by flexing the knee and hip (e.g. sleeping with a pillow under the knee) and pain is reduced. Pain may occur spontaneously.<\/p>\n

Because the pain threshold is lowered, normally painless stimuli may cause pain (allodynia). The response to the stimulus may be both continuous and exaggerated in amplitude (hyperalgesia). The sensation of pain may be referred to healthy areas.<\/p>\n

Motor, sensory and\/or reflex changes in the area innervated by the relevant nerve root in the lower extremity.<\/h4>\n

Neurogenic claudication<\/h4>\n

Pain in the hip, thigh, or leg on one or both sides with walking, increased tingling and numbness<\/strong>, sometimes loss of strength, relief of symptoms by sitting, squatting or lying down. It is often seen in patients with lumbar stenosis and often begins after the 5th decade.<\/p>\n

Lower urinary tract symptoms<\/h4>\n

Decreased bladder sensation is the earliest finding; later it is not uncommon to see \u201cirritative\u201d signs, including urinary urgency and increased postmicturition residue; less frequently enuresis and dribble incontinence are described in radiculopathy.<\/p>\n

Cauda equina syndrome (very rare)<\/h4>\n

Sphincter disorders, urinary incontinence, inability to urinate, significant sensory deficit in the lower extremities, loss of strength,<\/p>\n

Treatment<\/h3>\n

Conservative treatment: This term is used for nonsurgical treatment. Similar approaches can be used for acute disc herniation, with minor modifications. Most patients only require short-term treatment<\/strong> requires, the treatment is successful.<\/p>\n