• Spinal pain, hernia, paralysis

  Filed under KINESITHERAPY
  Nov 4

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  Intervertebral disc hernia formation

  Some authors claim that the herniated disc is affected by human develop constitutional type: more common in tall and thin, and low and obese individuals. Men have 1.5 to 3 times more likely than women (Memo with intervertebral disc herniation, 2001). Other authors argue that most of intervertebral disc herniation occurs 40 to 45 years of age. (Scientific evidence-based medical practice and medical technology assessment, 2000). The disease is closely related to the reason, it can be concluded that, is the most prevalent among the working people. Studies have shown that a profession characterized by hard physical work, prolonged sitting, frequent bending and lifting something, vibration (especially while driving), promotes chronic low back pain, disc herniation. Depending on the disc postural strain is different: it is lying - the smallest increase in four standing, and bending or sitting - six times. Low bending or lifting the weight load increases by disc pressure in the lower spine and lumbar vertebrae. (Back pain, prof. Med. Dr. H. HESA, 1998). When the correct seating, back naturally retains the "S" shape and a greater proportion of body weight have a pelvic bottom. Sitting stooped, lumbar vertebrae and pelvis consist of the "C" shape, so heavily loaded lower torso joints, discs and muscles. Prolonged sitting, keeping your back muscles, fatigue, lose the right tone, overstretch ligaments, which leads to back pain. It is therefore recommended to make a break and exercise. When a person is standing relaxed, lordozė becomes too large and lumbar back very bent. This is more pronounced in obese riebaliniam thickening layer of the front part of the stomach. Long-standing slack is not easy because of overstressed tissue and compressed disc edge there pain (Juocevičius A. et al., Low back pain rehabilitation in 2001).

  Most herniated disk is formed rapidly rotating or bending. It causes severe sacral pain because of pressure from the longitudinal ligament. Stretch back muscles reflexively, even increasing pain. When the rupture disk ring, and escapes the nucleus into the spinal canal, nerve root is pinched, causing neurological symptoms. When clipped roots, the pain and paraesthesiae spreading nerve course in the direction of the buttocks, leg, thigh to the foot. This symptom is called sciatica. Bending his leg during the hip joint with an outstretched path, tensioned, and nerve root pain. Intervertebral disc nucleus minkštiminis usually escapes in one direction, so there is one side of sciatica. (P. Plevokas A. Gradauskas, Surgical Basics Part I, 2000).

  Often ignored in the low back pain caused by someone pushing hard or prolonged sitting in one position. However, he is the first sign of the need to reduce the load on the spine. (Health, 2001, No.2).

  Intervertebral disc degeneration starts from about twenty years. These changes occur is influenced by hormonal, metabolic disorders, among them, and 'C' vitamin deficiency disease because of the lack of vitamin decays and cartilage disks in Collagen. It is also very important exogenous factors, such as infectious diseases, spinal cord injury, exercise. Value has a congenital weakness of the ligaments, discs of growth defects, senile changes, caused by the obliteration of small blood vessels. The first of these factors violated minkštiminis nucleus, which loses a lot of fluids, standėja decreases its elasticity, becomes brittle. At the same time developing and fiber degeneration in the ring. He hialinizuojasi, swollen, begins plaušotis, causing cracks and fissures. Body mass is pressed minkštiminis nucleus, loss of fixation strength of the fiber ring side, expand the country tightens the back of the front and rear longitudinal ligaments. The latter, being firmly attached to the vertebral periosteal, it starts to irritate, to expand, causing degenerative spine disease - inflammatory lesions composed of osteophyte, bone increased. Gap narrows between two vertebrae and their ligaments are thick, the pressure to the spine sprouting sąnarėlius increases. Such changes, grows, more and more minkštiminis nucleus moves into the spinal canal, and eventually rupture skaiduliniam ring, the hernia is formed (see figure), and if it is traumatic spinal cord counterfoil, a person develops radiculopathy.

  

  Figure. Disc herniation (Alternative treatments for back pain, 2002)

  Very often, the emergence of disk herniation has been associated with a forced posture in which a person has to work hard for its lifting. The disease starts with the fact that lifting a heavy object, suddenly felt a sharp pain in the lumbar-sacral area, and sometimes his spine even trakšteli. However, the disease may begin gradually and include pain occurs slowly and gradually increasing.

  Spinal cord herniation causes

  Etiology of spinal hernias is associated with harmful factors which existed in the early ontogenesis and broke the normal spinal cord and brain development.

  Pathology is most relevant to lumbar and sacral vertebrae. Spinal cord herniation depending on the contents are divided into three forms of disease.

  Meningocelė - when the spinal defect išsiviežia only the spinal cord meninges. When examining a patient under the skin to see elevation fluctuation is felt by palpation, the skin suplonėjusi, pigmented or even hairy. After the puncture falls apart. The spinal cord is not affected, and therefore there is no breach of symptomatics.

  Meningoradikulocelė - when the spinal defect is pulling back the meninges and roots, in addition, visible under the skin elevation is detected in peripheral leg paralysis or paresis, and trophic disorders.

  Mielomeningocelė - the spinal cord and lining of the hernia. It is characterized by peripheral leg paresis or paralysis, pelvic floor dysfunction and high trophic disorders.

  Mielocistocelė - the lining of the spinal cord and herniation of the spinal defect with a dilated central spinal canal. The spinal cord hernia sac covers the entire surface. Hernia blue bag, leather suplonėjusi, ulceration. This is very serious neurological symptoms: paralysis of the legs, pelvic organs and trophic disorders. (I. Avižonienė E. Barakauskas I. Bičkuvienė and others. "Nervous Diseases", 1998).

  Spinal disc herniation symptoms

  The main symptom is pain. They can be very high, average and weak. Great pains are constant, even at rest. The minimum motion to still increase. Patients usually lie in forced position. For severe pain can not sleep. Average pain patients as well as resting and feeling, however, tolerate and thus try to move slowly, looking antalginių different positions. Resting place of such pain absent, and they occur only when moving, sitting, standing, walking. As a result, patients can sleep peacefully. And the pain is dull weak and appears only in the physical handling or sudden movements.

  Localized pain in the abdomen and spread to one or both legs, usually under the sciatic nerve. Acute disease period pain is constant, increasing periodically. Reduction in pain at rest and in motion, coughing, sneezing - pasmarkėja. They can be of different nature: under pressure, stabbing, drilling and the like. The clinic depends on the localization of the hernia and root damage. About 95% of intervertebral disc herniation is L4 - L5 or L5 - S1 levels, ie, spinal flexibility, the highest places.

  There are big toe, foot tiesiančiųjų less muscle hypotrophy and weakness. Reduction in surface weakness L5 root innervation zone. Patellar and Achilles tendon reflexes are intact. The other objective symptoms include the buttock muscle relaxation, decay of the painful side of the buttock creases come down lower than the whole. It also highlights the thigh and calf muscle hypotonia, and later - hypotrophy. Sore leg visible and vegetative symptoms of foot coldness, cyanosis, sweating, heart failure and other hyperkeratosis. (Nervous Diseases, 1996).

  In the book "Back Pain" (Prof. Dr. med. Dr.H. HESA, 1998) says that there may be skin sensitivity problems - itching, numbness, muscle paralysis, or even signs. Such paralysis is characterized by human gait: a few, and cause deflection of the foot like a hang. Sometimes, when a full paralysis, severe pain in the legs pass. Often it is considered an improvement, successful treatment can begin at any irreparable paralysis effects. Particularly troublesome bladder and rectal disorders of weakened muscles. They are not only painful, but also shows that there was a large disc herniation, negrįžtančiu threat of paralysis. In these cases, urgent surgical intervention, the results of which will depend on the duration of paralysis.

  Spinal disc herniation diagnosis

  Computed tomography - non-invasive outpatient test, widely used in spinal disease diagnosis. Disc material twice more intense than CSF, and therefore the findings can be seen in hernia localization, size, potential sequestration spinal canal. CSF contrasted water-soluble iodine preparations, it is CT myelography. This study helps to highlight the root deployment.

  Perfect current diagnostic method of spinal pathology - Magnetic resonance imaging (MRI). MRI provides more accurate information about the soft tissue condition, far better to determine the lateral disc herniation, which helps diagnose spinal cord pathology. Myelography or Less applied research discographies.

  Improved diagnostics, reported that about 20-30% of people have intervertebral disc hernia, hernia but no specific clinical symptoms. This is largely determined by anatomical features of the spinal canal: a wide spinal canal, a small disc sequestration, and his situation. Therefore, the choice of tactics is an important clinical trial data and paraklinikinių correlation.

  Clinical Trials

  Important diagnostic clinical pain assessment. Patients should be carefully investigated clinical methods. Ščiupokos article "Back Pain" Clinical evaluation phases are distinguished:

  I - Clinical evaluation of low back pain;

  II - orthopedic spine research;

  III - clinical neurological spine study.

  Sensation of pain intensity in pain assessment scale. Back pain describe the nature of skausmažodžiai. Some of them related with the objective description nocicepsinio pain, others - with a feeling for the patient's pain behavior. It is important for the reflection and root pain. Reflex pain is nocicepsinės origin. It begins with sensory receptors on spinal tissue pain. This pain is felt at the fossil site of injury. Reflex pain is deeper and dull, its location is not defined. Nocicepsinį pain should be distinguished from the nerve endings noticeable - radicular pain. Šaknelinį causes pain along the axon acting stimulus, when the spinal cord mechanically deforms the counterfoil of intervertebral disc herniation. Šaknelinio pain location clearly defined. This is a sharp tingling pain.

  Orthopedic spine study evaluated the clinical anatomical areas: bone protrusions, spinal vertebrae, soft tissue, the walking, forced positions. If there is a lumbar motion segment pathology The affected leg kept going: it is towed, based on the inner or outer edge of the foot. Forced - It antalginės various postures. Often, potential pathological spinal deformity: absent spinal curves normal physiological or pathological occurred (scoliosis). Soft tissue measured palpation, special tests. This set of muscle trophic changes hiperalgezinės (trigger) areas, increased muscle tension. The assessment is active and passive movements of the spine.

  Spinal motion measurements of: 1) horizontal (rotated), 2) sagittal (flexion and construction), and 3) frontal (lateral flexion) planes.

  Clinical neurological spine study. It can determine the dorsal nerve and its branches infringement. Muscle strength measured by static and dynamic ways, dynamometry and special tests. Violation of L5-big toe and foot ends of the muscle (volatile heels) motor disorders. Stretching the symptoms - pain is a pathological reflex response in muscle tissue and fibroziniame related to the spinal motion segment pažeistuoju. In the sample, the patient feels pain in the organic site of injury or elsewhere. Often it is necessary to evaluate and painful spots, showing the dorsal branches of the nerve irritation.

  Superficial sensory analysis:

  The test brush and needle. According to sensory disorders can damage the localization:

  L5 - frontal and lateral leg, foot dorsal part of the great toe.

  Leg muscle strength assessment. Estimated static and dynamic conditions, dynamometry and special tests. Violation of L5 spinal cord segment, weak big toe and foot tiesiančiųjų muscle force (on the heels of volatility).

  If vertebralinis back pain is very strong and not suspected of any specific cause of pain, the patient's treatment leads to orthopedic and neurological spine studies. If a large biodynamic stereotype impairment (forced postures, movement, fixation of the spine configuration changes), in addition, there are neurological symptoms, suggesting that this is due to intervertebral disc herniation-induced spinal cord and dorsal nerve root compression. Then, the patient should be directed immediately neurologist or neurosurgeon counseling, perform radiological examinations - myelography, computerized spinal scan.

  Need to know the cause of pain, computed tomography and clinical findings. This would more effectively select and use tools and kineziterapines would get better treatment results.

  Thank you for reading

  With respect Bridget Zachovajevienė, physical therapist

  Tel. 8 ~ 698 ~ 75-901

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