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Lumbar Disk Herniation

Lumbar Disc Protrusion


Presentation

  • The classical presentation of CES is not obvious. Even if surgery is performed late due to delayed presentation, significant improvement in neurologic and bladder function can still be expected. Copyright 2014, SLACK Incorporated.[ncbi.nlm.nih.gov]
  • Leg pain continues to be the primary presenting symptom in this group of patients and is often not recognized as the radicular pain of a herniated disk by the primary care physician.[ncbi.nlm.nih.gov]
  • The numbness of the leg, present in 448 patients preoperatively, was either no longer present (63.9%) or had improved (30.3%). There were no serious complications, in particular no infections. The recurrence rate was 3.6%.[ncbi.nlm.nih.gov]
  • A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms.[nejm.org]
  • Presentation of a case of simultaneous lumbar disk herniation and epidural hematoma. An 85-year old patient with symptoms of compression of one or more nerve roots was examined with CT of the 3 lower lumbar intervertebral spaces.[ncbi.nlm.nih.gov]
Lower Extremity Pain
  • Review Ohnmeiss DD, Vanharanta H, Ekholm J:Degree of disc disruption and lower extremity pain. Spine. 1997 Jul 15;2214:1600-5. 8.Spencer DL: The anatomical basis of sciatica secondary to herniated lumbar disc: a review.[hss.edu]
Intermittent Claudication
  • A case of a lumbar epidural hematoma with 10-15 minutes of intermittent claudication was described. There was no history of major trauma or coagulation disorders.[ncbi.nlm.nih.gov]
Constipation
  • Constipation is a common side-effect from codeine. This may make back pain worse if you need to strain to go to the toilet. To prevent constipation, have lots to drink and eat foods with plenty of fibre.[patient.info]
  • Side effects include sedation, nausea, and constipation. Epidural steroid medication (injected into the space just outside of the sac of spinal fluid), reduces swelling, inflammation, and pain.[innerbody.com]
  • Side effects include nausea, sedation, confusion, and constipation. Cortisone injections: These can be injected directly into the area of the herniation to help reduce inflammation and pain.[medicalnewstoday.com]
  • However, you want to take only the medication you need because taking more doesn't help you recover faster, might cause unwanted side effects (such as constipation and drowsiness) and can result in dependency.[spine.org]
Fecal Incontinence
  • If the anal sphincter is not working, fecal incontinence may occur. This means the patient loses the ability to control the passage of stool from the bowels. If the urethral sphincter is not working properly, urine leaks from the bladder.[livestrong.com]
Back Pain
  • CLINICAL FEATURES: A 23-year-old woman suffered from chronic unremitting symptoms of lower back pain and left-leg pain. She was treated five years prior, without relief. Diagnosis at that time was low-back pain and lumbar subluxation.[ncbi.nlm.nih.gov]
  • The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity.[ncbi.nlm.nih.gov]
  • Patients treated with tubular diskectomy reported more leg pain and low-back pain, although the differences were small and not clinically relevant.[ncbi.nlm.nih.gov]
  • A greater amount of the total improvement in leg pain and back pain in older adults was noted in the first month of follow-up than in younger adults.[ncbi.nlm.nih.gov]
  • “Red flags” for potentially serious underlying causes of low back pain. Adapted from ACR Appropriateness Criteria: Low Back Pain. 3 Figure 3. “Red flags” for potentially serious underlying causes of low back pain.[jaoa.org]
Low Back Pain
  • Further study is warranted into the treatment of chronic low-back pain with chiropractic biophysics methods.[ncbi.nlm.nih.gov]
  • The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity.[ncbi.nlm.nih.gov]
  • Patients treated with tubular diskectomy reported more leg pain and low-back pain, although the differences were small and not clinically relevant.[ncbi.nlm.nih.gov]
  • “Red flags” for potentially serious underlying causes of low back pain. Adapted from ACR Appropriateness Criteria: Low Back Pain. 3 Figure 3. “Red flags” for potentially serious underlying causes of low back pain.[jaoa.org]
  • Lumbar disk herniation (LDH) with discogenic low back pain and sciatica is a common and complicated musculoskeletal disorder. The underlying mechanisms are poorly understood, and there are no effective therapies for LDH-induced pain.[ncbi.nlm.nih.gov]
Spine Pain
  • Low back pain and/or leg pain (sciatica) are the most common symptoms of a herniated disc in the lumbar (lower) spine. Pain may vary from mild to severe.[treatingpain.com]
  • : Pain moving your neck Deep pain near or over your shoulder blade Radiating pain in your upper arm, forearm, and possibly your fingers Pain from a bulging disc may start slowly and get worse over time or during certain activities.[depuysynthes.com]
  • : Pain moving your neck Deep pain near or over your shoulder blade Radiating pain in your upper arm, forearm, and possibly your fingers Pain from a herniated disc may start slowly and get worse over time or during certain activities.[depuysynthes.com]
  • See separate leaflet called Back and Spine Pain for a general overview of the different types of back pain .) The most common age to develop a prolapsed disc is between 30 and 50 years. Twice as many men as women are affected.[patient.info]
Acute Low Back Pain
  • How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med . 1986;315:1064–70. 17. Malmivaara A, Hakkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, et al.[aafp.org]
  • DC, PT: Comparison of Classification-Based Physical Therapy With Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back Pain: A Randomized Clinical Trial. Spine. 2813:1363-1371, July 1, 2003.[hss.edu]
Sciatica
  • Main outcome measures were scores from Roland-Morris Disability Questionnaire for Sciatica, Visual Analog Scale for leg pain and low-back pain, and Likert self-rating scale of global perceived recovery.[ncbi.nlm.nih.gov]
  • Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status.[ncbi.nlm.nih.gov]
  • Lumbar disk herniation (LDH) with discogenic low back pain and sciatica is a common and complicated musculoskeletal disorder. The underlying mechanisms are poorly understood, and there are no effective therapies for LDH-induced pain.[ncbi.nlm.nih.gov]
  • Our data clears that sciatica can be caused by contralateral lumbar disk herniation. When operation is considered, intervention only from the herniation side is sufficient.[ncbi.nlm.nih.gov]
  • SUMMARY OF BACKGROUND DATA: Lumbar disk herniation (LDH) is a major cause of low back pain and sciatica. Various vascular risk factors such as obesity, diabetes mellitus, and smoking have been reported to be associated with LDH.[ncbi.nlm.nih.gov]
Foot Drop
  • Foot drop is defined as inability to dorsiflex the foot at the ankle joint.[ncbi.nlm.nih.gov]
  • Weakness in the foot is especially common, with difficulty lifting the foot (known as foot drop) often reported in those with L4/L5 herniation.[sportsinjuryclinic.net]
  • This may cause numbness or pins and needles in the leg and be associated with weakness such as “foot drop” (difficulty lifting the toes and foot up) or weakness when pushing off with the foot.[spinal-foundation.org]
  • […] w/ or w/o surgery; - of all patients who sustain acute sciatica, less than 25% will require surgery; - despite the generally good prognosis, some patients will not recover such as this patient who had chronic anterior compartment atrophy and a mild foot[wheelessonline.com]
Paresthesia
  • A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms.[nejm.org]
  • CLINICAL FEATURES: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg.[ncbi.nlm.nih.gov]
  • His history was significant only for a spontaneous onset of lumbar back pain noted immediately after awkward bending six months prior, followed two to three days later by severe leg pain, paresthesias and ankle weakness, consistent with an L5 radiculopathy[cmaj.ca]
  • Tingling and numbness in the buttock or leg (paresthesias). Weakness in one or both legs.[innerbody.com]
Myelopathy
  • Lumbar disc degeneration with neurological symptom Lumbar disc disorder with myelopathy Lumbar disc herniation with myelopathy Lumbar disc prolapse with myelopathy Lumbar disc prolapse with radiculopathy Neurologic disorder due to degeneration of lumbar[icd10data.com]
  • […] disc disorder Myelopathy due to spinal cord compression Prolapsed intervertebral disc without myelopathy Schmorl's nodes Schmorls nodes Thoracic disc disorder ICD-10-CM M51.9 is grouped within Diagnostic Related Group(s) (MS-DRG v 36.0): 551 Medical[icd10data.com]
  • My concern with this is the actual description of the code - Intervertebral disc disorders with myelopathy, lumbar region.[aapc.com]
Neuralgia
  • […] non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Disorder (of) - see also Disease disc (intervertebral) M51.9 Neuritis (rheumatoid) M79.2 ICD-10-CM Diagnosis Code M79.2 Neuralgia[icd10data.com]
  • Community Wiki Code: M54.16 Code Name: ICD-10 Code for Radiculopathy, lumbar region Block: Other dorsopathies (M50-M54) Excludes 1: current injury - see injury of spine by body region discitis NOS (M46.4-) Details: Radiculopathy, lumbar region Excludes1: neuralgia[aapc.com]

Treatment

  • In group A, treatment was a success (excellent or good outcome) in 70.3% and deemed a failure (poor outcome or recourse to surgery) in the remaining 29.7%. In group B, treatment was a success in 78.3% and deemed a failure in the remaining 21.7%.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To compare the treatment effects of diskectomy and usual care.[ncbi.nlm.nih.gov]
  • INTERVENTIONS: Standard open diskectomy vs nonoperative treatment individualized to the patient.[ncbi.nlm.nih.gov]
  • INTERVENTION: Nonsurgical treatment customized for the individual patient.[ncbi.nlm.nih.gov]
  • BACKGROUND: There is a paucity of evidence demonstrating clinical outcomes of high-end athletes sustaining a treatment for lumbar disk herniation.[ncbi.nlm.nih.gov]

Prognosis

  • In patients with chronic or recurrent disk herniation, the prognosis for recovery from pain or dysfunction is often poor.[ncbi.nlm.nih.gov]
  • […] treated surgically have superior outcomes to those treated nonoperatively, because of the limitations with the methodology used in this study, further prospective studies are necessary to accurately compare treatment effects and to determine the long-term prognosis[ncbi.nlm.nih.gov]
  • […] symptoms of: Back pain that spreads down the front of the leg into the knee You may have weakness when flexing at the hip or extending the knee Feeling may be decreased or reduced over the front of the thigh and the inside part of the calf Treatment and Prognosis[pagelaw.com]
  • : used to diagnose L5 and S1 radiculopathy; - femoral stretch test: used to diagnose L4 radiculopathy; - this test is performed by raising the leg while the patient is prone; - wt relief flexion test: - MRI of Disc Herniation : - Natural History: - prognosis[wheelessonline.com]
  • Prognosis The natural history of disk herniation is difficult to determine because most persons receive some form of treatment for their back pain, and there is not always a formal diagnosis. 6 Clinical improvement is usual in most persons, and only about[aafp.org]

Etiology

  • Abstract The authors have retrospectively studied the trends in etiology, symptoms, and rate of recurrence for adolescents with disk herniations to determine the age at onset of symptoms, mechanism of injury, familial history, pattern of symptoms, level[ncbi.nlm.nih.gov]
  • […] of age 5 with a male-to-female ratio of 2:1. 6 In persons 25 to 55 years of age, about 95 percent of herniated disks occur at the lower lumbar spine (L4–5 level); disk herniation above this level is more common in persons older than 55 years. 7 , 8 Etiology[aafp.org]
  • Potential Etiologies Lumbar disc herniations can occur as a result of direct trauma or gradual degeneration over time.[morphopedics.wikidot.com]
  • One study 5 reported a strong familial predisposition to discogenic low back pain and suggested that the etiology of degenerative disc disease includes both genetic and environmental factors.[aafp.org]

Epidemiology

  • It is important for both patients and spine surgeons to understand epidemiology trends and outcomes of revision surgery for real recurrent lumbar disk herniation (real-RLDH).[ncbi.nlm.nih.gov]
  • Epidemiology of spinal disorders. In: Frymoyer JW, Ducker TB, Hadler NM, et al., eds. The adult spine: principles and practice. New York: Raven Press, 1997:93–141. 5. Heliovaara M. Epidemiology of sciatica and herniated lumbar intervertebral disk.[aafp.org]
  • Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg AM. 2006;88(2):3-9. Institute for Quality and Efficiency in Health Care (IQWiG). Slipped disk: overview. 2014; n.pag.[paindoctor.com]
  • An epidemiologic study with special reference to driving automobiles and cigarette smoking. Spine. 1984, 9: 608-13. 10.1097/00007632-198409000-00012.[bmcmusculoskeletdisord.biomedcentral.com]
  • An epidemiologic and immunogenetic study. Spine . 1988;13:1403–6. 6. Bigos SJ. Acute low back problems in adults. Rockville, Md.: U.S.[aafp.org]
Sex distribution
Age distribution

Pathophysiology

  • Abstract To better understand the pathophysiologic mechanisms underlying spinal nerve root injury induced by lumbar disk herniation (LDH), comparative proteomic analysis of cerebrospinal fluid (CSF) between patients with LDH (the experiment group) and[ncbi.nlm.nih.gov]
  • We discuss here the pathophysiology of this unusual case and point out how medieval practices for treating sciatica-like pain are not only unjustified from a medical viewpoint but also potentially dangerous. Copyright 2016 Elsevier Inc.[ncbi.nlm.nih.gov]
  • CONCLUSION: DWI is a potential tool for analysis of the pathophysiology of lumbar nerve roots compressed by herniated disks.[ncbi.nlm.nih.gov]

Prevention

  • It is essential to pay careful attention to prevent a dural tear. Patients may expect clinical outcomes similar to those following primary discectomy.[ncbi.nlm.nih.gov]
  • INTERVENTION AND OUTCOME: Initial treatment of this patient included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy.[ncbi.nlm.nih.gov]
  • Can lumbar disk disease be prevented? Maintaining a healthy weight, participating in regular exercise, and using good posture can lessen your risk for lumbar disk disease.[hopkinsmedicine.org]

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