37. Low back pain and intervertebral disc herniation

Question 1

What is spinal herniation?

Answer 1

Nucleus pulposus breaks through the anulus fibrosus of an intervertebral disc, leads to compression of the nerve roots. Mostly happens in lumbar region (L4-L5 and L5-S1), and posterolaterally

Question 2

Causes

Answer 2

Due to age-related degeneration of the anulus fibrosus

Trauma, lifting injuries, or straining

Question 3

Symptoms

Answer 3

Cervical - Pain in the neck, shoulders, and arms
Thoracic - Pain radiates into the chest
Lumbar - Pain extends into the buttocks, thighs, legs
Cauda Equina Syndrome occurs from a central disc herniation

Radicular pain, weak., numbness, reflex loss

Question 4

Diagnosis

Answer 4

Lasegue test, neurological exam., radicular pain area

X-ray, CT, MRI

Question 5

Treatment

Answer 5

Rest 1-2 days. Physical activity, physical therapy, chiropractor, NSAIDs, muscle relaxants, oral steroids, opiates, anti-depressants, epidural steroid injection, lumbar decompression surgery, microdiscectomy,

Question 6

Lower back pain

Answer 6

• Irritation of large nerve roots for the legs in the low back
• Irritation of smaller nerves that supply the low back
• Straining of thelarge paired lower back muscles (erector spinae)
• Damged bones, ligaments or joints
• Degeneration of an intervertebral disc