Common back problems
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Common back problems

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This is a presentation of the common lower back problems

This is a presentation of the common lower back problems

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  • 1. ORTHOPAEDIC DEPARTMENT ZAGAZIG UNIVERSITY FACULTY OF MEDICINE By Dr. Tarek A. ElHewala Lecturer of Orthopaedic Surgery Faculty of Medicine, Zagazig University
  • 2. Spinal Anatomy • The Human spine is formed of: 1. 7 cervical vertebrae. 2. 12 thoracic vertebrae. 3. 5 lumbar vertebrae. 4. Fused sacral and coccyx vertebrae.
  • 3. Spinal Anatomy • These bony structures articulate through the vertebral disc to provide: 1. Protection of the spinal cord and its nerve roots. 2. Mobility of the trunk.
  • 4. Spinal Anatomy • Schematic representation of a functional spinal unit (motion segment) in lumbar spine.
  • 5. Spinal Anatomy • Mid-sagittal section through a healthy young intervertebral disc. The white cartilage endplates, the gel-like nucleus pulposus and the surrounding anulus fibrosus can easily be distinguished.
  • 6. Spinal Anatomy The lumbar spinal canal anatomy and lumbar ligaments
  • 7. Spinal Anatomy Normal intervertebral foramen relations and contents.
  • 8. Lumbar Disc Herniation • Lumbar disc herniation is most frequently found in the 3rd and 4th decades of life at the level of L4/5 and L5/S1. • The cardinal symptom of lumbar disc herniation is radicular leg pain with or without a sensorimotor deficit of the affected nerve root.
  • 9. Lumbar Disc Herniation • The radiculopathy is not only caused by a mechanical compression of the nerve root but also by an inflammatory process caused by nucleus pulposus tissue
  • 10. Lumbar Disc Herniation • MRI is the imaging modality of choice for the diagnosis of disc herniation
  • 11. Lumbar Disc Herniation • In contrast to large disc extrusion and sequestrations, disc protrusions are frequently found in asymptomatic individuals
  • 12. Lumbar Disc Herniation • The best discriminator of symptomatic and asymptomatic disc herniation is nerve root compromise
  • 13. Lumbar Disc Herniation • Mild radiculopathy responds well to nonoperative treatment, but surgical treatment results in better short-term results in selected patients. • Severe radiculopathy responds poorly to nonoperative treatment and should be treated surgically. • The surgical treatment of choice is an open standard interlaminar discectomy or microsurgical discectomy.
  • 14. Lumbar Disc Herniation
  • 15. Lumbar Disc Herniation • Cauda Equina Syndrome caused by a central disc herniation. • Symptoms include bilateral leg pain, loss of perianal sensation, paralysis of the bladder, and weakness of the anal sphincter • Cauda equina syndromes require an emergency decompression and should be treated by complete laminectomy and wide decompression.
  • 16. Spinal Stenosis • Lumbar spinal stenosis can be defined as any narrowing of the spinal canal, lateral recess or intervertebral foramen.
  • 17. Spinal Stenosis
  • 18. Spinal Stenosis • Spinal stenosis most frequently results from degenerative alterations of the motion segment. • Lumbar spinal stenosis is a common condition in elderly patients. • Spinal stenosis is often associated with degenerative spondylolisthesis. • Degenerative spondylolisthesis most frequently occurs at the L4/5 level in females
  • 19. Spinal Stenosis
  • 20. Spinal Stenosis
  • 21. Spinal Stenosis
  • 22. Spinal Stenosis • The cardinal symptom of spinal stenosis is neurogenic claudication. • Neurologic examination of a patient often is remarkably normal. • The most important differential diagnosis is intermittent ischemic claudication.
  • 23. Spinal Stenosis
  • 24. Spinal Stenosis • MRI is the imaging modality of choice.
  • 25. Spinal Stenosis • Conservative treatment may only relieve symptoms for a short time period. • Conservative treatment does not affect the natural history of spinal canal narrowing.
  • 26. Spinal Stenosis • Surgery is generally accepted when the quality of life is substantially limited because of the neurogenic claudication. • Selective decompression (laminotomy) with preservation of the lamina is the preferred technique in the absence of segmental instability. • Instrumented fusion as an adjunct to laminectomy improves the long-term results in degenerative spondylolisthesis with spinal stenosis.
  • 27. Spinal Stenosis
  • 28. Lumbar Spondylo-Listhesis • The term spondylolisthesis comes from the Greek spondylo, meaning “vertebra,” and olisthesis, meaning “movement or slipping.” • Spondylolisthesis describes the pathologic state of one vertebra slipping on another; this can be forward (anterolisthesis) or backward (retrolisthesis).
  • 29. Lumbar Spondylo-Listhesis • Spondylolithesis: • Spondylo = Spine. • Lithesis = Dislocation. • Spondylolithesis of L4 on L5 • Retrolithesis of L5 on S1 29
  • 30. Lumbar Spondylo-Listhesis • Spondylolysis: • Spondylo = Spine. • Lysis = Disintegrate. •Pars Defect. • Spondylolysis of L5 • Spondylolysis of L5 with spondylolithesis of L5 on S1 30
  • 31. Lumbar Spondylo-Listhesis
  • 32. Lumbar Spondylo-Listhesis • Mechanical LBP may result from abnormal load distribution. • Discogenic, facet-joint and neurogenic, referred pain may coexist in spondylolisthesis.
  • 33. Lumbar Spondylo-Listhesis • Physical findings: – tight hamstrings – sensorimotor deficits – pain on backward bending and rotation (often facet joint pain) – pain on forward bending (often discogenic pain) – pain on extension from the forward bent position – limitation of walking distance
  • 34. Lumbar Spondylo-Listhesis
  • 35. Lumbar Spondylo-Listhesis
  • 36. Lumbar Spondylo-Listhesis
  • 37. Lumbar Spondylo-Listhesis
  • 38. Lumbar Spondylo-Listhesis
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