The document discusses the history and anatomy of lumbar disc disease. Key points include:
1) Aurelianus in the 5th century described symptoms of sciatica and Andreas Vesalius in 1543 first described the intervertebral disc.
2) Mixter and Barr in 1934 described disc herniation as the cause of sciatica.
3) The lumbar spine has intervertebral discs that can prolapse and press on nerve roots, commonly occurring posterolaterally at L4-L5 and L5-S1 levels.
Common Referred Pain Patterns – Low Back
Document by Luc Peeters, MSc.Ost. and Grégoire Lason, MSc.Ost.
Joint principals of the International Academy of Osteopathy (I.A.O.)
More information at www.osteopathy.eu
A Power Point Presentation on the Disease Rheumatoid Arthritis covering everything from explanation and history to causes, effects, treatments, diagnosis, and prognosis.
Percutaneous discectomy is a minimally invasive surgical procedure that treats contained, herniated discs. Specific procedures within the class include: manual percutaneous lumbar discectomy, Automated percutaneous lumbar discectomy (APLD) laser discectomy and nucleoplasty percutaneous intradiscal radiofrequency thermocoagulation is a procedure that allows the controlled delivery of heat to the intervertebral disc via an electrode or coil.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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3. HISTORY
Aurelianus (5th century) clearly described the
symptoms of SCIATICA.
Andreas Vesalius (1543) first described the
intervertebral disc.
Middleton & Teacher (1911) described a case of
paraplegia following attempting to lift heavy weight from
floor on postmortem they found fibrocartilage in extradural
space.
Elseberg (1928) described Chondromas derived from
disc of cervical region.
4. Stookey (1928) described cartilaginous
compression thought as chondromas
responsible for clinical prersentation.
Dandy (1929) reported removal of a disc
tumour or chondroma from patients with
sciatica.
Mixter and Barr (1934) described disc
herniation as the cause of Sciatica.
5. Peet& Echols (1934) referred to as Chondroma or
Ecchondrosis was really protrusion of intervertebral
disc.
Lindblom(1948) first described DISCOGRAPHY.
Lyman Smith (1963) described CHEMONUCLEOLYSIS.
Kambin & Gellman (1983) reported percutaneous
approach for lumbar discectomy.
24. LUMBAR DISC PROLAPSE
DEFINITION
It is condition in which there is
outpouching of the disc Nucleus pulposus
along with few annular fibres and end plate
cartilage through the tears in annulus fibrosus
into the extradural space.
25. EPIDEMIOLOGY
• AGE: 30 – 40 years
• SEX: Male affected more than female
• MOST COMMON LEVEL: L4-L5 (next common
level is L5-S1)
• MOST COMMON TYPE: Posterolateral type
29. EFFECT OF SMOKING
Blood vessel get
constricted
Transport of nutrients
& disposal of waste
products decreased
Disc cells get deficient
nutrition or die
Disc degenerates &
results in DISC
INSTABILITY
31. STAGES OF DISC DEGENERATION
Stage of dysfunction
Stage of instability
Stage of stabilization
32. STAGE OF DYSFUNCTION
Episode of rotational Posterior facet joint Small capsular &
or compressive trauma & annular strain annular tear occurs
Small subluxation
of posterior joint
Posterior joint
SYNOVITIS
Posterior segment muscle
protect joint by sustained
hypertonic contraction
33. STAGE OF INSTABILITY
FACET Degeneration Laxity of
JOINT of cartilage capsule
INCREASED
ABNORMAL
MOVEMENT
Loss of nucleus
DISC Coalescence Bulging of
internal
of tears annulus
disruption
34. STAGE OF STABILIZATION
Destruction Fibrosis in
FACET JOINT
of cartilage joint
INCREASED
STIFFNESS
DISC Loss of Fibrosis in disc
nucleus & osteophytes
STABILIZATION
36. PATHOPHYSIOLOGY OF LUMBAR
INTERVERTEBRAL DISC PROLAPSE
With aging, vascular channels start to fail and vascular diffusion
of nutrients decrease thus number of viable chondrocytes in the
nucleus pulposus diminishes
Synthesis rate & concentration of
proteoglycans decreases & proportion of
collagen increase in nucleus pulposus
Water binding capacity of the nucleus
decreases
Nucleus becomes more fibrous & stiffer
Nucleus is less able to bear & disburse load,
transferring load to the posterior annulus
37. Facet joints undergo
ANNULUS Facet joints share degenerative
IN TACT even more of the changes & develop
axial load osteophytes
FACET JOINT
SYNDROME
40. Extruded disc &
degraded nuclear
material impinge on
the nerve roots
Nucleus pulposus is an
immunogenic which
induce an inflammatory
response
Produces radicular
pain syndrome &
RADICULOPATHY
69. KEY DIAGNOSTIC POINTS
LUMBAR DISC PROLAPSE
Leg pain greater than back pain
Neurological deficit present
ANNULAR TEARS
Back pain greater than leg pain
Bilateral SLRT positive
FACET JOINT ARTHROPATHY
Localized tenderness present unilaterally over joint
Pain occurs immediately on spinal extension
Pain exacerbated with ipsilateral side bending
70. SPINAL STENOSIS
Back and/or leg pain develops after walks a limited distance.
Flexion relieves symptoms
No neurological deficit
Pain not reproduced on SLRT
MYOGENIC OR MUSCLE RELATED
Pain localised to affected muscle
Pain increases on prolonged muscle use
Pain reproduced with sustained muscle contraction against
resistance
Contralateral pain with side bending
71. INVESTIGATION
THE CORNERSTONE OF DIAGNOSIS OF
LUMBAR DISC DISEASE IS THE HISTORY AND
PHYSICAL EXAMINATION NOT THE
INVESTIGTION.
78. DISADVANTAGE OF MYELOGRAPHY
• Myelographyis capable of showing the level
at which the pathology lies but fails to show
the nature of the lesion or its precise location
in the anatomic segment .
80. USES OF DISCOGRAPHY
• To evaluate equivocal abnormality seen on myelography, CT
or MRI
• To isolate a symptomatic disc among multiple level
abnormality
• To diagnose a lateral disc herniation
• To establish contained discogenic pain
• To select fusion levels
• To evaluate the previously operated spine
81. CT DISCOGRAPHY
USES
• To determine whether the disc herniation is
contained, protruded, extruded or
sequestrated.
• To evaluate previously operated lumbar spine
to distinguish between mass effect from scar
tissue or disc material.
82. COMPUTED TOMOGRAPHY
ADVANTAGES
• CT is an extremely useful, highly accurate & noninvasive tool in
the evaluation of spinal disease.
• CT provides superior imaging of cortical and trabecular bone
compared with MRI.
• It provides contrast resolution and identify root compressive
lesions such as disc herniation.
• It also helps to differentiate between bony osteophyte from
soft disc.
• It helps to diagnose foraminal encroachment of disc material
due to its ability to visualize beyond the limits of the dural sac
and root sleeves.
83. LIMITATIONS
• It cannot differentiate between scar tissue
and new disc herniation
• It does not have sufficient soft tissue
resolution to allow differentiation between
annulus and nucleus.
84. MAGNETIC RESONANCE IMAGING
• It allows direct visualization of herniated disc
material and its relationship to neural tissue
including intrathecal contents.
98. CONTRAST ENCHANCED MRI
• Here GADOLINIUM labeled
diethylenetriaminepentaacetate (Gd-DTPA)
administered intravenously and MRI scan
done.
ADVANTAGES
• Display the inflammatory reaction critical to
the pathophysiology of radicular pain or
radiculopathy
• Allows discrimination of scar from recurrent
disc.
99. OTHER DIAGNOSTIC TESTS
• ELECTROMYOGRAPHY – to rule out peripheral
neuropathy.
• SOMATOSENSORY EVOKED POTENTIALS
(SSEP) – to identify the level of root
involvement
• POSITRON EMISSION TOMOGRAPHY
101. CONSERVATIVE
Majority of disc prolapse respond well to
conservative therapy. Resolution of first disc
prolapse takes place approximately 75% of
patients over a period of 3 months.
104. EXERCISES
GENERAL RULES FOR EXERCISE
• Do each exercise slowly. Hold the exercise position for a slow
count of five.
• Start with five repetitions and work up to ten. Relax
completely between each repetition.
• Do the exercises for 10 minutes twice a day.
• Care should be taken when doing exercises that are painful. A
little pain when exercising is not necessarily bad. If pain is
more or referred to the legs the patient may have overdone
it.
• Do the exercises every day without fail.
113. CHEMONUCLEOLYSIS
Chymopapain Degrades the Water holding
injected into the proteoglycans in the capacity of the disc
disc nucleus is decreased
Shrinkage of the
disc
115. SURGERY
GOAL
To relive neural compression and
henceradiculopathy while minimizing
complications.
116. INDICATIONS
ABSOLUTE
• Bladder and bowel involvement: The cauda equine syndrome
• Increasing neurological deficit
RELATIVE
• Failure of conservative treatment
• Recurrent sciatica
• Significant neurological deficit with significant SLR reduction
• Disc rupture into a stenotic canal
• Recurrent neurological deficit
117. CONTRAINDICATIONS FOR
SURGERY
• Wrong patient ( poor potency for recovery)
• Wrong diagnosis
• Wrong level
• Painless HNP (do not operate for primary complaint
of weakness or paresthesia, in the absence of pain)
• Inexperienced surgeon applying poor technical skills
• Lack of adequate instruments
123. COMPLICATIONS OF
LAMINECTOMY AND DISCECTOMY
• Infection – Superficial wound infection , Deep disc space
infection
• Thrombophlebitis/ Deep vein thrombosis
• Pulmonary embolism
• Dural tears may result in Pseudomeningocoele, CSF leak,
Meningitis
• Postoperative cauda equine lesions
• Neurological damage or nerve root injury
• Urinary retention and urinary tract infection
124. FAILED BACK SYNDROME
It is a condition characterized by persistent
postoperative backache and sciatica.
VERY COMMON CAUSES
• Recurrent/ Persistent disc material at operated site
• Herniated Nucleus Pulposus at other site
• Epidural scar / Fibrosis
• Facet arthrosis / Spinal stenosis
125. COMMON CAUSES – Neuritis, Referred pain from
nonspinous site
UNCOMMON CAUSES
• Discitis / Osteomyelitis/ Epidural abscess
• Arachnoiditis
• Conus tumour
• Thoracic, High lumbar Herniated Nucleus Pulposus
• Epidural haematoma
126. The recurrence of pain after disc surgery
should be treated with all available
conservative treatment modalities initially.
The surgery should be tailored to the
anatomic problem only.
134. Patient not suitable for artificial disc
replacement are
• Osteoporosis
• Spondylolisthesis
• Infection or tumour of spine
• Spine deformities from trauma
• Facet arthrosis
138. INTRADISCAL ELECTROTHERMAL
THERAPY
• It is a new minimally invasive technique done
as an outpatient procedure.
• Done in patients with low back pain caused by
tears in the outer wall of the intervertebral
disc.
139. PROGNOSIS
• Extruded disc, Large herniations,
Sequestrations have a greater tendency to
resolution than small herniations& disc
bulges.
• Recurrence of disc prolapse can be prevented
by a proper exercise programme and
avoidance of stress to the lower part of back.
140. REFERENCES
• MACNAB’S BACKACHE by DavidA.Wong 4th edition
• THE LUMBAR SPINE by Sam W Wiesel 2nd edition
• MANAGING LOW BACK PAIN by W.H.Kirkildy – Willis 3rd
edition
• ORTHOPAEDIC PHYSICAL ASSESSMENT by David Magee 5th
edition
• ORTHOPAEDIC PRINCIPLE AND THEIR APPLICATION by TUREK
4TH Edition
• CAMPBELL’S OPERATIVE ORTHOPAEDICS 11TH EDITION
• INTERNET
141. “LEARN TO BE
GOOD TO
YOUR BACK
AND YOUR
BACK WILL BE
GOOD TO
YOU….”