Dr. Ebraheim’s educational animated video describing disc herniation of the lumbo sacral spine, the etiology, signs and symptoms, diagnosis , and treatment options.
Check my new book, Synopsis of Orthopedic Emergencies on amazon. Here is the link.
[ Ссылка ]
The spine is comprised of bony vertebrae separated by discs.
Spinal cord ends at level of T12-L1. Conus Medullaris is the lower end of the spinal cord. Cauda Equina is a division of multiple nerve roots beginning at the level of L1.
Conditions of the lumbar spine including disc herniation are a main cause of low back pain.
The lumbar spine (lower back) consists of five vertebrae numbered L1 to L5. These vertebrae are attached to the sacrum at the lower end of the spine. The discs between the vertebrae are round cushioning pads which act as shock absorbers. Inner disc layer is soft gelatinous tissue (Nucleus Pulposus). Outer disc layer is thick and strong tissue (Annulus Fibrosus).
A disc herniation of the lumbosacral region could involve the nerve roots. In 95% of all disc herniation cases, the L4-L5 or L5-S1 disc levels are involved. Herniation of the L4-L5 disc will affect the L5 nerve root. herniation of the L5-S1 disc will affect the S1 nerve root.
Types of disc herniation include:
1-Protruision/Bulge: a bulging disc with intact annular and posterior longitudinal ligament fibers.
2-Disc herniation:
Type A
•Disruption of inner annular fibers with intact outer annular fibers.
Type B
•Disrupted annulas with tail of disc material extending into the disc space.
3-Sequestration
•Free fragment without tail extending into disc space.
•Fragment may be reabsorbed spontaneously.
Typical locations of disc herniation
Central
•Involves multiple nerve roots.
•Predominantly cause low back pain more than leg pain
•May cause incontinence of the bladder and bowel.
•Urgent surgical treatment if patients present with neurological deficits.
Posterolateral
•Usual location, most commonly involving one nerve root (the lower one).
•Example: L4-L5 posterolateral herniation will involve L5 nerve root.
Foraminal
•Occurs in 8-10% of the cases
•Involving the exiting nerve.
•Example: L4-L5 foraminal herniation will involve L4 nerve root.
Discogenic back pain internal disc disruption
•Early disc degeneration.
•Pain worsens with flexion/sitting.
•Slightly better with extension.
•Forward flexion limited on exam.
•No radicular symptoms.
