tailieunhanh - Chapter 016. Back and Neck Pain (Part 7)

MRI of lumbar herniated disk; left S1 radiculopathy. Sagittal T1weighted image on the left with arrows outlining disk margins. Sagittal T2 image on the right reveals a protruding disk at the L5-S1 level (arrows), which displaces the central thecal sac. The mechanism by which intervertebral disk injury causes back pain is controversial. The inner annulus fibrosus and nucleus pulposus are normally devoid of innervation. Inflammation and production of proinflammatory cytokines within the protruding or ruptured disk may trigger or perpetuate back pain. Ingrowth of nociceptive (pain) nerve fibers into inner portions of a diseased disk may be responsible for chronic. | Chapter 016. Back and Neck Pain Part 7 MRI of lumbar herniated disk left S1 radiculopathy. Sagittal T1-weighted image on the left with arrows outlining disk margins. Sagittal T2 image on the right reveals a protruding disk at the L5-S1 level arrows which displaces the central thecal sac. The mechanism by which intervertebral disk injury causes back pain is controversial. The inner annulus fibrosus and nucleus pulposus are normally devoid of innervation. Inflammation and production of proinflammatory cytokines within the protruding or ruptured disk may trigger or perpetuate back pain. Ingrowth of nociceptive pain nerve fibers into inner portions of a diseased disk may be responsible for chronic diskogenic pain. Nerve root injury radiculopathy from disk herniation may be due to compression inflammation or both pathologically demyelination and axonal loss are usually present. Symptoms of a ruptured disk include back pain abnormal posture limitation of spine motion particularly flexion or radicular pain. A dermatomal pattern of sensory loss or a reduced or absent deep tendon reflex is more suggestive of a specific root lesion than is the pattern of pain. Motor findings focal weakness muscle atrophy or fasciculations occur less frequently than focal sensory or reflex changes. Symptoms and signs are usually unilateral but bilateral involvement does occur with large central disk herniations that compress multiple descending nerve roots within the spinal canal. Clinical manifestations of specific nerve root lesions are summarized in Table 16-2. There is suggestive evidence that lumbar disk herniation with a nonprogressive nerve root deficit can be managed nonsurgically. The size of the disk protrusion may naturally decrease over time. The differential diagnosis covers a variety of serious and treatable conditions including epidural abscess hematoma or tumor. Fever constant pain uninfluenced by position sphincter abnormalities or signs of spinal cord disease suggest an .