Kodi Degenerative Disc Disease (DDD) ndi chiyani?: Chidule

by Dr Alex Jimenez | Ululu Wabwerere, Chiropractic, Kupweteka Kwambiri Kwambiri, aakulu Chisoni, Health, Herniated Disc, Ululu Wakumananso, khosi Chisoni, Sciatica, Sciatica Nerve Pain, Scoliosis, Ukhondo wa msana, Care Care, Kuchiza, Ubwino

Degenerative Disc Disease ndi liwu lodziwika bwino la chikhalidwe chomwe chowonongeka cha intervertebral disc chimayambitsa ululu wosaneneka, womwe ukhoza kukhala kupweteka kwa msana mu lumbar msana kapena kupweteka kwa khosi mumsana. Si "matenda" payekha, koma kwenikweni kuwonongeka kwa intervertebral disc ya msana. The intervertebral disc ndi kapangidwe kamene kamakhala ndi chidwi kwambiri posachedwapa, chifukwa cha zotsatira zake zachipatala. Kusintha kwa pathological komwe kungachitike pakuwonongeka kwa disc kumaphatikizapo fibrosis, kuchepera, ndi disc desiccation. Zowonongeka zosiyanasiyana za anatomical zimathanso kuchitika mu intervertebral disc monga sclerosis ya endplates, fissuring ndi mucinous degeneration of annulus, ndi mapangidwe a osteophytes.

Kupweteka kwapang'onopang'ono ndi kupweteka kwa khosi ndizovuta zazikulu za epidemiological, zomwe zimaganiziridwa kuti zikugwirizana ndi kusintha kosinthika mu diski. Ululu wammbuyo ndi chifukwa chachiwiri chomwe chimayambitsa ulendo wopita kuchipatala ku USA. Akuti pafupifupi 80% ya akuluakulu aku US amavutika ndi ululu wammbuyo kamodzi kamodzi pa moyo wawo. (Modic, Michael T., ndi Jeffrey S. Ross) Choncho, kumvetsetsa bwino za matenda osachiritsika a disk ndikofunikira kuti athe kuthana ndi vutoli.

Anatomy of Related Structures

Anatomy of the Spine

Msana ndiye dongosolo lalikulu, lomwe limasunga kaimidwe ndikuyambitsa mavuto osiyanasiyana ndi njira za matenda. Msanawu umapangidwa ndi vertebrae zisanu ndi ziwiri za khomo lachiberekero, khumi ndi awiri a thoracic vertebrae, asanu a lumbar vertebrae, ndi osakanikirana sacral ndi coccygeal vertebrae. Kukhazikika kwa msana kumasungidwa ndi mizati itatu.

Mzere wapambuyo umapangidwa ndi anterior longitudinal ligament ndi gawo lakumbuyo la vertebral body. Mzere wapakati umapangidwa ndi gawo lakumbuyo la thupi la vertebral ndi posterior longitudinal ligament. Mzere wam'mbuyo uli ndi thupi lakumbuyo lomwe lili ndi njira zodutsa, laminae, mbali, ndi njira zozungulira. (Matenda a Degenerative Disk: Background, Anatomy, Pathophysiology)

Anatomy ya Intervertebral Disc

Intervertebral disc ili pakati pa matupi awiri oyandikana amtundu wa vertebral. Pafupifupi gawo limodzi mwa magawo atatu a kutalika kwa msana wa msana umapangidwa ndi intervertebral discs. Chimbale ichi chimapanga mgwirizano wa fibrocartilaginous, wotchedwanso symphysis joint. Zimalola kuyenda pang'ono kwa vertebrae ndikugwirizanitsa vertebrae pamodzi. Intervertebral disc imadziwika ndi kukana kwake komanso kukana kukanikiza. Diski ya intervertebral imapangidwa makamaka ndi magawo atatu; mkati mwa gelatinous nucleus pulposus, outer annulus fibrosus, ndi cartilage endplates zomwe zimakhala zapamwamba komanso zotsika pamtunda wa matupi a vertebral.

Nucleus pulposus ndi gawo lamkati la gelatinous. Amakhala ndi proteoglycan ndi gel wamadzi wolumikizidwa pamodzi ndi mtundu II Collagen ndi ulusi wa elastin wokonzedwa momasuka komanso mosakhazikika. Aggrecan ndiye proteoglycan yayikulu yomwe imapezeka mu nucleus pulposus. Amakhala pafupifupi 70% ya nucleus pulposus ndi pafupifupi 25% ya annulus fibrosus. Ikhoza kusunga madzi ndikupereka mphamvu za osmotic, zomwe zimafunika kuti zithetse kuponderezedwa ndikuchita ngati chododometsa. Kuchuluka kwa aggrecan mu diski yodziwika bwino kumapangitsa kuti minofu ikhale yothandizira kuponderezana popanda kugwa ndipo katunduyo amagawidwa mofanana kwa annulus fibrosus ndi thupi la vertebral panthawi ya kayendetsedwe ka msana. (Wheater, Paul R, et al.)

Mbali yakunja imatchedwa annulus fibrosus, yomwe ili ndi ulusi wambiri wamtundu wa I collagen wokonzedwa ngati wosanjikiza wozungulira. Ulusi wa collagen umayenda mozungulira pakati pa lamellae ya annulus m'njira zosinthika ndikupangitsa kuti chitha kukana kulimba. Mitsempha yozungulira imalimbitsa annulus fibrosus mozungulira. Kumbali yakutsogolo, ligament yokhuthala imalimbitsanso annulus fibrosus ndipo ligament yocheperako imalimbitsa mbali yakumbuyo. (Choi, Yong-Soo)

Kawirikawiri, pamakhala chimbale chimodzi pakati pa vertebrae iliyonse kupatula pakati pa ma atlas ndi axis, omwe ali oyambirira ndi achiwiri a vertebrae m'thupi. Ma disks awa amatha kusuntha pafupifupi 6? m'magulu onse oyendayenda ndi kuzungulira mozungulira mbali iliyonse. Koma ufulu woyenda uwu umasiyana pakati pa magawo osiyanasiyana a vertebral column. Mitsempha ya khomo lachiberekero imakhala ndi kayendetsedwe kake kake kwambiri chifukwa ma intervertebral discs ndi aakulu ndipo pali malo otsetsereka otsika komanso otukuka pamwamba pa thupi la vertebral. Amakhalanso ndi zolumikizira zopingasa. Mitsempha ya thoracic imakhala ndi maulendo ocheperako pang'onopang'ono, kutambasula, ndi kusinthasintha, koma imakhala ndi maulendo omasuka a lateral pamene amamangiriridwa ku nthiti. Mitsempha ya m'mimba imakhala yabwino komanso yowonjezera, chifukwa ma discs awo a intervertebral ndi aakulu ndipo njira za spinous zimakhala pambuyo pake. Komabe, lateral lumbar rotation ndi yochepa chifukwa mbali zigawo zili sagittally. (Matenda a Degenerative Disk: Background, Anatomy, Pathophysiology)

Kupereka Magazi

The intervertebral disc ndi imodzi mwazinthu zazikulu kwambiri zam'mimba zomwe zimakhala ndi ma capillaries omwe amatha kumapeto. Minofu imatenga zakudya kuchokera ku ziwiya za subchondral fupa lomwe lili moyandikana ndi hyaline cartilage pamapeto pake. Zakudya izi monga mpweya ndi shuga zimatengedwa kupita ku intervertebral disc kupyolera mu kufalikira kosavuta. (�Intervertebral Disc� Spine� Orthobullets.Com�)

Kupereka Mitsempha

Kukhazikika kwamphamvu kwa intervertebral discs ndizovuta ndipo zimasiyana malinga ndi malo omwe ali mumsana wa msana. Kupatsirana kwamphamvu kumaganiziridwa kuti kumalumikizidwa ndi zinthu P, calcitonin, VIP, ndi CPON. Sinu vertebral mitsempha, yomwe imachokera ku dorsal root ganglion, innervates ulusi wapamwamba wa annulus. Ulusi wa minyewa supitilira ulusi wapamtunda.

Ma lumbar intervertebral discs amaperekedwanso ku posterolateral mbali ndi nthambi zochokera ku ventral primary rami komanso kuchokera ku gray rami communicantes pafupi ndi mphambano yawo ndi ventral primary rami. Mbali zam'mbali za ma discs zimaperekedwa ndi nthambi zochokera ku rami communicantes. Ena mwa ma rami communicantes amatha kuwoloka ma intervertebral discs ndikulowa mu minofu yolumikizana, yomwe imakhala mozama ku chiyambi cha psoas. (Palmgren, Tove, et al.)

Ma cervical intervertebral discs amaperekedwanso kumbali ya lateral ndi nthambi za mitsempha ya vertebral. Mitsempha ya khomo lachiberekero la sinu vertebral inapezekanso kuti ili ndi njira yopita kumtunda mumtsinje wa vertebral womwe umapereka diski pamalo awo olowera ndi omwe ali pamwambapa. (BOGDUK, NIKOLAI, et al.)

Pathophysiology ya Degenerative Disc Disease

Pafupifupi 25% ya anthu asanakwanitse zaka 40 amasonyeza kusintha kwa disc degenerative pamlingo wina. Zaka zoposa 40, umboni wa MRI umasonyeza kusintha kwa anthu oposa 60%. (Suthar, Pokhraj) Choncho, n'kofunika kuphunzira njira yowonongeka ya intervertebral discs popeza yapezeka kuti iwonongeke mofulumira kuposa minofu ina iliyonse yokhudzana ndi thupi, zomwe zimayambitsa kupweteka kwa msana ndi khosi. Kusintha kwa ma intervertebral discs atatu kumalumikizidwa ndi kusintha kwa thupi la vertebral ndi mafupa omwe akuwonetsa njira yopita patsogolo komanso yamphamvu.

Njira yowonongeka ya intervertebral discs yagawidwa m'magawo atatu, malinga ndi Kirkaldy-Willis ndi Bernard, otchedwa "degenerative cascade". Magawo awa amatha kupindika ndipo amatha kuchitika pakadutsa zaka zambiri. Komabe, kuzindikira magawowa mwachipatala sikutheka chifukwa cha kuphatikizika kwa zizindikiro ndi zizindikiro.

Gawo 1 (Degeneration Phase)

Gawo ili limadziwika ndi kuchepa. Pali kusintha kwa histological, komwe kumawonetsa misozi yozungulira ndi mikwingwirima mu annulus fibrosus. Misozi yozungulira iyi imatha kukhala misozi yokulirapo ndipo chifukwa annulus pulposus imakhala yosakhazikika, misozi iyi imatha kubweretsa kupweteka kwa msana kapena kupweteka kwapakhosi, komwe kumakhala komweko komanso kuyenda kowawa. Chifukwa cha kupwetekedwa mobwerezabwereza mu ma diski, mapeto amatha kupatukana zomwe zimayambitsa kusokonezeka kwa magazi ku diski ndipo motero, kuchotseratu zakudya zake komanso kuchotsa zinyalala. The annulus ikhoza kukhala ndi micro-fractures mu collagen fibrils, yomwe ingakhoze kuwonedwa pa electron microscopy ndi MRI scan ingasonyeze desiccation, bulging of disc, and high-intensity zone mu annulus. Kulumikizana kwa nkhope kumatha kuwonetsa synovial reaction ndipo kungayambitse kupweteka kwambiri ndi synovitis yogwirizana komanso kulephera kusuntha olowa mumagulu a zygapophyseal. Kusintha kumeneku sikungakhale kwenikweni mwa munthu aliyense. (Gupta, Vijay Kumar, et al.)

The nucleus pulposus imakhudzidwanso ndi njirayi popeza mphamvu yake yotseketsa madzi imachepetsedwa chifukwa cha kudzikundikira kwa ma proteoglycans osinthidwa ndi biochemically. Zosinthazi zimabweretsedwa makamaka ndi michere iwiri yotchedwa matrix metalloproteinase-3 (MMP-3) ndi tissue inhibitor ya metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, ndi Maynak Gupta) Kusagwirizana kwawo kumabweretsa kuwonongedwa kwa ma proteoglycans. Kuchepa kwa mphamvu yotengera madzi kumapangitsa kuchepa kwa mphamvu ya hydrostatic mu nucleus pulposus ndikupangitsa kuti annular lamellae ikhale yolimba. Izi zitha kukulitsa kusuntha kwa gawolo zomwe zimapangitsa kumeta ubweya ku khoma la annular. Kusintha konseku kungayambitse njira yotchedwa annular delamination ndi fissuring mu annulus fibrosus. Izi ndi njira ziwiri zosiyana za pathological ndipo zonsezi zingayambitse kupweteka, chifundo cham'deralo, hypomobility, minyewa yolumikizana, kusuntha kopweteka kwamagulu. Komabe, kuyezetsa kwa minyewa panthawiyi nthawi zambiri kumakhala kwabwinobwino.

Gawo 2 (Gawo la Kusakhazikika)

Gawo la kusagwira ntchito likutsatiridwa ndi siteji ya kusakhazikika, yomwe ingakhale chifukwa cha kuwonongeka kwapang'onopang'ono kwa umphumphu wamakina wa mgwirizanowu. Pakhoza kukhala zosintha zingapo zomwe zimachitika panthawiyi, kuphatikizapo kusokonezeka kwa disc ndi resorption, zomwe zingayambitse kutaya kwa danga la disk. Misozi ingapo ya annular imathanso kuchitika panthawiyi ndi kusintha komwe kumalumikizana ndi zagopophyseal. Zitha kuphatikiza kuwonongeka kwa cartilage ndi facet capsular laxity zomwe zimatsogolera ku subluxation. Kusintha kwa biomechanical kumeneku kumabweretsa kusakhazikika kwa gawo lomwe lakhudzidwa.

Zizindikiro zomwe zimawonedwa m'gawoli ndizofanana ndi zomwe zimawonedwa pakalephereka monga "kupereka njira" yamsana, kuwawa mukayimirira nthawi yayitali, ndi "kugwira" kumbuyo ndikusuntha. Zimatsagana ndi zizindikiro monga kusuntha kwachilendo m'malo olumikizirana mafupa panthawi ya palpation ndikuwona kuti msana ukugwedezeka kapena kutembenukira kumbali utayima kwakanthawi pambuyo pa kupindika. (Gupta, Vijay Kumar et al.)

Gawo 3 (Kukhazikikanso)

Mu gawo lachitatu komanso lomaliza, kuchepa kwapang'onopang'ono kumapangitsa kuti danga likhale locheperako ndi fibrosis ndi mapangidwe a osteophyte ndi transdiscal bridging. Zowawa zomwe zimabwera chifukwa cha kusinthaku ndizovuta kwambiri poyerekeza ndi magawo awiri apitawo, koma izi zimatha kusiyana pakati pa anthu. Kuchepetsa danga la disc kumeneku kumatha kukhala ndi zotsatira zingapo pa msana. Izi zitha kupangitsa kuti ngalande ya intervertebral ikhale yocheperako kumtunda wapamwamba-otsika ndi kuyandikira kwa ma pedicles oyandikana nawo. Mitsempha yautali, yomwe imathandizira msana wa vertebral, ingakhalenso yoperewera m'madera ena omwe amachititsa kuti azikhala osasamala komanso osakhazikika. Kusuntha kwa msana kungayambitse ligamentum flavum ndipo kungayambitse kusokonezeka kwapamwamba kwambiri. Izi pamapeto pake zimabweretsa kuchepa kwa m'mimba mwake munjira ya anteroposterior ya danga la intervertebral ndi stenosis ya ngalande zam'mitsempha zam'mwamba.

Mapangidwe a osteophytes ndi hypertrophy ya mbali zitha kuchitika chifukwa cha kusintha kwa axial katundu pa msana ndi matupi a vertebral. Izi zikhoza kupanga pazitsulo zapamwamba komanso zotsika kwambiri ndipo osteophytes amatha kupita kumtsinje wa intervertebral pamene mbali za hypertrophied zimatha kupita kumtsinje wapakati. Osteophytes amaganiziridwa kuti amapangidwa kuchokera ku kuchuluka kwa cartilage ya articular pa periosteum pambuyo pake amapita ku endochondral calcification ndi ossification. Ma osteophytes amapangidwanso chifukwa cha kusintha kwa mpweya wa okosijeni komanso chifukwa cha kusintha kwa kuthamanga kwamadzimadzi kuphatikizapo kuwonongeka kwa katundu. Ma osteophytes ndi periarticular fibrosis angayambitse mafupa olimba. Njira za articular zimathanso kulunjika ku njira ya oblique yomwe imayambitsa retrospondylolisthesis yomwe imatsogolera kufupikitsa kwa intervertebral canal, mitsempha ya mitsempha, ndi ngalande ya msana. (KIRKALDY-WILLIS, WH et al.)

Zosintha zonsezi zimayambitsa kupweteka kwa msana, komwe kumachepetsa kwambiri. Zizindikiro zina monga kuchepa kwa kuyenda, kutsekemera kwa minofu, kuuma, ndi scoliosis zikhoza kuchitika. Ma cell a synovial stem ndi macrophages amakhudzidwa ndi njirayi potulutsa zinthu zakukula ndi mamolekyu amtundu wa extracellular, omwe amakhala ngati amkhalapakati. Kutulutsidwa kwa ma cytokines kwapezeka kuti kumagwirizana ndi gawo lililonse ndipo kungakhale ndi zotsatira zochiritsira pakukula kwa chithandizo chamtsogolo.

Etiology ya Zowopsa za Degenerative Disc Disease

Kukalamba ndi Kuwonongeka

N'zovuta kusiyanitsa ukalamba ndi kusintha kosasinthika. Pearce et al anena kuti ukalamba ndi kuwonongeka zikuyimira magawo otsatizana mkati mwa njira imodzi yomwe imachitika mwa anthu onse koma pamitengo yosiyana. Kuwonongeka kwa ma disc, komabe, kumachitika nthawi zambiri mwachangu kuposa ukalamba. Choncho, amakumana ngakhale odwala zaka ntchito.

Zikuwoneka kuti pali mgwirizano pakati pa ukalamba ndi kuwonongeka, koma palibe chifukwa chodziwika chomwe chakhazikitsidwa. Kafukufuku wambiri wachitika okhudzana ndi zakudya, kufa kwa maselo, komanso kudzikundikira kwa zinthu zowonongeka za matrix komanso kulephera kwapakati. Madzi omwe ali mu intervertebral disc amachepetsa ndi kukula kwa msinkhu. Nucleus pulposus imatha kupeza zipsera zomwe zimatha kulowa mu annulus fibrosus. Chiyambi cha ndondomekoyi chimatchedwa chondrosis intervertebralis, chomwe chikhoza kuwonetsa chiyambi cha kuwonongeka kwa intervertebral disc, endplates, ndi matupi amtundu. Njirayi imayambitsa kusintha kwakukulu kwa maselo a diski ndipo imakhala ndi biomechanical ndi sequelae yachipatala yomwe nthawi zambiri ingayambitse kuwonongeka kwakukulu kwa munthu wokhudzidwayo.

Kuchuluka kwa maselo mu annulus kumachepa ndi kukula kwa msinkhu. Izi ndichifukwa choti ma cell omwe ali mu diski amakumana ndi senescence ndipo amataya mphamvu yakuchulukana. Zina zomwe zimayambitsa kuwonongeka kwa zaka zapakati pa intervertebral discs zimaphatikizapo kutayika kwa maselo, kuchepetsa zakudya, kusinthidwa pambuyo pa kumasulira kwa mapuloteni a matrix, kudzikundikira kwa zinthu zowonongeka zowonongeka kwa matrix, ndi kutopa kwa matrix. Kuchepetsa zakudya ku diski yapakati, yomwe imalola kusonkhanitsa zinthu zowonongeka za selo ndi mamolekyu owonongeka a matrix akuwoneka ngati kusintha kofunikira kwambiri pakusintha zonsezi. Izi zimasokoneza zakudya ndipo zimayambitsa kutsika kwa pH, zomwe zimatha kusokoneza magwiridwe antchito a cell ndikupangitsa kufa kwa cell. Kuwonjezeka kwa catabolism ndi kuchepa kwa anabolism ya maselo a senescent kungayambitse kuwonongeka. (Buckwalter, Joseph A.) Malinga ndi kafukufuku wina, mu nucleus pulposus munali maselo ochuluka a senescence poyerekeza ndi annulus fibrosus ndipo ma discs a herniated anali ndi mwayi waukulu wa cell senescence.� (Roberts, S. et al.)

Ukalamba ukapitilira kwakanthawi, kuchuluka kwa chondroitin 4 sulfate ndi chondroitin 5 sulfate, komwe kumakhala hydrophilic kwambiri, kumachepa pomwe chiŵerengero cha keratin sulfate ku chondroitin sulfate chimawonjezeka. Keratan sulfate ndi mofatsa hydrophilic komanso ali ndi chizolowezi kakang'ono kupanga khola aggregates ndi asidi hyaluronic. Pamene aggrecan imagawanika, ndipo kulemera kwake kwa maselo ndi ziwerengero zimachepa, kukhuthala ndi hydrophilicity ya nucleus pulposus imachepa. Kusintha kwapang'onopang'ono kwa intervertebral discs kumachulukitsidwa ndi kuchepetsedwa kwa hydrostatic pressure ya nucleus pulposus ndi kuchepa kwa zakudya zopatsa thanzi mwa kufalikira. Pamene madzi amtundu wa extracellular matrix achepa, kutalika kwa intervertebral disc kudzachepanso. Kukaniza kwa disc ku katundu wa axial kudzachepetsedwanso. Chifukwa katundu wa axial umasamutsidwa mwachindunji ku annulus fibrosus, annulus clefts amatha kung'ambika mosavuta.

Njira zonsezi zimabweretsa kusintha kwapangidwe komwe kumawonedwa mu matenda osokonekera a disc. Chifukwa cha kuchepa kwa madzi mu annulus fibrosus ndi kutayika kogwirizana ndi kutsata, axial load imatha kugawidwanso kumbuyo kwa mbali m'malo mwa mbali yapakatikati ndi yapakatikati. Izi zingayambitse matenda a nyamakazi, hypertrophy ya matupi apafupi a vertebral, ndi bony spurs kapena bony overgrowth, yotchedwa osteophytes, chifukwa cha ma discs osokonekera. (Choi, Yong-Soo)

Genetics ndi Degeneration

Chigawo cha chibadwa chapezeka kuti ndicho chinthu chachikulu pa matenda osokonezeka a disc. Kafukufuku wamapasa, ndi kafukufuku wokhudza mbewa, awonetsa kuti majini amathandizira pakuwonongeka kwa ma disc. (Boyd, Lawrence M., et al.) Majini omwe ali ndi code ya kolajeni I, IX, ndi XI, interleukin 1, aggrecan, vitamini D receptor, matrix metalloproteinase 3 (MMP� 3), ndi mapuloteni ena ali m'gulu la majini omwe ali. amalangizidwa kuti achite nawo matenda osokonekera a disc. Ma polymorphisms mu 5 A ndi 6 A alleles omwe amapezeka m'dera lachitukuko la majini omwe amawongolera kupanga MMP 3 amapezeka kuti ndi chifukwa chachikulu cha kuwonjezeka kwa lumbar disc degeneration mwa okalamba. Kuyanjana pakati pa majini osiyanasiyanawa kumathandizira kwambiri ku matenda a intervertebral disc degeneration onse.

Chakudya ndi Kuwonongeka

Kuwonongeka kwa disc kumakhulupiriranso kuti kumachitika chifukwa cha kulephera kwa zakudya zopatsa thanzi ku maselo a intervertebral disc. Kupatula kukalamba kwanthawi zonse, kuperewera kwa zakudya m'maselo a disc kumakhudzidwa kwambiri ndi calcification ya endplate, kusuta, komanso thanzi lonse. Kuperewera kwa zakudya m'thupi kungayambitse kupangika kwa lactic acid pamodzi ndi kutsika kwa oxygen komwe kumakhudzana. Zotsatira zake zochepa pH zingakhudze mphamvu ya ma disc kuti apange ndi kusunga matrix owonjezera a ma diski ndipo amachititsa kuti intervertebral disc degeneration. Ma disks owonongeka alibe mphamvu yoyankhira mwachibadwa ku mphamvu yakunja ndipo angayambitse kusokonezeka ngakhale kuchokera ku vuto laling'ono lakumbuyo. (Taher, Fadi, et al.)

Zinthu zakukula zimathandizira ma chondrocytes ndi ma fibroblasts kuti apange matrix ochulukirapo a extracellular. Imalepheretsanso kaphatikizidwe ka matrix metalloproteinases. Zitsanzo za zinthu zakukula izi zikuphatikiza kusintha kwa kukula, kukula kwa insulini, komanso kukula kwa fibroblast factor. Matrix owonongeka amakonzedwa ndi kuchuluka kwa kusintha kwa kukula kwa fibroblast factor factor.

Chilengedwe ndi Kuwonongeka

Ngakhale kuti ma diski onse ali a msinkhu wofanana, ma diski omwe amapezeka m'magulu apansi a lumbar ali pachiopsezo chosintha zowonongeka kusiyana ndi ma diski omwe amapezeka kumtunda wapamwamba. Izi zikusonyeza kuti osati kukalamba kokha komanso, komanso kukweza makina, ndizomwe zimayambitsa. Chiyanjano pakati pa matenda osokonezeka a disk ndi zinthu zachilengedwe zafotokozedwa momveka bwino ndi Williams ndi Sambrook ku 2011. (Williams, FMK, ndi PN Sambrook) Kulemera kwa thupi komwe kumagwirizanitsidwa ndi ntchito yanu ndi chinthu choopsa chomwe chili ndi chothandizira pa disc. matenda osachiritsika. Palinso kuthekera kwa mankhwala omwe amachititsa kuti ma disc awonongeke, monga kusuta fodya, malinga ndi maphunziro ena. (Batti�, Michele C.) Nicotine wakhala akuphatikizidwa mu maphunziro amapasa omwe amachititsa kuti magazi asamayende bwino ku intervertebral disc, zomwe zimapangitsa kuti ma disc awonongeke. (BATTI�, MICHELE C., et al.) Komanso, kuyanjana kwapezeka pakati pa zotupa za atherosclerotic mu aorta ndi ululu wochepa wa msana wonena za kugwirizana pakati pa atherosclerosis ndi matenda osokoneza bongo. (Kauppila, LI) Kuwonongeka kwa diski kunakhudzidwa ndi kunenepa kwambiri, kunenepa kwambiri, matenda a kagayidwe kachakudya, komanso kuwonjezeka kwa thupi m'maphunziro ena. (�A Population-Based Study Of Juvenile Disc Degeneration And Its Association With Overweight And Obesity, Low Back Pain, And Diminished Functional Status. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg. Am 2011;93(7):662-70�)

Ululu mu Disc Degeneration (Discogenic Pain)

Ululu wa discogenic, womwe ndi mtundu wa ululu wa nociceptive, umachokera ku nociceptors mu annulus fibrosus pamene dongosolo la mitsempha limakhudzidwa ndi matenda osokoneza bongo. Anulus fibrosus imakhala ndi mitsempha yoteteza chitetezo cha mthupi kumtunda wakunja wa diski ndi mankhwala ena monga vasoactive intestinal polypeptide, calcitonin peptide yokhudzana ndi majini, ndi mankhwala P. (KONTTINEN, YRJ� T., et al.) ma intervertebral discs amachitika, mawonekedwe abwinobwino ndi katundu wamakina amasinthidwa ndikupangitsa kusuntha kwachilendo. Ma disc nociceptors awa amatha kutengeka modabwitsa ku zokopa zamakina. Ululuwu ukhozanso kukwiyitsidwa ndi kutsika kwa pH komwe kumachitika chifukwa cha kukhalapo kwa lactic acid, zomwe zimapangitsa kuchuluka kwa oyimira pakati pa ululu.

Ululu wochokera ku degenerative disc matenda angabwere kuchokera kuzinthu zambiri. Zitha kuchitika chifukwa cha kuwonongeka kwamapangidwe, kupanikizika, ndi kukwiya kwa mitsempha ya msana. Diski yokha imakhala ndi mitsempha yochepa chabe ya mitsempha, koma kuvulala kulikonse kungathe kulimbikitsa mitsempha iyi, kapena yomwe ili mu posterior longitudinal ligament, kuti ipweteke. Kusuntha kwakung'ono mu vertebrae kumatha kuchitika, zomwe zingayambitse kupweteka kwa minofu ya reflex chifukwa diski yawonongeka ndikuwonongeka chifukwa cha kuchepa kwamphamvu ndi kutalika. Kusuntha kowawa kumachitika chifukwa minyewa yomwe imapereka malowa imapanikizidwa kapena kukwiyitsidwa ndi zigawo zamagulu ndi mitsempha mu foramen yomwe imatsogolera kumutu ndi ululu wammbuyo. Ululu umenewu ukhoza kukulirakulira chifukwa cha kutulutsidwa kwa mapuloteni otupa omwe amagwira ntchito pa mitsempha mu foramen kapena kutsika kwa mitsempha mumsana wa msana.

Zitsanzo za pathological za ma disc osokonekera, zikawonedwa pansi pa maikulosikopu, zimasonyeza kuti pali minofu ya vascularized granulation ndi zowonjezereka zomwe zimapezeka mu ming'alu ya kunja kwa annulus fibrosus yomwe ikupita ku nucleus pulposus. Malo amtundu wa granulation amalowetsedwa ndi maselo ochuluka a mast ndipo nthawi zonse amathandizira kuti pakhale njira zowonongeka zomwe zimadzetsa ululu wa discogenic. Izi zikuphatikizapo neovascularization, intervertebral disc degeneration, disc kutupa minofu, ndi mapangidwe fibrosis. Ma mast cell amatulutsanso zinthu, monga tumor necrosis factor ndi interleukins, zomwe zitha kuwonetsa kuyambitsa njira zina zomwe zimathandizira kupweteka kwamsana. Zinthu zina zomwe zingayambitse njirazi ndi monga phospholipase A2, yomwe imapangidwa kuchokera ku arachidonic acid cascade. Zimapezeka muzowonjezereka mu gawo lachitatu la kunja kwa annulus ya disc degenerative ndipo amaganiziridwa kuti amalimbikitsa nociceptors omwe ali pamenepo kuti atulutse zinthu zowonongeka kuti ayambe kupweteka. Zinthu izi zimabweretsa kuvulala kwa axonal, edema ya intraneural, komanso kuchepa kwa magazi. (Brisby, Helena)

Ululu wammbuyo umaganiziridwa kuti umachokera ku intervertebral disc yokha. Chifukwa chake ululuwo udzachepa pang'onopang'ono pakapita nthawi pamene diski yowonongeka imasiya kupweteketsa. Komabe, ululuwo umachokera ku diski yokha mwa 11% ya odwala malinga ndi maphunziro a endoscopy. Choyambitsa chenicheni cha ululu wammbuyo chikuwoneka chifukwa cha kusonkhezera kwa malire apakati a mitsempha ndi ululu wotchulidwa pa mkono kapena mwendo zikuwoneka kuti zimachokera chifukwa cha kusonkhezera kwapakati pa mitsempha. Chithandizo cha disc degeneration chiyenera makamaka kuyang'ana pa mpumulo wa ululu kuti achepetse kuvutika kwa wodwalayo chifukwa ndi chizindikiro cholemala kwambiri chomwe chimasokoneza moyo wa wodwala. Choncho, ndikofunika kukhazikitsa njira ya ululu chifukwa zimachitika osati chifukwa cha kusintha kwapangidwe mu intervertebral discs komanso chifukwa cha zinthu zina monga kutulutsidwa kwa mankhwala ndi kumvetsetsa njirazi zingayambitse kupweteka kwabwino. (Choi, Yong-Soo)

Chiwonetsero Chachipatala cha Matenda Osasinthika a Chimbale

Odwala ndi matenda osachiritsika chimbale amakumana ndi miyandamiyanda zizindikiro malinga ndi malo matenda. Omwe ali ndi lumbar disc degeneration amamva ululu wochepa wammbuyo, zizindikiro zazikulu, ndi kufooka. Omwe ali ndi vuto la chiberekero cha chiberekero amakhala ndi ululu wa khosi ndi kupweteka kwa mapewa.

Kupweteka kwapang'onopang'ono kumatha kukulitsidwa ndi mayendedwe ndi malo. Kawirikawiri, zizindikirozo zimayipitsidwa ndi kupindika, pamene kutambasula kumawathandiza. Kuvulala kwakung'ono kopindika, ngakhale kusuntha kalabu ya gofu, kumatha kuyambitsa zizindikiro. Ululu nthawi zambiri umakhala wocheperako poyenda kapena kuthamanga, posintha malo pafupipafupi komanso pogona. Komabe, ululuwo nthawi zambiri umakhala wokhazikika ndipo nthawi zambiri, umasiyana kwambiri pakati pa munthu ndi munthu ndipo anthu ambiri amavutika ndi ululu wochepa kwambiri wa m'munsi mwa msana mosalekeza pamene nthawi zina amavutika ndi ululu, chiuno, ndi mwendo. Kuchuluka kwa ululu kumawonjezeka nthawi ndi nthawi ndipo kudzakhala kwa masiku angapo kenako ndikuchepa pang'onopang'ono. "Kupweteka" kumeneku ndi vuto lalikulu ndipo liyenera kuthandizidwa ndi mankhwala oletsa ululu. Kupweteka koipitsitsa kumachitikira pamalo okhala ndipo kumakulirakulira pamene mukugwada, kukweza, ndi kupotoza mayendedwe pafupipafupi. Kukula kwa ululuwo kumasiyana kwambiri ndi ena omwe amakhala ndi ululu wowawa nthawi ndi nthawi kwa ena omwe amamva kuwawa koopsa komanso kosalekeza nthawi ndi nthawi.� (Jason M. Highsmith, MD)

Kupweteka komwe kumapezeka mumsana wa axial nthawi zambiri kumachokera ku ma nociceptors omwe amapezeka mkati mwa intervertebral discs, facet joints, sacroiliac joints, dura mater of the nerve roots, ndi mapangidwe a myofascial omwe amapezeka mkati mwa axial msana. Monga tafotokozera m'magawo apitawa, kusintha kwachibadwa kwa thupi kungayambitse kuchepa kwa msana wa msana wotchedwa spinal stenosis, kukula kwa msana wotchedwa osteophytes, hypertrophy of the inferior and superior articular process, spondylolisthesis, bulging of ligamentum flavum ndi disc herniation. . Kusintha kumeneku kumabweretsa kusonkhanitsa kwa zizindikiro zomwe zimadziwika kuti neurogenic claudication. Pakhoza kukhala zizindikiro monga kupweteka kwa msana ndi kupweteka kwa mwendo pamodzi ndi dzanzi kapena kugwedeza m'miyendo, kufooka kwa minofu, ndi kutsika kwa phazi. Kutaya matumbo kapena chikhodzodzo kungapangitse kuti msana ulowetsedwe ndipo chithandizo chamankhwala chiyenera kufunikira kuti tipewe kulemala kosatha. Zizindikirozi zimatha kukhala zovuta ndipo zimatha kuwoneka mosiyanasiyana mwa anthu osiyanasiyana.

Kupweteka kungathenso kufalikira ku ziwalo zina za thupi chifukwa chakuti msana umapereka nthambi zingapo kumalo awiri osiyana a thupi. Choncho, pamene disc degenerated ikanikizira pa mizu ya mitsempha ya msana, ululu ukhoza kukumananso ndi mwendo umene mitsempha imakhala yosasunthika. Chodabwitsa ichi, chotchedwa radiculopathy, chikhoza kuchitika kuchokera kuzinthu zambiri zomwe zimachokera, chifukwa cha ndondomeko yowonongeka. The bulging disc, ngati ikukwera chapakati, imatha kukhudza mizu yotsika ya cauda equina, ngati iphulika ponseponse, imatha kukhudza mizu ya mitsempha yomwe imatuluka pamtsinje wotsatira wa intervertebral ndipo mitsempha ya msana mkati mwa ventral ramus imatha kukhudzidwa pamene diski imatuluka. pambali. Momwemonso, ma osteophyte omwe amatuluka m'mphepete mwa kumtunda ndi kumunsi kwa gawo lapambuyo la matupi amtundu wa vertebral amatha kusokoneza minofu yomweyi yomwe imayambitsa zizindikiro zomwezo. Superior articular process hypertrophy imathanso kusokoneza mizu ya minyewa kutengera momwe amawonera. Mitsempha ingaphatikizepo mizu ya mitsempha isanatuluke kuchokera kumtsinje wotsatira wa intervertebral ndi mizu ya mitsempha mkati mwa mitsempha yapamwamba ya mitsempha ndi thumba lamkati. Zizindikiro izi, chifukwa cha kutsekeka kwa mitsempha, zatsimikiziridwa ndi maphunziro a cadaver. Neural compromise imaganiziridwa kuti imachitika pomwe m'mimba mwake wa neuroforaminal watsekeredwa mozama ndikuchepetsa 70%. Komanso, neural compromise imatha kupangidwa pamene diski yapambuyo imapanikizidwa pansi pa 4 millimeters kutalika, kapena pamene kutalika kwa foraminal kumachepetsedwa kukhala osachepera 15 millimeters zomwe zimatsogolera ku foraminal stenosis ndi mitsempha ya mitsempha. (Taher, Fadi, et al.)

Njira yodziwira matenda

Odwala amawunikiridwa poyambilira ndi mbiri yolondola komanso kuunika bwino kwakuthupi ndi kufufuza koyenera komanso kuyezetsa kodzutsa. Komabe, mbiri yakale nthawi zambiri imakhala yosamvetsetseka chifukwa cha ululu wopweteka womwe sungathe kukhazikitsidwa bwino komanso zovuta kudziwa malo enieni a anatomical panthawi yoyesera zokopa chifukwa cha chikoka cha matupi a anatomical oyandikana nawo.

Kupyolera mu mbiri ya wodwalayo, chifukwa cha ululu wochepa wammbuyo ukhoza kudziwika kuti umachokera ku nociceptors mu intervertebral discs. Odwala angaperekenso mbiri yakale yazizindikiro zomwe zimagwirizanitsidwa ndi gluteal dera dzanzi, kugwedezeka komanso kuuma kwa msana komwe nthawi zambiri kumawonjezeka ndi ntchito. Kukoma mtima kungayambitsidwe ndi kugwedeza pa msana. Chifukwa cha chikhalidwe cha matendawa kukhala osatha komanso opweteka, odwala ambiri amatha kukhala ndi vuto la kukhumudwa komanso nkhawa. Kupsinjika maganizo kumaganiziridwa kuti kumapangitsa kuti matendawa achuluke. Komabe, palibe mgwirizano womveka bwino pakati pa kuuma kwa matenda ndi kukhumudwa kapena nkhawa. Ndi bwino kukhala tcheru ndi matenda a maganizo amenewa. Pofuna kupewa matenda ena oopsa, mafunso ayenera kufunsidwa okhudza kutopa, kuchepa thupi, kutentha thupi, ndi kuzizira, zomwe zingasonyeze matenda ena. (Jason M. Highsmith, MD)

Etiology ina ya ululu wochepa wa msana iyenera kuchotsedwa pofufuza wodwalayo chifukwa cha matenda osokoneza bongo. Matenda a m'mimba, omwe angayambitse kupweteka kwa msana monga aortic aneurysm, renal calculi, ndi matenda a kapamba, ayenera kuchotsedwa.

Matenda a Degenerative disc ali ndi mitundu ingapo yosiyanasiyana yomwe iyenera kuganiziridwa pamene wodwala akupereka ululu wammbuyo. Izi zikuphatikizapo; idiopathic low back ululu, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, ndi lumbar radiculopathy. (�Degenerative Disc Disease � Physiopedia�)

zofufuza

Kufufuza kumagwiritsidwa ntchito kutsimikizira kuti ali ndi matenda a degenerative disc. Izi zitha kugawidwa m'maphunziro a labotale, maphunziro oyerekeza, mayeso oyendetsa mitsempha, ndi njira zowunikira.

Maphunziro Ojambula

Kujambula mu matenda osokonekera a disk makamaka amagwiritsidwa ntchito kufotokoza maubwenzi a anatomical ndi mawonekedwe a morphological a ma disk omwe akhudzidwa, omwe ali ndi phindu lalikulu lachirengedwe pakupanga zisankho zamtsogolo za njira zothandizira. Njira iliyonse yojambula, monga plain radiography, CT, kapena MRI, ikhoza kupereka zambiri zothandiza. Komabe, chifukwa chachikulu chikhoza kupezeka mu 15% mwa odwalawo popeza palibe kusintha kowonekera bwino kwa radiological komwe kumawoneka mu matenda osokonekera a diski popanda disc herniation ndi kuperewera kwa ubongo. Komanso, palibe mgwirizano pakati pa kusintha kwa thupi komwe kumawoneka pa kujambula ndi kuopsa kwa zizindikiro, ngakhale kuti pali mgwirizano pakati pa chiwerengero cha osteophytes ndi kuopsa kwa ululu wammbuyo. Kusintha kwapang'onopang'ono kwa radiography kumatha kuwonedwanso mwa anthu opanda zizindikiro zomwe zimapangitsa kuti zikhale zovuta kutsata zofunikira zachipatala komanso nthawi yoyambira kulandira chithandizo. (�Degenerative Disc Disease � Physiopedia�)

Plain Radiography

Izi zotsika mtengo komanso zopezeka paliponse zamtundu wa khomo lachiberekero zimatha kupereka chidziwitso chofunikira pakupunduka, kuyanjanitsa, ndi kusintha kwa mafupa osokonekera. Pofuna kudziwa kukhalapo kwa kusakhazikika kwa msana ndi sagittal balance, flexion dynamic, kapena maphunziro owonjezera ayenera kuchitidwa.

Kujambula kwa Magnetic Resonance (MRI)

MRI ndiyo njira yomwe imagwiritsidwa ntchito kwambiri pozindikira kusintha kwapang'onopang'ono kwa intervertebral disc molondola, modalirika, komanso momveka bwino. Amagwiritsidwa ntchito poyesa koyamba kwa odwala omwe ali ndi ululu wa khosi pambuyo pa plain radiography. Ikhoza kupereka zithunzi zosasokoneza m'zigwa zingapo ndipo zimapereka zithunzi zabwino kwambiri za disk. MRI imatha kuwonetsa ma disc hydration ndi morphology kutengera kuchuluka kwa proton, chilengedwe chamankhwala, ndi madzi. Chithunzi chachipatala ndi mbiri ya wodwalayo ziyenera kuganiziridwa pomasulira malipoti a MRI monga momwe zasonyezedwera kuti pafupifupi 25% ya radiologists amasintha lipoti lawo pamene deta yachipatala ilipo. Fonar adapanga sikani yoyamba yotsegula ya MRI yokhala ndi kuthekera kwa wodwala kuti ayesedwe m'malo osiyanasiyana monga kuyimirira, kukhala, ndi kugwada. Chifukwa cha mawonekedwe apaderawa, makina otsegula a MRI amatha kugwiritsidwa ntchito poyang'ana odwala omwe ali ndi zolemetsa ndikuyimirira kuti azindikire kusintha kwapathological komwe nthawi zambiri kumanyalanyazidwa mu MRI scan wamba monga lumbar degenerative disc matenda ndi herniation. Makinawa ndi abwino kwa odwala omwe ali ndi vuto la claustrophobic, chifukwa amatha kuwonera kanema wawayilesi wamkulu akamasanthula. (Matenda a Degenerative Disk: Background, Anatomy, Pathophysiology.�)

Nucleus pulposus ndi annulus fibrosus ya diski nthawi zambiri imatha kudziwika pa MRI, zomwe zimatsogolera ku kuzindikira kwa disc herniation monga momwe zilili komanso zosapezeka. Monga MRI ingasonyezenso misozi ya annular ndi posterior longitudinal ligament, ingagwiritsidwe ntchito kuyika herniation. Izi zitha kukhala zosavuta za annular bulging ku free fragment disc herniations. Izi zitha kufotokozera ma diski a pathological monga ma disc otuluka, ma diski otuluka, ndi ma diski osamuka.

Pali machitidwe angapo owerengera otengera mphamvu ya MRI, kutalika kwa disc, kusiyanitsa pakati pa nucleus ndi annulus, ndi kapangidwe ka disc. Njirayi, ndi Pfirrmann et al, yakhala ikugwiritsidwa ntchito kwambiri komanso kuvomerezedwa ndichipatala. Malinga ndi dongosolo losinthidwa, pali 8 magiredi a lumbar disc degenerative matenda. Kalasi 1 imayimira intervertebral disc yachibadwa ndipo giredi 8 imagwirizana ndi gawo lomaliza la kuwonongeka, zomwe zikuwonetsa kukula kwa matenda a disc. Pali zithunzi zofananira zomwe zimathandizira kuzindikira. Pamene akupereka kusiyanitsa kwa minofu yabwino komanso kufotokozera mwatsatanetsatane kapangidwe ka disc, zithunzi zolemera za sagittal T2 zimagwiritsidwa ntchito pofuna cholinga. (Pfirrmann, Christian WA, et al.)

Modic wafotokoza kusintha komwe kumachitika m'matupi amtundu wa vertebral pafupi ndi ma disc omwe akuwonongeka monga mtundu wa 1 ndi mtundu wa 2 kusintha. Mukusintha kwa Modic 1, pali kuchepa kwamphamvu kwa zithunzi zolemera za T1 komanso kuchuluka kwazithunzi zolemetsa za T2. Izi zimaganiziridwa kuti zimachitika chifukwa mbale zomalizira zakhala ndi matenda a sclerosis ndipo mafupa oyandikana nawo akuwonetsa kuyankha kotupa pamene kufalikira kwa coefficient kumawonjezeka. Kuwonjezeka kwa coefficient ya diffusion ndi kukana kotheratu kufalikira kumadza chifukwa cha mankhwala omwe amatulutsidwa kudzera mu makina a autoimmune. Kusintha kwa mtundu wa Modic 2 kumaphatikizapo kuwonongeka kwa fupa la fupa la vertebral endplates chifukwa cha kuyankha kotupa komanso kulowetsedwa kwa mafuta m'mafupa. Zosinthazi zitha kupangitsa kuti ma signature achuluke pazithunzi zolemera za T1. (Modic, MT et al.)

Computed Tomography (CT)

Pamene MRI sichipezeka, Computed tomography imaonedwa kuti ndi kuyesa kwachidziwitso komwe kungathe kuzindikira kutayika kwa disc chifukwa kumakhala ndi kusiyana kwabwino pakati pa m'mphepete mwa posterolateral m'mphepete mwa mafupa oyandikana nawo, mafuta a perineal, ndi herniated disc material. Ngakhale zili choncho, pozindikira ma lateral herniations, MRI imakhalabe njira yosinthira yosankha.

CT scan ili ndi maubwino angapo kuposa MRI monga imakhala ndi malo ocheperako, otsika mtengo, komanso kuzindikira kwabwino kwa kusintha kwa bonny komwe kumakhala kosawoneka bwino ndipo mwina kuphonyedwe panjira zina. CT imatha kuzindikira kusintha koyambilira kwa ma facet joints ndi spondylosis molondola kwambiri. Umphumphu wa Bony pambuyo pa kusakanikirana umayesedwanso bwino ndi CT.

Disc herniation ndi minyewa yolumikizana nayo imatha kupezeka pogwiritsa ntchito njira zomwe Gundry ndi Heitoff. Ndikofunikira kuti kutulutsa kwa disc kugone molunjika pamizu ya mitsempha yomwe ikudutsa pa diskiyo ndikukhala yokhazikika komanso yosasunthika ndi malo a dorsolateral. Payenera kukhala kuwonekera minyewa minyewa kupsinjika kapena kusamutsidwa. Potsirizira pake, mitsempha yopita kumalo otsekemera (malo a herniation) nthawi zambiri imakula ndikuphulika ndi edema, kutchuka kwa mitsempha yoyandikana ndi epidural, ndi zotupa zotupa zomwe zimapangitsa kuti malirewo asawonekere.

Lumba Dchithunzithunzi

Njirayi ndi yotsutsana ndipo, kaya kudziwa malo a ululu kuli ndi phindu lililonse lokhudza opaleshoni kapena ayi, sikunatsimikizidwe. Zotsatira zabodza zimatha kuchitika chifukwa cha hyperalgesia yapakati kwa odwala omwe ali ndi ululu wopweteka (neurophysiologic kupeza) komanso chifukwa cha zifukwa zamaganizo. Ndizokayikitsa kukhazikitsa ndendende pamene ululu wa discogenic umakhala wofunikira kwambiri. Amene amachirikiza kafukufukuyu amalimbikitsa ndondomeko zokhwima zosankhidwa kwa odwala komanso pamene akumasulira zotsatira ndikukhulupirira kuti ichi ndi chiyeso chokha chomwe chingazindikire ululu wa discogenic. Lumbar discography ingagwiritsidwe ntchito nthawi zingapo, ngakhale sizinakhazikitsidwe mwasayansi. Izi zikuphatikizapo; Kuzindikira kwa lateral herniation, kuzindikira zizindikiro za diski pakati pa zovuta zambiri, kuyesa zolakwika zofanana zomwe zimawonedwa pa CT kapena MRI, kuunika kwa msana pambuyo pa opaleshoni, kusankha mlingo wa fusion, ndi zowonetsera za ululu wa discogenic kukhalapo.

Discography imakhudzidwa kwambiri ndikupeza matenda a pathophysiology m'malo mozindikira mawonekedwe a diski. Choncho, kuyesa kwa ululu wa discogenic ndi cholinga cha discography. MRI ikhoza kuwulula diski yowoneka mosadziwika bwino popanda ululu, pamene ululu wopweteka ukhoza kuwoneka pa discography kumene MRI imapeza zochepa. Pa jakisoni wa saline wamba kapena zinthu zofananira, malekezero a spongy amatha kuchitika ndi ma discs omwe amavomereza kusiyanasiyana kochulukirapo. Zomwe zimasiyanitsa zimatha kupitilira mu nucleus pulposus kudzera m'misozi ndi ming'alu mu annulus fibrosus mu ma disc osadziwika. Kupanikizika kwa zinthu zosiyanitsa izi kungayambitse kupweteka chifukwa cha kusakhazikika kwa mitsempha ya meningeal, mitsempha ya msana, anterior primary rami, ndi gray rami communicantes yopereka kunja kwa annulus fibrosus. Kupweteka kwakukulu kumatha kukwiyitsidwa pamene zinthu zosiyanitsazo zifika pamalo pomwe mitsempha imalowetsedwa ndi disc yosadziwika bwino. Komabe, mayeso a discographywa ali ndi zovuta zingapo monga kuvulala kwa mitsempha, mankhwala kapena bakiteriya diskitis, kusiyanitsa kosagwirizana, komanso kuwonjezereka kwa ululu. (Bartynski, Walter S., ndi A. Orlando Ortiz)

Imaging Modality Combination

Kuti muyese kupanikizika kwa mitsempha ya mitsempha ndi chiberekero cha chiberekero mokwanira, njira zogwiritsira ntchito zojambula zingafunike.

Zithunzi za CT

Pambuyo pochita discography yoyamba, CT discography imachitika mkati mwa maola 4. Itha kugwiritsidwa ntchito pozindikira momwe diskiyo ilili monga herniated, protruded, extruded, content or sequestered. Ikhoza kugwiritsidwanso ntchito pamsana kuti isiyanitse zotsatira za misa ya minofu yowopsya kapena zinthu za disc pambuyo pa opaleshoni ya msana.

CT Myelography

Mayesowa amawonedwa ngati njira yabwino kwambiri yowunikira kupsinjika kwa mizu ya mitsempha. Pamene CT ichitidwa mophatikizana kapena pambuyo pa myelography, tsatanetsatane wokhudzana ndi mafupa a mafupa osiyanasiyana amatha kupezeka mosavuta.

Njira Zowunika

Transforaminal Selective Nerve Root Blocks (SNRBs)

Pamene matenda a multilevel degenerative disc akuganiziridwa pa MRI scan, mayeserowa angagwiritsidwe ntchito kuti adziwe mizu yeniyeni ya mitsempha yomwe yakhudzidwa. SNRB ndi mayeso ozindikira komanso achire omwe angagwiritsidwe ntchito pa lumbar spinal stenosis. Mayesowa amapanga gawo la demotomal la hypoesthesia pobaya mankhwala ochititsa dzanzi ndi zinthu zosiyana motsogozedwa ndi fluoroscopic kupita ku muzu wachidwi wa minyewa. Pali mgwirizano pakati pa ma multilevel cervical degenerative disc matenda zizindikiro ndi zomwe zapezeka pa MRI ndi zomwe zapezeka mu SNRB malinga ndi Anderberg et al. Pali mgwirizano wa 28% ndi zotsatira za SNRB komanso zowawa za dermatomal radicular ndi madera a neurologic deficit. Matenda owopsa kwambiri a MRI amapezeka kuti amagwirizana ndi 60%. Ngakhale kuti sichigwiritsidwa ntchito nthawi zonse, SNRB ndi kuyesa kothandiza poyesa odwala asanachite opaleshoni mu multilevel degenerative disc matenda makamaka pa msana pamodzi ndi zochitika zachipatala ndi zomwe anapeza pa MRI. (Narouze, Samer, ndi Amaresh Vydyanathan)

Maphunziro a Electro Myographic

Mayeso a distal motor and sensory nerve conduction, otchedwa electromyographic studies, omwe ali abwinobwino ndi mayeso osadziwika bwino a singano amatha kuwulula zizindikiro za kupsinjika kwa mitsempha zomwe zimawonekera m'mbiri yachipatala. Mizu ya mitsempha yokwiyitsidwa imatha kukhazikitsidwa pogwiritsa ntchito jekeseni kuti azitha kupha mitsempha yomwe yakhudzidwa kapena zolandilira zowawa mu danga la disc, cholumikizira cha sacroiliac, kapena zigawo zamagulu ndi discography. (�Journal Of Electromyography & Kinesiology Calendar�)

Maphunziro a Laboratory

Kuyeza kwa labotale nthawi zambiri kumachitika kuti asaphatikizepo matenda ena osiyanasiyana.

Monga seronegative spondyloarthropathies, monga ankylosing spondylitis, ndizomwe zimayambitsa kupweteka kwa msana, HLA B27 immuno-histocompatibility iyenera kuyesedwa. Pafupifupi anthu a 350,000 ku US ndi 600,000 ku Ulaya akhudzidwa ndi matenda otupawa a etiology yosadziwika. Koma HLA B27 sapezeka kawirikawiri mwa anthu aku Africa America. Ma spondyloarthropathies ena a seronegative omwe amatha kuyesedwa pogwiritsa ntchito jiniyi akuphatikizapo nyamakazi ya psoriatic, kutupa kwamatumbo, ndi matenda a nyamakazi kapena Reiter syndrome. Serum immunoglobulin A (IgA) imatha kukulitsidwa mwa odwala ena.

Mayeso monga erythrocyte sedimentation rate (ESR) ndi C-reactive protein (CRP) level test for the acute phase reactants amawonedwa ndi zotupa zoyambitsa kupweteka kwa msana monga osteoarthritis ndi malignancy. Kuwerengera kwathunthu kwa magazi kumafunikanso, kuphatikiza mawerengedwe osiyanitsira kuti atsimikizire etiology ya matendawa. Matenda a autoimmune amaganiziridwa pamene mayeso a Rheumatoid factor (RF) ndi anti-nuclear antibody (ANA) amakhala ndi HIV. Seramu uric acid ndi synovial fluid kusanthula kwa makhiristo kungakhale kofunikira nthawi zina kuti muchotse gout ndi pyrophosphate dihydrate deposition.

chithandizo

Palibe njira yotsimikizirika yochiritsira yomwe madokotala amavomerezana ndi madokotala onse okhudza chithandizo cha matenda osokoneza bongo chifukwa chomwe chimayambitsa ululu chikhoza kusiyana ndi anthu osiyanasiyana komanso momwe zimakhalira kupweteka komanso kusiyana kwakukulu muzochitika zachipatala. Zosankha zamankhwala zitha kukambidwa mozama pansi; chithandizo chanthawi zonse, chithandizo chamankhwala, ndi chithandizo cha opaleshoni.

Chithandizo Chodziletsa

Njira yochiritsirayi imaphatikizapo kuchita masewera olimbitsa thupi ndi machitidwe, machitidwe a thupi, jekeseni, maphunziro a msana, ndi njira zobwerera kusukulu.

Thandizo Logwiritsa Ntchito Zolimbitsa Thupi ndi Makhalidwe Othandizira

Malingana ndi matenda a wodwalayo, mitundu yosiyanasiyana ya masewera olimbitsa thupi ikhoza kuperekedwa. Imaonedwa kuti ndi imodzi mwa njira zazikulu zoyendetsera kasamalidwe koyenera kuti athetse ululu wopweteka kwambiri. Zochita zolimbitsa thupi zimatha kusinthidwa kuti ziphatikizepo zolimbitsa thupi zotambasula, zolimbitsa thupi, komanso zolimbitsa thupi. Chimodzi mwazovuta zazikulu za mankhwalawa ndi kulephera kuyesa mphamvu pakati pa odwala chifukwa cha kusiyana kwakukulu kwa machitidwe ochita masewera olimbitsa thupi, mafupipafupi, ndi mphamvu. Malinga ndi kafukufuku, mphamvu zambiri za ululu wammbuyo wammbuyo wokhala ndi nthawi yosiyana siyana zazizindikiro zinapezedwa pochita masewera olimbitsa thupi mkati mwa ntchito ya wodwalayo. Kusintha kwakukulu kunawonedwa pakati pa odwala omwe ali ndi zizindikiro zosatha ndi mankhwalawa ponena za kusintha kwa ntchito ndi kuchepetsa ululu. Mankhwala ochiritsira omwe amapangidwira wodwala aliyense pansi pa kuyang'aniridwa ndi kutsatiridwa kwa wodwalayo akuwonekanso kuti ndi othandiza kwambiri kwa odwala omwe akudwala msana. Njira zina zodzitchinjiriza zitha kugwiritsidwa ntchito kuphatikiza kukonza njira iyi. (Hayden, Jill A., et al.)

Zochita zolimbitsa thupi za aerobic, ngati zimachitidwa pafupipafupi, zimatha kupititsa patsogolo kupirira. Kuti muchepetse kupsinjika kwa minofu, njira zopumula zingagwiritsidwe ntchito. Kusambira kumaonedwanso ngati masewera olimbitsa thupi a ululu wammbuyo. Zochita zapansi zingaphatikizepo masewero olimbitsa thupi, kutambasula kwa hamstring, kutambasula kumbuyo, kutambasula mawondo awiri mpaka kuchibwano, kukweza mipando, kusinthidwa, kulimbitsa m'mimba, ndi masewera olimbitsa thupi a mapiri ndi sag.

Makhalidwe Athupi

Njirayi imaphatikizapo kugwiritsa ntchito mphamvu zamagetsi zamagetsi, kupumula, mapaketi a ayezi, biofeedback, mapepala otentha, phonophoresis, ndi iontophoresis.

Transcutaneous Electrical Nerve Stimulation (TENS)

Mwa njira iyi yosasokoneza, kusonkhezera kwa magetsi kumaperekedwa pakhungu pofuna kulimbikitsa mitsempha yozungulira m'deralo kuti athetse ululu pamlingo wina. Njirayi imachepetsa ululu mukangotsatira kugwiritsa ntchito koma kugwira ntchito kwake kwanthawi yayitali ndikokayikitsa. Ndi maphunziro ena, zapezeka kuti palibe kusintha kwakukulu pakumva ululu ndi momwe zimagwirira ntchito poyerekeza ndi placebo. Zipangizo zomwe zimapanga TENSzi zitha kupezeka mosavuta kuchokera ku dipatimenti ya odwala kunja. Chotsatira chokhacho chikuwoneka ngati kupsa mtima pang'ono komwe kumachitika mwa odwala atatu. (Johnson, Mark I)

Back School

Njirayi inayambitsidwa ndi cholinga chochepetsera zizindikiro za ululu ndi kubwereranso kwawo. Idayambitsidwa koyamba ku Sweden ndipo imaganizira za kaimidwe, ergonomics, masewera olimbitsa thupi oyenera kumbuyo, komanso mawonekedwe a chigawo cha lumbar. Odwala amaphunzitsidwa kaimidwe koyenera kukhala, kuyimirira, kukweza zolemera, kugona, kusamba kumaso, ndi kutsuka mano kupeŵa ululu. Poyerekeza ndi njira zina zochiritsira, chithandizo cha kusukulu yakumbuyo chatsimikiziridwa kukhala chothandiza nthawi zonse zaposachedwa komanso zapakatikati pakuwongolera ululu wammbuyo komanso magwiridwe antchito.

Maphunziro Oleza Mtima

Mwa njira iyi, wothandizira amalangiza wodwalayo momwe angasamalire zizindikiro za ululu wammbuyo. Mapangidwe amtundu wa msana ndi biomechanics okhudza njira zovulaza amaphunzitsidwa poyamba. Kenaka, pogwiritsa ntchito zitsanzo za msana, matenda osokoneza bongo a disk amafotokozedwa kwa wodwalayo. Kwa wodwala payekhapayekha, malo oyenerera amatsimikiziridwa ndiyeno amafunsidwa kuti asunge malowo kuti asatengere zizindikiro.

Njira ya Bio-Psychosocial ku Multidisciplinary Back Therapy

Kupweteka kwa msana kosalekeza kungayambitse kuvutika maganizo kwambiri kwa wodwalayo, zomwe zimayambitsa kusokonezeka kwa maganizo ndi kukhumudwa. Izi zikhoza kusokoneza zotsatira zachipatala zomwe zimapangitsa kuti njira zambiri zothandizira zikhale zopanda ntchito. Choncho, odwala ayenera kuphunzitsidwa za njira zamaganizo zomwe zimatchedwa "makhalidwe" ndi "bio-psychosocial" kuti athetse ululu. Kuphatikiza pa kuchiza zomwe zimayambitsa zowawa, zamaganizidwe, ndi chikhalidwe cha anthu ziyeneranso kuyang'aniridwa mwanjira iyi. Pofuna kuchepetsa malingaliro a wodwalayo za ululu ndi kulemala, njira monga zoyembekeza zosinthidwa, njira zotsitsimula, kuwongolera kuyankhidwa kwa thupi ndi khalidwe lophunzira, ndi kulimbikitsana zimagwiritsidwa ntchito.

Kuchiza Mankhwala

Kwa ululu wopweteka kwambiri wa msana, mankhwalawa akuwoneka kuti ndi opindulitsa. Kwa nthawi ya chaka chimodzi, chithandizo chakutikita minofu chapezeka kuti n'chothandiza kwambiri kwa odwala ena poyerekeza ndi acupuncture ndi njira zina zopumulira. Komabe, sizothandiza kwambiri kuposa TENS komanso kuchita masewera olimbitsa thupi ngakhale odwala payekha angakonde wina kuposa mnzake. (Furlan, Andrea D., et al.)

Kusokoneza Msana

Thandizo limeneli limakhudza kusinthasintha kwa mgwirizano kupitirira kusuntha kwake, koma osapitirira momwe thupi limakhalira. Ichi ndi chithandizo chamanja chomwe chimakhudza kuwongolera kwa lever kwakutali ndi liwiro lotsika. Zimaganiziridwa kuti zimathandizira kupweteka kwa msana kupyolera mu njira zingapo monga kumasulidwa kwa mitsempha yotsekedwa, kuwonongeka kwa articular ndi peri-articular adhesions, komanso kupyolera mu zigawo zowonongeka za msana zomwe zinasamutsidwa. Zingathenso kuchepetsa kuphulika kwa diski, kumasula minofu ya hypertonic, kulimbikitsa ulusi wa nociceptive mwa kusintha ntchito ya neurophysiological ndikuyikanso menisci pamtunda wa articular.

Kuponderezedwa kwa msana kumaganiziridwa kuti ndikopambana kwambiri poyerekeza ndi njira zambiri monga TENS, mankhwala ochita masewera olimbitsa thupi, mankhwala a NSAID, ndi chithandizo cha kusukulu. Kafukufuku yemwe alipo pano ndi wabwino pakuchita bwino kwake munthawi yayitali komanso yayifupi. Ndiwotetezeka kwambiri kupereka odwala osaphunzitsidwa bwino omwe ali ndi vuto la disc herniation ndi cauda equina zomwe zimangodziwika pansi pa 1 mwa anthu 3.7 miliyoni. (Bronfort, Gert, et al.)

Thandizo la Lumbar

Odwala omwe akuvutika ndi ululu wopweteka kwambiri chifukwa cha zowonongeka pamagulu angapo ndi zifukwa zingapo angapindule ndi chithandizo cha lumbar. Pali umboni wotsutsana wokhudzana ndi mphamvu zake ndi maphunziro ena omwe amati kusintha kwapang'onopang'ono kwa mpumulo wanthawi yayitali komanso wanthawi yayitali pomwe ena amati palibe kusintha kotereku poyerekeza ndi njira zina zamankhwala. Zothandizira za lumbar zimatha kukhazikika, kukonza zolakwika, kuchepetsa mphamvu zamakina, ndikuchepetsa kusuntha kwa msana. Itha kukhalanso ngati placebo ndikuchepetsa ululu posisita madera omwe akhudzidwa ndikugwiritsa ntchito kutentha.

Lumbar Traction

Njirayi imagwiritsa ntchito chingwe chomwe chimamangiriridwa ku nthiti ya Iliac ndi m'munsi mwa nthiti ndipo imagwiritsa ntchito mphamvu yotalika pamtunda wa axial kuti athetse ululu wopweteka kwambiri. Mulingo ndi nthawi ya mphamvuyo zimasinthidwa malinga ndi wodwalayo ndipo zimatha kuyezedwa pogwiritsa ntchito zida poyenda komanso kugona. Lumbar traction imagwira ntchito potsegula malo a intervertebral disc komanso kuchepetsa lumbar lordosis. Zizindikiro za matenda a disc degenerative zimachepetsedwa kudzera mu njirayi chifukwa cha kusintha kwa msana kwakanthawi komanso zopindulitsa zake. Amachepetsa kupsinjika kwa mitsempha ndi kupsinjika kwamakina, kumasokoneza zomatira mu gawo ndi annulus, komanso zizindikiro zowawa za nociceptive. Komabe, palibe umboni wochuluka wokhudzana ndi mphamvu zake zochepetsera ululu wammbuyo kapena kupititsa patsogolo ntchito za tsiku ndi tsiku. Komanso, zoopsa zomwe zimagwirizanitsidwa ndi lumbar traction zidakali pansi pa kafukufuku ndipo malipoti ena akupezeka kumene achititsa kuti mitsempha ikhale yovuta, kupuma, ndi kusintha kwa magazi chifukwa cha mphamvu yolemetsa komanso kuyika kolakwika kwa chingwe. (Harte, A et al.)

Chithandizo chamankhwala

Thandizo lachipatala limaphatikizapo chithandizo chamankhwala ndi mankhwala otsitsimula minofu, jakisoni wa steroid, NSAIDs, opioids, ndi ena ochepetsa ululu. Izi ndizofunikira, kuwonjezera pa chithandizo chokhazikika, mwa odwala ambiri omwe ali ndi matenda osokoneza bongo. Pharmacotherapy cholinga chake ndikuwongolera kulemala, kuchepetsa ululu ndi kutupa ndikuwongolera moyo wabwino. Zimaperekedwa malinga ndi wodwala payekhapayekha popeza palibe mgwirizano wokhudzana ndi chithandizocho.

Zotsitsimula Minofu

Matenda a Degenerative disc amatha kupindula ndi zotsitsimula za minofu mwa kuchepetsa kupindika kwa minofu ndikuchotsa ululu. Kuchita bwino kwa mankhwala otsitsimula minofu pakuwongolera ululu ndi mawonekedwe ogwirira ntchito kwakhazikitsidwa kudzera m'mitundu ingapo ya kafukufuku. Benzodiazepine ndiye njira yopumula kwambiri yomwe ikugwiritsidwa ntchito pano.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Mankhwalawa amagwiritsidwa ntchito kawirikawiri ngati sitepe yoyamba mu disc degenerative matenda kupereka analgesia, komanso anti-yotupa zotsatira. Pali umboni wamphamvu wosonyeza kuti umachepetsa ululu wopweteka kwambiri. Komabe, kugwiritsidwa ntchito kwake kumachepetsedwa ndi kusokonezeka kwa m'mimba, monga pachimake gastritis. Ma selective COX2 inhibitors, monga celecoxib, amatha kuthana ndi vutoli pongoyang'ana COX2 receptors. Kugwiritsiridwa ntchito kwawo sikuvomerezedwa kwambiri chifukwa cha zotsatira zake pakukula kwa matenda a mtima ndi ntchito yayitali.

Mankhwala Opioid

Ichi ndi sitepe yokwera pamwamba pa makwerero opweteka a WHO. Amasungidwa kwa odwala omwe akuvutika ndi ululu wopweteka kwambiri osayankha ma NSAID ndi omwe ali ndi vuto la GI losapiririka ndi mankhwala a NSAID. Komabe, malangizo a mankhwala ochizira ululu wammbuyo amasiyana kwambiri pakati pa asing'anga. Malinga ndi mabuku, 3 mpaka 66% ya odwala akhoza kutenga mawonekedwe a opioid kuti athetse ululu wawo wammbuyo. Ngakhale kuchepetsedwa kwakanthawi kochepa kwazizindikiro kumazindikirika, pali chiwopsezo chakugwiritsa ntchito mankhwala osokoneza bongo kwanthawi yayitali, kulolerana kwakukulu, komanso kuvutika kupuma mwa okalamba. Mseru ndi kusanza ndi zina mwazovuta zomwe zimachitika kwakanthawi kochepa. (�Kubwereza Mwadongosolo: Chithandizo cha Opioid Pakupweteka Kwambiri Kwamsana: Kuchuluka, Kuchita Bwino, Ndi Kuyanjana Ndi Chizoloŵezi�)

Anti-Depressants

Anti-depressants, pa mlingo wochepa, ali ndi phindu la analgesic ndipo akhoza kukhala opindulitsa kwa odwala omwe ali ndi ululu wopweteka kwambiri omwe angakhale ndi zizindikiro za kuvutika maganizo. Ululu ndi kuzunzika kungakhale kusokoneza kugona kwa wodwalayo ndi kuchepetsa ululu. Izi zitha kuthandizidwa pogwiritsa ntchito anti-depressants pamlingo wochepa ngakhale palibe umboni wosonyeza kuti zimathandizira ntchitoyo.

Chithandizo cha jekeseni

Majekeseni a Epidural Steroid

Jekeseni wa Epidural steroid ndi mtundu wa jakisoni womwe umagwiritsidwa ntchito kwambiri pochiza matenda osachiritsika a disc komanso radiculopathy yogwirizana. Pali kusiyana pakati pa mtundu wa steroid wogwiritsidwa ntchito ndi mlingo wake. 8- 10 mL ya osakaniza a methylprednisolone ndi saline wamba amaonedwa kuti ndi othandiza komanso otetezeka. Jakisoni atha kuperekedwa kudzera munjira za interlaminar, caudal, kapena transforamina. Singano ikhoza kuikidwa motsogozedwa ndi fluoroscopy. Chosiyana choyamba, ndiye kuti anesthesia ya m'deralo ndipo potsirizira pake, steroid imalowetsedwa mu epidural space pamtunda wokhudzidwa kudzera mwa njirayi. Kuchepetsa ululu kumatheka chifukwa cha kuphatikiza kwa zotsatira za anesthesia wamba ndi steroid. Kuthetsa ululu mwamsanga kungapezeke kudzera mu mankhwala oletsa ululu wamba mwa kuletsa kufalikira kwa chizindikiro cha ululu komanso kutsimikiziranso za matendawa. Kutupa kumachepanso chifukwa cha zochita za ma steroid potsekereza kuphulika kwa pro-inflammatory.

M'zaka khumi zapitazi, kugwiritsa ntchito jakisoni wa epidural steroid kwakula ndi 121%. Komabe, pali kutsutsana pakugwiritsa ntchito kwake chifukwa cha kusiyanasiyana kwamayankhidwe komanso zotsatira zake zoyipa. Nthawi zambiri, ma jakisoniwa amakhulupilira kuti amachepetsa zizindikiro kwakanthawi kochepa. Madokotala ena akhoza kubaya jekeseni 2 mpaka 3 mkati mwa nthawi ya sabata imodzi, ngakhale zotsatira za nthawi yayitali zimakhala zofanana ndi za wodwala jekeseni imodzi yokha. Kwa chaka chimodzi, jakisoni wopitilira anayi sayenera kuperekedwa. Kuti muchepetse ululu mwachangu komanso mogwira mtima, morphine wopanda preservative-free morphine itha kuwonjezeredwa mujakisoniyo. Ngakhale mankhwala am'deralo, monga lidocaine ndi bupivacaine, amawonjezeredwa pachifukwa ichi. Umboni wa kuchepetsa ululu kwa nthawi yaitali ndi wochepa. (�Mayeso Oyendetsedwa ndi Placebo Kuti Muyese Kuchita Bwino Kwa Kuchepetsa Ululu Pogwiritsa Ntchito Ketamine Yokhala Ndi Epidural Steroids Pakupweteka Kwambiri Pakumbuyo Kwapambuyo�)

Pali zotsatirapo zoyipa chifukwa cha mankhwalawa, kuwonjezera pa kukwera mtengo kwake komanso zovuta zake. Singano zitha kusokonekera ngati fluoroscopy sikugwiritsidwa ntchito mochuluka ngati 25% ya milandu, ngakhale kukhalapo kwa ogwira ntchito odziwa zambiri. Kuyika kwa epidural kumatha kudziwika ndi pruritus modalirika. Kupsinjika kwa kupuma kapena kusunga mkodzo kumatha kuchitika pambuyo jekeseni wa morphine motero wodwalayo ayenera kuyang'aniridwa kwa maola 24 atatha jekeseni.

Majekeseni a Facet

Majekeseniwa amaperekedwa kumalo olumikizana, omwe amatchedwanso zygapophysial joints, omwe amakhala pakati pa ma vertebrae awiri oyandikana. Anesthesia imatha kubayidwa mwachindunji kumalo olowa kapena kunthambi yapakati ya dorsal rami, yomwe imayimitsa. Pali umboni wosonyeza kuti njirayi imapangitsa kuti ntchito ikhale yabwino, moyo wabwino, komanso kuchepetsa ululu. Amaganiziridwa kuti amapereka phindu lalifupi komanso lalitali, ngakhale kuti kafukufuku wasonyeza kuti jekeseni wamtundu uliwonse ndi jakisoni wa epidural steroid ndi wofanana. (Wynne, Kelly A)

Majekeseni a SI Joint

Ichi ndi cholumikizira cha diarthrodial synovial chokhala ndi minyewa yochokera ku ma axon a myelin ndi omwe si a myelin. Jakisoniyo amatha kuchiza matenda osokonekera a disc omwe amaphatikiza kuphatikiza kwa sacroiliac komwe kumabweretsa kupumula kwakanthawi komanso kwakanthawi kuzizindikiro monga kupweteka kwa msana komanso kupweteka kwa miyendo, ntchafu, ndi matako. Jekeseni akhoza kubwerezedwa miyezi iwiri kapena itatu iliyonse koma ayenera kuchitidwa pokhapokha ngati pakufunika kutero. (MAUGARS, Y. et al.)

Intradiscal Non Operative Therapies for Discogenic Pain

Monga tafotokozera pansi pa zofufuza, discography ingagwiritsidwe ntchito ngati njira yodziwira komanso yochizira. Pambuyo pa diski yodwala matendawa, njira zingapo zochepetsera zochepa zimatha kuyesedwa musanayambe opaleshoni. Kutentha kwamagetsi ndi kutentha kwake kungagwiritsidwe ntchito kugwirizanitsa posterior annulus potero kulimbitsa collagen fibers, denaturing ndi kuwononga oyimira pakati otupa ndi ma nociceptors, ndi kusindikiza ziwerengero. Njira zomwe zimagwiritsidwa ntchito mu izi zimatchedwa intradiscal electrothermal therapy (IDET) kapena radiofrequency posterior annuloplasty (RPA), momwe electrode imaperekedwa ku diski. IDET ili ndi umboni wocheperako pakuchepetsa zizindikiro za odwala omwe ali ndi vuto la disc, pomwe RPA ili ndi chithandizo chochepa chokhudzana ndi nthawi yayitali komanso yayitali. Njira zonsezi zingayambitse zovuta monga kuvulala kwa mitsempha ya mitsempha, kusokonezeka kwa catheter, matenda, ndi post-procedure disc herniation.

Kuchiza Opaleshoni

Chithandizo cha opaleshoni chimasungidwa kwa odwala omwe ali ndi chithandizo cholephereka cholephereka poganizira kuopsa kwa matendawa, zaka, zovuta zina, chikhalidwe chachuma, komanso kuchuluka kwa zotsatira zomwe zikuyembekezeka. Akuti pafupifupi 5% ya odwala omwe ali ndi matenda osokoneza bongo amachitidwa opaleshoni, mwina chifukwa cha matenda awo a lumbar kapena matenda a chiberekero. (Rydevik, Bjrn L.)

Njira za Lumbar Spine

Opaleshoni ya lumbar imasonyezedwa kwa odwala omwe ali ndi ululu wopweteka kwambiri, ndi nthawi ya 6 kwa miyezi 12 ya mankhwala osagwira ntchito, omwe ali ndi vuto lalikulu la msana. Opaleshoniyo nthawi zambiri imakhala yosankha pokhapokha ngati pali matenda a cauda equina. Pali mitundu iwiri yamachitidwe omwe cholinga chake ndikuphatikiza kuphatikizika kwa msana kapena decompression kapena zonse ziwiri. (Matenda a Degenerative Disk: Background, Anatomy, Pathophysiology.�)

Kutha kwa msana Kumaphatikizapo kuyimitsa mayendedwe pagawo lopweteka la vertebral kuti muchepetse ululu pophatikiza ma vertebrae angapo pogwiritsa ntchito kumezanitsa mafupa. Amaonedwa kuti ndi othandiza kwa nthawi yayitali kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto la msana kapena kuyenda mopitirira muyeso. Pali njira zingapo zopangira opaleshoni ya fusion. (Gupta, Vijay Kumar, et al)

• Lumbar spinal posterolateral guttur fusion

Njirayi imaphatikizapo kuika fupa la fupa mu gawo la posterolateral la msana. Kumezanitsa mafupa kumatha kukololedwa kuchokera ku posterior iliac crest. Mafupa amachotsedwa pa periosteum kuti alumikizane bwino. Kulimbitsa kumbuyo kumafunika pakapita opaleshoni ndipo odwala angafunike kukhala m'chipatala kwa masiku 5 mpaka 10. Kuyenda pang'ono ndi kusiya kusuta ndikofunikira kuti muphatikize bwino. Komabe, zoopsa zingapo monga kusagwirizana, matenda, magazi, ndi mgwirizano wolimba ndi ululu wammbuyo ukhoza kuchitika.

• Posterior lumbar interbody fusion

Mwanjira iyi, njira zochepetsera kapena diskectomy zitha kuchitidwanso mwanjira yomweyo. Mafupa amapangidwa mwachindunji ku danga la disc ndipo ligamentum flavum imachotsedwa kwathunthu. Kwa matenda osokonekera a disc, danga la interlaminar limakulitsidwanso pochita gawo lapakati lapakati. Zingwe zakumbuyo ndizosankha ndi njira iyi. Zili ndi zovuta zingapo poyerekezera ndi njira yapambuyo monga ma graft ang'onoang'ono okha omwe angalowetsedwe, malo ochepetsetsa omwe amapezeka kuti asakanike, komanso zovuta pochita opaleshoni kwa odwala omwe ali ndi vuto la msana. Chiwopsezo chachikulu chomwe chimakhudzidwa ndi osakhala mgwirizano.

• Anterior lumbar interbody fusion

Njirayi ndi yofanana ndi yakumbuyo kupatula kuti imayandikira pamimba m'malo mwa kumbuyo. Zili ndi ubwino wosasokoneza minofu yam'mbuyo ndi mitsempha ya mitsempha. Iwo contraindicated odwala ndi kufooka kwa mafupa ndipo ali ndi chiopsezo magazi, retrograde umuna amuna, sanali mgwirizano, ndi matenda.

• Transforaminal lumbar interbody fusion

Iyi ndi njira yosinthidwa ya posterior njira yomwe ikukhala yotchuka. Zimapereka chiopsezo chochepa ndi kuwonetseredwa bwino ndipo zimasonyezedwa kuti zimakhala ndi zotsatira zabwino kwambiri ndi zovuta zingapo monga CSF kutayikira, kuwonongeka kwa ubongo kwakanthawi, ndi matenda a bala.

Total Disc Arthroplasty

Iyi ndi njira ina yogwiritsira ntchito disc fusion ndipo yakhala ikugwiritsidwa ntchito pochiza matenda a lumbar degenerative disc pogwiritsa ntchito diski yowonongeka kuti isinthe diski yomwe yakhudzidwa. Prosthesis yonse kapena nyukiliya prosthesis ingagwiritsidwe ntchito kutengera momwe alili.

Kusokonezeka Kuchotsa mbali ya diski ya vertebral body, yomwe imayambitsa mitsempha kuti itulutse ndikupereka mwayi wochira kudzera mu njira zotchedwa diskectomy ndi laminectomy. Kuchita bwino kwa njirayi ndi kokayikitsa ngakhale kuti ndi opaleshoni yomwe imachitika kawirikawiri. Zovuta ndizochepa kwambiri zomwe zimakhala ndi mwayi wochepa wobwereza zizindikiro ndi kukhutira kwakukulu kwa odwala. (Gupta, Vijay Kumar, et al)

• Lumbar discectomy

Opaleshoniyo imachitidwa kudzera mu njira yakumbuyo yapakatikati mwa kugawa ligamentum flavum. Mizu ya mitsempha yomwe imakhudzidwa imadziwika ndipo bulging annulus imadulidwa kuti itulutse. Kuyezetsa kwathunthu kwa minyewa kuyenera kuchitidwa pambuyo pake ndipo odwala nthawi zambiri amakhala oyenera kupita kwawo pakadutsa masiku 1 ~ 5. Zochita zolimbitsa thupi zocheperako ziyenera kuyambika posachedwa ndikutsatiridwa ndi ntchito yopepuka kenako ntchito yolemetsa pa 2 ndi masabata a 12 motsatana.

• Lumbar laminectomy

Izi zitha kuchitidwa mozama mulingo umodzi, komanso kudzera mumagulu angapo. Laminectomy iyenera kukhala yayifupi momwe mungathere kuti mupewe kusakhazikika kwa msana. Odwala awonetsa mpumulo wazizindikiro komanso kuchepa kwa radiculopathy kutsatira ndondomekoyi. Zoopsazi zingaphatikizepo kusadziletsa kwa matumbo ndi chikhodzodzo, CSF kutuluka, kuwonongeka kwa mizu ya mitsempha, ndi matenda.

Njira za Cervical Spine

Cervical degenerative disc matenda amasonyezedwa kwa opaleshoni pamene pali ululu wosapiririka wokhudzana ndi kuperewera kwa magalimoto ndi zomverera. Opaleshoni imakhala ndi zotsatira zabwino zoposa 90% ngati pali umboni wa radiographic wa kupsinjika kwa mizu ya mitsempha. Pali zosankha zingapo kuphatikiza anterior cervical diskectomy (ACD), ACD, and fusion (ACDF), ACDF yokhala ndi kukonza mkati, ndi posterior foraminotomy. (Matenda a Degenerative Disk: Background, Anatomy, Pathophysiology.�)

Machiritso Otengera Ma cell

Stem cell transplantation yatuluka ngati njira yatsopano yothandizira matenda osokonekera omwe ali ndi zotsatira zabwino. Kukhazikitsidwa kwa autologous chondrocytes kwapezeka kuti kumachepetsa ululu wa discogenic pazaka 2. Masiku ano mankhwala amenewa akukumana ndi mayesero a anthu. (Jeong, Je Hoon, et al.)

Gene Therapy

Kusintha kwa ma gene kuti ayimitse njira yowonongeka kwa ma disc komanso ngakhale kuyambitsanso kusinthika kwa ma disc akufufuzidwa. Pachifukwa ichi, majini opindulitsa amayenera kudziwika pamene akuchepetsa ntchito yowonongeka yomwe imalimbikitsa majini. Zosankha zatsopanozi zimapereka chiyembekezo kuti chithandizo chamtsogolo chiwongoleredwe pakukonzanso ma intervertebral discs. (Nishida, Kotaro, et al.)

Matenda a degenerative disc ndi nkhani yathanzi yomwe imadziwika ndi ululu wopweteka kwambiri chifukwa cha kuwonongeka kwa intervertebral disc, monga kupweteka kwa msana mu lumbar msana kapena kupweteka kwa khosi pakhosi. Ndi kuwonongeka kwa intervertebral disc ya msana. Zosintha zingapo za pathological zitha kuchitika pakuwonongeka kwa disc. Zowonongeka zosiyanasiyana za anatomical zimathanso kuchitika mu intervertebral disc. Kupweteka kwapang'onopang'ono ndi kupweteka kwa khosi ndizovuta zazikulu za epidemiological, zomwe zimaganiziridwa kuti zimagwirizana ndi matenda osokonezeka a disc. Ululu wammbuyo ndi chifukwa chachiwiri chomwe chimayambitsa maulendo a dokotala ku United States. Akuti pafupifupi 80% ya akuluakulu aku US amavutika ndi ululu wammbuyo kamodzi kamodzi pa moyo wawo. Chifukwa chake, kumvetsetsa bwino za matenda osokonekera a disc ndikofunikira kuti athe kuthana ndi vutoli. - Dr. Alex Jimenez DC, CCST Insight

Kukula kwa chidziwitso chathu kumangokhala kwa chiropractic, minofu ndi mafupa, mankhwala akuthupi, thanzi, ndi zovuta zaumoyo komanso/kapena zolemba zamankhwala, mitu, ndi zokambirana. Timagwiritsa ntchito ndondomeko zaumoyo ndi thanzi kuti tithandizire ndikuthandizira kuvulala kapena kusokonezeka kwa minofu ndi mafupa. Zolemba zathu, mitu yathu, mitu yathu, ndi zidziwitso zathu zimakhudza nkhani zachipatala, zovuta, ndi mitu yomwe ikugwirizana ndikuthandizira mwachindunji kapena mwanjira ina momwe timagwirira ntchito pachipatala.* Ofesi yathu yayesetsa kupereka mawu otithandizira ndipo yazindikira kafukufuku wofunikira kapena maphunziro othandizira ma post athu. Timapanganso makope othandizira maphunziro a kafukufuku kuti apezeke ku board kapena kwa anthu akafunsidwa. Timamvetsetsa kuti timaphimba nkhani zomwe zimafuna kufotokozera zina za momwe zingathandizire mu ndondomeko ya chisamaliro kapena ndondomeko ya chithandizo; kotero, kuti mupitirize kukambirana nkhaniyi pamwambapa, chonde muzimasuka kufunsa Dr. Alex Jimenez kapena tilankhule nafe pa 915-850-0900. Wopereka (ma) Ovomerezeka ku Texas* & New Mexico*�

Wosankhidwa ndi Dr. Alex Jimenez DC, CCST

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