Iyini Isifo Se-Degenerative Disc (DDD)?: Uhlolojikelele

by UDkt Alex Jimenez | Ukuhlungu obusemhlane, I-Chiropractic, Ubuhlungu Bokubuyela Emuva, Ubuhlungu obungapheliyo, Impilo, I-Disc Herniated, Ubuhlungu Emuva Emuva, Neck Pain, Sciatica, I-Sciatica Nerve Pain, I-Scoliosis, Ukuhlanzeka komgogodla, Care Spine, Ukwelashwa, Ubuhle

I-Degenerative Disc Disease yigama elijwayelekile lesimo lapho i-intervertebral disc eyonakele ibangela ubuhlungu obungapheli, okungenzeka kube ubuhlungu obuphansi emuva emgodleni we-lumbar noma ubuhlungu bentamo emgodleni wesibeletho. Akusona "isifo" ngesesibili, kodwa empeleni ukuwohloka kwe-disc intervertebral yomgogodla. I-intervertebral disc iyisakhiwo esinakekelwa kakhulu muva nje, ngenxa yemiphumela yomtholampilo. Izinguquko ze-pathological ezingenzeka ekuwohlokeni kwe-disc zihlanganisa i-fibrosis, ukunciphisa, ne-disc desiccation. Ukukhubazeka okuhlukahlukene kwe-anatomical kungase kwenzeke futhi ku-disc intervertebral efana ne-sclerosis yama-endplates, ukuwohloka kwe-fissuring kanye ne-mucinous ye-annulus, nokwakhiwa kwama-osteophyte.

Ubuhlungu obuphansi emuva nobuhlungu bentamo yizinkinga ezinkulu ze-epidemiological, okucatshangwa ukuthi zihlobene nezinguquko eziwohlokayo kudiski. Ubuhlungu beqolo yimbangela yesibili ehamba phambili yokuvakashela udokotela e-USA. Kulinganiselwa ukuthi cishe i-80% yabantu abadala base-US bahlushwa ubuhlungu obuphansi emuva okungenani kanye ngesikhathi sokuphila kwabo. (Modic, Michael T., noJeffrey S. Ross) Ngakho-ke, ukuqonda okuphelele kwesifo se-disc degenerative kuyadingeka ekulawuleni lesi simo esivamile.

I-Anatomy Yezakhiwo Ezihlobene

Anatomy of the Spine

Umgogodla uyisakhiwo esiyinhloko, esigcina ukuma futhi sibangele izinkinga ezihlukahlukene ngezinqubo zesifo. Umgogodla wakhiwe ama-vertebrae ayisikhombisa omlomo wesibeletho, ama-vertebrae e-thoracic ayishumi nambili, ama-vertebrae amahlanu ase-lumbar, kanye nama-vertebrae e-sacral ne-coccygeal ahlanganisiwe. Ukuzinza komgogodla kugcinwa ngamakholomu amathathu.

Ikholomu yangaphambili yenziwa i-anterior longitudinal ligament kanye nengxenye yangaphambili yomzimba we-vertebral. Ikholomu ephakathi yenziwa ingxenye yangemuva yomzimba we-vertebral kanye ne-posterior longitudinal ligament. Ikholomu engemuva iqukethe ikhothamo lomzimba elingasemuva elinezinqubo eziphambeneyo, ama-laminae, ama-facets, nezinqubo ze-spinous. (�Isifo Sediski Esiwohlozayo: Isendlalelo, I-Anatomy, I-Pathophysiology)

I-Anatomy ye-Intervertebral Disc

I-Intervertebral disc iphakathi kwemizimba emibili esondelene yama-vertebral kukholomu ye-vertebral. Cishe ingxenye eyodwa kwezine yobude obuphelele bekholomu yomgogodla yenziwa ngama-intervertebral discs. Le diski yakha i-fibrocartilaginous joint, ebizwa nangokuthi i-symphysis joint. Ivumela ukunyakaza okuncane ku-vertebrae futhi ibambe ama-vertebrae ndawonye. I-Intervertebral disc ibonakala ngezimfanelo zayo zokumelana nokucindezeleka nokumelana nokucindezela. I-intervertebral disc yakhiwa ikakhulukazi izingxenye ezintathu; i-gelatinous nucleus pulposus yangaphakathi, i-outer annulus fibrosus, ne-cartilage endplates etholakala phezulu nangaphansi lapho kuhlangana khona imizimba yama-vertebral.

I-Nucleus pulposus ingxenye yangaphakathi ene-gelatinous. Iqukethe i-proteoglycan nejeli yamanzi ehlanganiswe ndawonye ngohlobo lwe-II I-Collagen nemicu ye-elastin ehlelwe ngokukhululeka nangokungajwayelekile. I-Aggrecan iyi-proteoglycan enkulu etholakala ku-nucleus pulposus. Ihlanganisa cishe i-70% ye-nucleus pulposus futhi cishe i-25% ye-annulus fibrosus. Ingagcina amanzi futhi inikeze izici ze-osmotic, ezidingekayo ukuze zimelane nokucindezelwa futhi zisebenze njengento ebamba ukushaqeka. Lesi samba esiphezulu se-aggrecan ku-disc evamile sivumela izicubu ukusekela ukucindezelwa ngaphandle kokuwa futhi imithwalo isakazwa ngokulinganayo ku-annulus fibrosus kanye nomzimba we-vertebral ngesikhathi sokunyakaza komgogodla. (Wheater, Paul R, et al.)

Ingxenye engaphandle ibizwa ngokuthi i-annulus fibrosus, enemicu eminingi ye-collagen yohlobo lwe-I ehlelwe njengongqimba oluyisiyingi. Imicu ye-collagen igijima ngendlela etshekile phakathi kwe-lamellae ye-annulus ezindaweni ezishintshanayo eyinikeza amandla okumelana namandla aqinile. Imigqa ye-Circumferential iqinisa i-annulus fibrosus ngokuzungezile. Kusici sangaphambili, umsipha owugqinsi uqinisa futhi i-annulus fibrosus futhi umsipha omncane uqinisa uhlangothi olungemuva. (Choi, Yong-Soo)

Ngokuvamile, kune-disc eyodwa phakathi kwawo wonke ama-vertebrae ngaphandle kwe-atlas ne-axis, okuyi-vertebrae yokuqala neyesibili yomlomo wesibeletho emzimbeni. Lawa madiski angahamba cishe ku-6? kuwo wonke ama-eksisi okunyakaza nokuzungeza eksisi ngayinye. Kodwa le nkululeko yokuhamba iyahlukahluka phakathi kwezingxenye ezahlukene zekholomu ye-vertebral. I-vertebrae yomlomo wesibeletho inobubanzi obukhulu kakhulu bokunyakaza ngenxa yokuthi ama-intervertebral discs makhudlwana futhi kukhona indawo ebanzi ephansi futhi e-convex ephezulu yomzimba we-vertebral. Futhi banamajoyinti e-facet aqondaniswe ngokuphambene. Ama-vertebrae e-thoracic anobubanzi obuncane bokunyakaza e-flexion, extension, and rotation, kodwa abe ne-flexion yamahhala ye-lateral njengoba enamathele ezimbanjeni. I-lumbar vertebrae ine-flexion enhle nesandiso, futhi, ngoba ama-intervertebral discs awo amakhulu futhi izinqubo ze-spinous zitholakala ngemuva. Kodwa-ke, ukujikeleza kwe-lumbar kwe-lateral kunqunyelwe ngoba amalunga e-facet atholakala nge-sagittally. (�Isifo Sediski Esiwohlozayo: Isendlalelo, I-Anatomy, I-Pathophysiology�)

Ukuhlinzekwa Ngegazi

I-intervertebral disc ingenye yezakhiwo ezinkulu ze-avascular emzimbeni ezinama-capillaries aphela kuma-endplates. Izicubu zithola izakhi ezivela ezitsheni ezisethanjeni le-subchondral eliseduze ne-hyaline cartilage ekugcineni. Lezi zakhi ezifana ne-oxygen ne-glucose ziyiswa ku-intervertebral disc ngokusebenzisa ukusabalalisa okulula. (�I-Intervertebral Disc � Umgogodla � Orthobullets.Com�)

Ukunikezwa Kwezinzwa

I-sensory innervation yama-intervertebral discs iyinkimbinkimbi futhi iyahlukahluka ngokuya ngendawo ekholomu yomgogodla. Ukudluliswa kwezinzwa kucatshangwa ukuthi kulamula ngento engu-P, i-calcitonin, i-VIP, ne-CPON. I-Sinu vertebral nerve, ephuma ku-dorsal root ganglion, ayivamisi imicu engaphezulu ye-annulus. Imicu yezinzwa ayinwebeki ngalé kwemicu engaphezulu.

Ama-Lumbar intervertebral discs nawo ahlinzekwa kusici se-posterolateral namagatsha asuka ku-ventral primary rami kanye nasuka kuma-rami rami communicantes ampunga eduze nokuhlangana kwawo ne-ventral primary rami. Izingxenye ze-lateral zama-discs zinikezwa amagatsha avela ku-rami communicantes. Amanye ama-rami communicantes angase awele ama-intervertebral discs futhi afakwe emathangeni axhumene nawo, alele ekujuleni kwemvelaphi ye-psoas. (Palmgren, Tove, et al.)

Ama-disc intervertebral discs nawo ahlinzekwa esicini sangemuva ngamagatsha we-vertebral nerve. Izinzwa ze-sinu vertebral zomlomo wesibeletho nazo zitholakale zinenkambo ekhuphukayo emgodini we-vertebral ohlinzeka nge-disc endaweni yawo yokungena kanye nalokhu okungenhla. (BOGDUK, NIKOLAI, et al.)

I-Pathophysiology ye-Degenerative Disc Disease

Cishe i-25% yabantu ngaphambi kweminyaka yobudala ye-40 ibonisa izinguquko ze-disc degenerative ezingeni elithile. Ngaphezu kweminyaka engu-40 ubudala, ubufakazi be-MRI bubonisa izinguquko kubantu abangaphezu kuka-60%. (Suthar, Pokhraj) Ngakho-ke, kubalulekile ukutadisha inqubo ewohlokayo yama-intervertebral discs njengoba kutholakale ukuthi iyancipha ngokushesha kunanoma iyiphi enye izicubu ezixhumene emzimbeni, okuholela ebuhlungu emuva nasentanyeni. Izinguquko kuma-disc intervertebral amathathu zihlotshaniswa nezinguquko emzimbeni we-vertebral kanye namalunga aphakamisa inqubo eqhubekayo nenamandla.

Inqubo ewohlokayo yama-intervertebral discs ihlukaniswe yaba izigaba ezintathu, ngokusho kukaKirkaldy-Willis noBernard, okubizwa ��i-degenerative cascade��. Lezi zigaba zingadlulana futhi zingenzeka phakathi namashumi eminyaka. Nokho, ukuhlonza lezi zigaba ngokomtholampilo akunakwenzeka ngenxa yokunqwabelana kwezimpawu nezimpawu.

Isigaba 1 (Isigaba Sokuwohloka)

Lesi sigaba sibonakala ngokuwohloka. Kukhona izinguquko ze-histological, ezibonisa izinyembezi ezizungezile kanye nemifantu ku-annulus fibrosus. Lezi zinyembezi ezizungezayo zingase ziphenduke izinyembezi ze-radial futhi ngenxa yokuthi i-annulus pulposus igcinwe kahle, lezi zinyembezi zingabangela ubuhlungu beqolo noma ubuhlungu bentamo, obusendaweni kanye nokunyakaza okubuhlungu. Ngenxa yokuhlukunyezwa okuphindaphindiwe kuma-discs, ama-endplates angakwazi ukuhlukanisa okuholela ekuphazamisekeni kokunikezwa kwegazi ku-disc futhi ngakho-ke, ukuyivimbela ukunikezwa kwayo kwezakhi kanye nokususwa kwemfucuza. I-annulus ingase iqukathe ama-micro-fractures ku-collagen fibrils, engabonakala ku-electron microscopy futhi ukuskena kwe-MRI kungase kwembule i-desiccation, i-bulging ye-disc, kanye nendawo ephakeme kakhulu ku-annulus. Amalunga e-facet angase abonise ukusabela kwe-synovial futhi angabangela ubuhlungu obukhulu nge-synovitis ehambisanayo kanye nokungakwazi ukuhambisa ilunga emalungeni e-zygapophyseal. Lezi zinguquko kungenzeka zingenzeki kuwo wonke umuntu. (Gupta, Vijay Kumar, et al.)

I-nucleus pulposus nayo ihileleke kule nqubo njengoba umthamo wayo wokubhoboza amanzi uyancipha ngenxa yokunqwabelana kwama-proteoglycans ashintshiwe ngamakhemikhali ezinto eziphilayo. Lezi zinguquko zilethwa ikakhulukazi ama-enzyme amabili abizwa nge-matrix metalloproteinase-3 (MMP-3) kanye ne-tissue inhibitor ye-metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, noMaynak Gupta) Ukungalingani kwabo kuholela ekubhujisweni kwama-proteoglycans. Amandla ancishisiwe okumunca amanzi aholela ekuncipheni kokucindezela kwe-hydrostatic ku-nucleus pulposus futhi kubangela ukuthi i-annular lamellae ibophe. Lokhu kungandisa ukuhamba kwaleyo ngxenye okuholela ekucindezelekeni kwe-shear odongeni lwe-annular. Zonke lezi zinguquko zingaholela enqubweni ebizwa ngokuthi i-annular delamination kanye ne-fissuring ku-annulus fibrosus. Lezi yizinqubo ezimbili ezihlukene ze-pathological futhi zombili zingaholela ebuhlungu, ububele bendawo, i-hypomobility, imisipha ekhonjiwe, ukunyakaza okuhlangene okubuhlungu. Nokho, ukuhlolwa kwezinzwa kulesi sigaba kuvame ukujwayelekile.

Isigaba 2 (Isigaba Sokungazinzi)

Isigaba sokungasebenzi kahle silandelwa yisigaba sokungazinzi, esingase sibangele ukuwohloka okuqhubekayo kobuqotho bemishini yenhlanganisela ehlangene. Kungase kube nezinguquko eziningana ezihlangatshezwane nalesi sigaba, okuhlanganisa ukuphazanyiswa kwe-disc kanye ne-resorption, okungaholela ekulahlekelweni kwesikhala sediski. Izinyembezi eziningi ze-annular zingase zenzeke kulesi sigaba ngezinguquko ezihambisanayo kumalunga e-zagopophyseal. Angase ahlanganise ukuwohloka kwe-cartilage kanye ne-facet capsular laxity okuholela e-subluxation. Lezi zinguquko ze-biomechanical zibangela ukungazinzi kwengxenye ethintekile.

Izimpawu ezibonakala kulesi sigaba ziyafana nalezo ezibonakala esigabeni sokungasebenzi njengokuthi �ukunikeza indlela� yomhlane, izinhlungu lapho ume isikhathi eside, kanye �ukubamba� emhlane nomnyakazo. Zihambisana nezimpawu ezinjengokunyakaza okungavamile emalungeni ngesikhathi sokushibilika nokubona ukuthi umgogodla uyanyakaza noma ushintshele ohlangothini ngemva kokuma uqonde isikhathi esithile ngemva kokugoba. (Gupta, Vijay Kumar et al.)

Isigaba 3 (Isigaba Sokuqiniswa kabusha)

Kulesi sigaba sesithathu nesokugcina, ukuwohloka okuqhubekayo kuholela ekunciphiseni isikhala sediski nge-fibrosis kanye nokwakheka kwe-osteophyte kanye ne-transdiscal bridging. Ubuhlungu obuvela kulezi zinguquko bukhulu kakhulu uma kuqhathaniswa nezigaba ezimbili ezedlule, kodwa lezi zingahluka phakathi kwabantu ngabanye. Lokhu kuncishiswa kwesikhala sediski kungaba nemiphumela eminingana emgogodleni. Lokhu kungabangela umsele we-intervertebral ukuba ube mncane endaweni ephakeme-ephansi ngokulinganiselwa kwama-pedicles aseduze. Imigqa ye-longitudinal, esekela ikholomu ye-vertebral, ingase iphinde ibe ntula kwezinye izindawo eziholela ekuvimbeni nasekungaqini komgogodla. Ukunyakaza komgogodla kungabangela i-ligamentum flavum ukuba iqhume futhi ingabangela ukuguqulwa kwenqubo ye-aricular ephakeme kakhulu. Lokhu ekugcineni kuholela ekunciphiseni kobubanzi ekuqondeni kwe-anteroposterior yesikhala se-intervertebral kanye ne-stenosis yezimpande ze-nerve ephezulu.

Ukwakhiwa kwama-osteophyte kanye ne-hypertrophy yama-facets kungenzeka ngenxa yokuguqulwa komthwalo we-axial kumgogodla kanye nemizimba yama-vertebral. Lezi zingakheka kuzo zombili izinqubo ze-articular eziphakeme nezingaphansi futhi ama-osteophyte angaphumela ku-intervertebral canal kuyilapho ama-facet hypertrophied angaphumela emseleni ophakathi. Kucatshangwa ukuthi ama-osteophyte enziwa ekwandeni kwe-articular cartilage ku-periosteum ngemva kwalokho angena endochondral calcification kanye ne-ossification. Ama-osteophyte nawo akhiwa ngenxa yezinguquko ekucindezelekeni komoya-mpilo nangenxa yoshintsho kumfutho wamanzi ngaphezu kokukhubazeka kokusabalalisa umthwalo. I-osteophyte kanye ne-periarticular fibrosis ingabangela amalunga aqinile. Izinqubo ze-articular zingase futhi ziqondise ku-oblique direction ebangela i-retrospondylolisthesis eholela ekunciphiseni kwe-intervertebral canal, i-nerve root canal, kanye nomgogodla womgogodla. (KIRKALDY-WILLIS, WH et al.)

Zonke lezi zinguquko ziholela ebuhlungu obuphansi emuva, obunciphisa kakhulu. Ezinye izimpawu ezifana nokunciphisa ukunyakaza, ukuzwela kwemisipha, ukuqina, kanye ne-scoliosis kungenzeka. Amaseli we-synovial stem nama-macrophages ahileleke kule nqubo ngokukhulula izici zokukhula kanye nama-molecule e-matrix e-extracellular, asebenza njengabalamuleli. Ukukhululwa kwama-cytokines kutholakale ukuthi kuhlotshaniswa nesigaba ngasinye futhi kungase kube nomthelela wokwelapha ekuthuthukiseni ukwelashwa kwesikhathi esizayo.

I-Etiology Yezici Zengozi Yesifo Se-Degenerative Disc

Ukuguga Nokuwohloka

Kunzima ukuhlukanisa ukuguga nezinguquko eziwohlokayo. U-Pearce et al uphakamise ukuthi ukuguga nokuncipha kumelela izigaba ezilandelanayo ngaphakathi kwenqubo eyodwa eyenzeka kubo bonke abantu kodwa ngamanani ahlukene. Ukuwohloka kwediski, nokho, kwenzeka kaningi ngesivinini esisheshayo kunokuguga. Ngakho-ke, itholakala ngisho nasezigulini ezineminyaka yobudala yokusebenza.

Kubonakala kunobudlelwano phakathi kokuguga nokuwohloka, kodwa asikho isizathu esicacile esisasunguliwe. Ucwaningo oluningi luye lwenziwa mayelana nokudla, ukufa kwamangqamuzana, nokuqoqwa kwemikhiqizo ye-matrix eyonakele kanye nokwehluleka kwe-nucleus. Okuqukethwe kwamanzi kwe-disc intervertebral kuncipha ngokukhula kweminyaka. I-Nucleus pulposus ingathola imifantu engadlulela ku-annulus fibrosus. Ukuqala kwale nqubo kubizwa ngokuthi i-chondrosis inter vertebralis, engaphawula ukuqala kokucekelwa phansi kwe-intervertebral disc, ama-endplates, nemizimba yama-vertebral. Le nqubo ibangela izinguquko eziyinkimbinkimbi ekubunjweni kwamangqamuzana e-disc futhi ine-biomechanical ne-sequelae yomtholampilo engase ibangele ukukhubazeka okukhulu kumuntu othintekile.

Ukugxila kweseli ku-annulus kuncipha ngokukhula kweminyaka. Lokhu kungenxa yokuthi amaseli ku-disc angaphansi kwe-senescence futhi alahlekelwa amandla okwanda. Ezinye izimbangela ezihlobene nokuwohloka kweminyaka ethile yama-intervertebral discs zihlanganisa ukulahlekelwa kwamangqamuzana, ukunciphisa ukudla okunomsoco, ukuguqulwa ngemva kokuhumusha kwamaprotheni e-matrix, ukuqoqwa kwemikhiqizo yama-molecule e-matrix eyonakele, nokuhluleka kokukhathala kwe-matrix. Ukunciphisa ukudla okunomsoco ku-disc ephakathi, okuvumela ukuqoqwa kwemikhiqizo ye-cell waste kanye nama-molecule e-matrix eyonakele kubonakala kuwushintsho olubaluleke kakhulu kuzo zonke lezi zinguquko. Lokhu kuphazamisa umsoco futhi kubangela ukwehla kwezinga le-pH, okungase kuphazamise ukusebenza kwamaseli futhi kungaholela ekufeni kwamangqamuzana. Ukwenyuka kwe-catabolism kanye nokuncipha kwe-anabolism yamaseli e-senescent kungase kukhuthaze ukuwohloka. (Buckwalter, Joseph A.) Ngokocwaningo oluthile, kwakunamangqamuzana amaningi e-senescence ku-nucleus pulposus uma kuqhathaniswa ne-annulus fibrosus futhi ama-herniated discs abe nethuba eliphakeme lokubukeka kwamangqamuzana.� (Roberts, S. et al.)

Lapho inqubo yokuguga iqhubeka isikhathi esithile, ukugxila kwe-chondroitin 4 sulfate ne-chondroitin 5 sulfate, okuyi-hydrophilic kakhulu, kuncipha kuyilapho isilinganiso se-keratin sulfate ku-chondroitin sulfate sikhula. I-Keratan sulfate ine-hydrophilic kancane futhi inomkhuba omncane wokwenza ama-aggregate azinzile nge-hyaluronic acid. Njengoba i-aggrecan ihlukaniswa, futhi isisindo sayo samangqamuzana nezinombolo ziyancipha, i-viscosity ne-hydrophilicity ye-nucleus pulposus iyancipha. Izinguquko eziguquguqukayo kuma-intervertebral discs zisheshisa ngokunciphisa ingcindezi ye-hydrostatic ye-nucleus pulposus kanye nokuncipha kokunikezwa kwezakhi ngokusabalalisa. Lapho okuqukethwe kwamanzi kwe-matrix engaphandle kwe-extracellular kuncipha, ukuphakama kwe-disc intervertebral nakho kuzokwehla. Ukumelana kwe-disc kumthwalo we-axial nakho kuzoncishiswa. Ngenxa yokuthi umthwalo we-axial ube usudluliselwa ngqo ku-annulus fibrosus, ama-annulus clefts angadatshulwa kalula.

Zonke lezi zindlela ziholela ekushintsheni kwesakhiwo esibonakala kwisifo se-disc degenerative. Ngenxa yokuqukethwe kwamanzi okuncishisiwe ku-annulus fibrosus kanye nokulahlekelwa okuhlobene nokuthobelana, umthwalo we-axial ungasatshalaliswa kabusha kusici esingemuva sama-facets esikhundleni sengxenye evamile yangaphambili nemaphakathi yama-facets. Lokhu kungabangela i-facet arthritis, i-hypertrophy yemizimba yama-vertebral eseduze, kanye nama-bony spurs noma ama-bony overgrowth, okwaziwa ngokuthi ama-osteophyte, ngenxa yama-discs alulazayo. (Choi, Yong-Soo)

IGenetics kanye Nokuwohloka

Ingxenye yofuzo itholakale iyisici esiyinhloko ekuguleni kwe-disc degenerative. Izifundo zamawele, kanye nezifundo ezibandakanya amagundane, zibonise ukuthi izakhi zofuzo zidlala indima ekuwohlokeni kwe-disc. (Boyd, Lawrence M., et al.) Izakhi zofuzo ezinekhodi ye-collagen I, IX, ne-XI, i-interleukin 1, i-aggrecan, i-vitamin D receptor, i-matrix metalloproteinase 3 (MMP � 3), namanye amaprotheni aphakathi kwezakhi zofuzo kuphakanyiswe ukubandakanyeka esifweni se-disc degenerative. I-Polymorphisms ku-5 A kanye ne-6 A alleles ezenzeka esifundeni somgqugquzeli wezakhi zofuzo ezilawula ukukhiqizwa kwe-MMP 3 kutholakala ukuthi kuyisici esiyinhloko sokwanda kwe-lumbar disc degeneration kubantu asebekhulile. Ukusebenzisana phakathi kwalezi zakhi zofuzo ezihlukahlukene kunomthelela omkhulu ekuguleni kwe-intervertebral disc degeneration yonke.

Ukondleka kanye Nokuwohloka

Ukuwohloka kwe-Disc nakho kukholakala ukuthi kwenzeka ngenxa yokwehluleka kokunikezwa kokudla okunomsoco kumaseli e-intervertebral disc. Ngaphandle kwenqubo evamile yokuguga, ukuntuleka kokudla okunomsoco wamaseli e-disc kuthinteka kabi ngokubala kwe-endplate, ukubhema, kanye nesimo sokudla okunempilo. Ukuntuleka kokudla okunomsoco kungaholela ekwakhekeni kwe-lactic acid kanye nomfutho we-oxygen ophansi ohambisana nawo. Umphumela we-pH ophansi ungathinta ikhono lamaseli e-disc ukwakha nokugcina i-matrix ye-extracellular yama-disc futhi ibangele ukuwohloka kwe-intervertebral disc. Ama-discs awonakele awanawo amandla okuphendula ngokujwayelekile emandleni angaphandle futhi angase aholele ekuphazamiseni ngisho nasekunciphiseni okuncane emuva. (UTaher, Fadi, et al.)

Izici zokukhula zishukumisa ama-chondrocyte nama-fibroblasts ukukhiqiza inani elengeziwe le-matrix engaphandle kwamaseli. Iphinde ivimbele ukuhlanganiswa kwe-matrix metalloproteinase. Isibonelo salezi zici zokukhula sihlanganisa ukuguqula isici sokukhula, isici sokukhula esifana ne-insulin, kanye nesici sokukhula esiyisisekelo se-fibroblast. I-matrix eyonakele ilungiswa ngezinga elengeziwe lesici sokukhula esishintshayo kanye nesici sokukhula esiyisisekelo se-fibroblast.

Imvelo kanye nokuwohloka

Ngisho noma wonke ama-disc aneminyaka efanayo, ama-discs atholakala ezingxenyeni eziphansi ze-lumbar asengozini kakhulu ekushintsheni okulimazayo kunama-discs atholakala engxenyeni engenhla. Lokhu kusikisela ukuthi hhayi ukuguga kuphela kodwa, futhi ukulayisha ngomshini, kuyisici esibangela. Ukuhlangana phakathi kwesifo se-disc degenerative kanye nezici zemvelo kuye kwachazwa ngendlela ebanzi ngu-Williams no-Sambrook ngo-2011. (Williams, FMK, no-PN Sambrook) Ukulayisha okunamandla ngokomzimba okuhlotshaniswa nomsebenzi wakho kuyisici esiyingozi esinomthelela othile kwidiski. isifo esiwohlozayo. Kukhona futhi kungenzeka ukuthi amakhemikhali abangela ukuwohloka kwe-disc, njengokubhema, ngokusho kwezinye izifundo. (Batti�, Michele C.) I-Nicotine iye yathinteka ezifundweni ezimbili ukuze kubangele ukugeleza kwegazi okuphazamisekile ku-intervertebral disc, okuholela ekuwohlokeni kwe-disc. (BATTI�, MICHELE C., et al.) Ngaphezu kwalokho, inhlangano itholakale phakathi kwezilonda ze-atherosclerotic ku-aorta kanye nobuhlungu obuphansi emuva obukhomba ukuxhumana phakathi kwe-atherosclerosis nesifo se-disc degenerative. (Kauppila, LI) Ubunzima bokuwohloka kwe-disc kwakuhilelekile ekukhulupheleni ngokweqile, ukukhuluphala, i-metabolic syndrome, kanye nokwanda kwenkomba yomzimba kwezinye izifundo. (�Ucwaningo Olususelwe Kwabantu Lokuwohloka Kwediski Lezingane Nokuhlotshaniswa Kwalo Nokukhuluphala Nokukhuluphala, Ubuhlungu Beqolo Eliphansi, kanye Nesimo Sokusebenza Esinciphile. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Ngo-2011;93(7):662�70�)

Ubuhlungu be-Disc Degeneration (Ubuhlungu be-Discogenic)

Ubuhlungu be-Discogenic, okuwuhlobo lobuhlungu be-nociceptive, buvela kuma-nociceptors ku-annulus fibrosus lapho isimiso sezinzwa sithinteka yi-disc degenerative. I-Annulus fibrosus iqukethe ama-immune reactive nerve fibers engxenyeni yangaphandle yediski namanye amakhemikhali afana ne-vasoactive intestinal polypeptide, i-calcitonin peptide ehlobene ne-gene, kanye ne-substance P. (KONTTINEN, YRJ� T., et al.) Lapho izinguquko eziwohlokayo ama-intervertebral discs ayenzeka, isakhiwo esivamile kanye nomthwalo wemishini kuguqulwa okuholela ekunyakazeni okungavamile. Lawa ma-nociceptors e-disc angathola ukuzwa ngokungavamile ekushukumiseni kwemishini. Ubuhlungu bungacasulwa futhi indawo ephansi ye-pH ebangelwa ukuba khona kwe-lactic acid, okubangela ukwanda kokukhiqizwa kwabalamuli bobuhlungu.

Ubuhlungu obuvela ku-degenerative disc disease bungase buvele emisuka eminingi. Kungase kwenzeke ngenxa yokulimala kwesakhiwo, ingcindezi, nokucasuka emithanjeni yomgogodla. I-disc ngokwayo iqukethe imicu yezinzwa ezimbalwa kuphela, kodwa noma yikuphi ukulimala kungenza lezi zinzwa, noma lezo ezise-posterior longitudinal ligament, zibangele ubuhlungu. Ukunyakaza okuncane ku-vertebrae kungenzeka, okungase kubangele ubuhlungu be-reflex muscle spasms ngoba i-disc yonakalisiwe futhi igugile ngenxa yokulahlekelwa ukucindezeleka nokuphakama. Ukunyakaza okubuhlungu kuphakama ngenxa yokuthi izinzwa ezihlinzeka indawo zicindezelwe noma zicasulwa ama-facet joints kanye nemigqa e-foramen eholela emlenzeni nasemhlane ubuhlungu. Lobu buhlungu bungase buthuthukiswe ukukhululwa kwamaprotheni avuthayo asebenza emithanjeni e-foramen noma imizwa ehlayo emgodini womgogodla.

Izibonelo ze-pathological of the degenerative discs, lapho zibonwa ngaphansi kwe-microscope, zembula ukuthi kukhona izicubu ze-granulation ze-vascularized kanye ne-innervations eningi etholakala emifantwini yongqimba lwangaphandle lwe-annulus fibrosus oludlulela ku-nucleus pulposus. Indawo yezicubu ze-granulation ingenelwa ngamaseli e-mast amaningi futhi afaka isandla ngokungaguquki ezinqubweni ze-pathological ekugcineni eziholela ebuhlungu be-discogenic. Lokhu kufaka phakathi i-neovascularization, i-intervertebral disc degeneration, ukuvuvukala kwezicubu ze-disc, nokwakheka kwe-fibrosis. Amaseli e-Mast aphinde akhiphe izinto, ezifana ne-tumor necrosis factor kanye nama-interleukins, okungase kube uphawu lokuvula ezinye izindlela ezidlala indima ekubangeleni iqolo. Ezinye izinto ezingase zivuse lezi zindlela zihlanganisa i-phospholipase A2, ekhiqizwa ku-arachidonic acid cascade. Itholakala ekugxilweni okwandisiwe engxenyeni yesithathu yangaphandle ye-annulus ye-disc degenerative futhi kucatshangwa ukuthi ivuselela ama-nociceptors atholakala lapho ukuze akhulule izinto ezivuthayo ukuze kubangele ubuhlungu. Lezi zinto ziletha ukulimala kwe-axonal, i-intraneural edema, kanye nokuphelelwa amandla. (Brisby, Helena)

Ubuhlungu obungemuva kucatshangwa ukuthi buvela ku-intervertebral disc ngokwayo. Ngakho-ke kungani ubuhlungu buzokwehla kancane kancane ngokuhamba kwesikhathi lapho i-disc ewohlokayo iyeka ukubangela ubuhlungu. Kodwa-ke, ubuhlungu empeleni buvela ku-disc ngokwayo kuphela ku-11% yeziguli ngokusho kwezifundo ze-endoscopy. Isizathu sangempela sobuhlungu bokubuyela emuva sibonakala sibangelwa ukugqugquzelwa komngcele ophakathi we-nerve kanye nobuhlungu obudluliselwe eceleni kwengalo noma umlenze kubonakala kuphakama ngenxa yokukhuthazwa komgogodla we-nerve. Ukwelashwa kwe-disc degeneration kufanele kugxile kakhulu ekunciphiseni ubuhlungu ukuze kwehliswe ukuhlupheka kwesiguli ngoba kuwuphawu olukhubaza kakhulu oluphazamisa ukuphila kwesiguli. Ngakho-ke, kubalulekile ukusungula indlela yobuhlungu ngoba ayenzeki kuphela ngenxa yezinguquko zesakhiwo kuma-intervertebral discs kodwa futhi ngenxa yezinye izici ezifana nokukhululwa kwamakhemikhali nokuqonda lezi zindlela kungaholela ekunciphiseni ubuhlungu obuphumelelayo. (Choi, Yong-Soo)

Ukwethulwa Komtholampilo Kwesifo Se-Degenerative Disc

Iziguli ezinesifo se-disc degenerative zibhekana nenqwaba yezimpawu kuye ngokuthi lesi sifo sikuphi. Labo abane-lumbar disc degeneration bathola ubuhlungu obuphansi emuva, izimpawu ze-radicular, nobuthakathaka. Labo abane-cervical disc degeneration banobuhlungu bentamo nobuhlungu behlombe.

Ubuhlungu obuphansi emuva bungase buthuthukiswe ukunyakaza kanye nesimo. Ngokuvamile, izimpawu ziba zimbi kakhulu ngokuguquguquka, kuyilapho isandiso sivame ukuzikhulula. Ukulimala okuncane okusonteka, ngisho nokushwiba iklabhu yegalofu, kungabangela izimpawu. Ubuhlungu ngokuvamile bubonakala buncane lapho uhamba noma ugijima, lapho ushintsha indawo njalo nalapho ulele. Kodwa-ke, ubuhlungu ngokuvamile buyi-subjective futhi ezimweni eziningi, buyahlukahluka kakhulu kumuntu nomuntu futhi abantu abaningi bazobhekana nezinga eliphansi lobuhlungu obungapheli esifundeni esingaphansi ngokuqhubekayo ngenkathi ngezikhathi ezithile behlushwa ubuhlungu be-groin, i-hip, nomlenze. Ukuqina kobuhlungu kuzokwanda ngezikhathi ezithile futhi kuzohlala izinsuku ezimbalwa bese kuncipha kancane kancane. Lokhu �ukuqubuka� kuyisiqephu esibucayi futhi sidinga ukwelashwa ngama-analgesics anamandla. Ubuhlungu obukhulu kakhulu buzwakala endaweni ehlezi futhi buyakhula ngenkathi ugoba, uphakamisa, futhi usonta ukunyakaza njalo. Ubukhulu bobuhlungu bungahluka kakhulu ngokuthi abanye baba nobuhlungu obungapheli kwabanye ababa nobuhlungu obukhulu nobukhubaza ngezikhathi ezithile.� (Jason M. Highsmith, MD)

Ubuhlungu obusendaweni kanye nesisa emgodleni we-axial ngokuvamile buvela kuma-nociceptors atholakala ngaphakathi kwama-intervertebral discs, ama-facet joints, ama-sacroiliac joints, i-dura mater yezimpande ze-nerve, kanye nezakhiwo ze-myofascial ezitholakala ngaphakathi komgogodla we-axial. Njengoba kushiwo ezigabeni ezedlule, izinguquko ze-anatomical eziwohlokayo zingase zibangele ukuncipha komgogodla obizwa ngokuthi i-spinal stenosis, ukwanda kwezinqubo zomgogodla ezibizwa ngokuthi i-osteophytes, i-hypertrophy yezinqubo eziphansi neziphakeme ze-articular, i-spondylolisthesis, ukuqhuma kwe-ligamentum flavum kanye ne-disc herniation. . Lezi zinguquko ziholela ekuqoqweni kwezimpawu ezaziwa ngokuthi i-neurogenic claudication. Kungase kube nezimpawu ezinjengobuhlungu obuphansi emuva kanye nobuhlungu bomlenze kanye nokuba ndikindiki noma ukushoshozela emilenzeni, ubuthakathaka bemisipha, nokuwa konyawo. Ukulahlekelwa amathumbu noma ukulawulwa kwesinye kungase kusikisele ukuthi umgogodla ubophene futhi ukunakekelwa ngokushesha kuyadingeka ukuze kuvinjelwe ukukhubazeka unomphela. Lezi zimpawu zingahluka ngokuqina futhi zingase zibonakale ngezindlela ezihlukahlukene kubantu abahlukene.

Ubuhlungu bungaphinde bukhanye kwezinye izingxenye zomzimba ngenxa yokuthi umgogodla unikeza amagatsha amaningana ezindaweni ezimbili ezihlukene zomzimba. Ngakho-ke, lapho i-disc ewohlokile icindezela impande yezinzwa zomgogodla, ubuhlungu bungabuye butholakale emlenzeni lapho inzwa ekugcineni ingena khona. Lesi simo, esibizwa ngokuthi i-radiculopathy, singenzeka emithonjeni eminingi evela, ngenxa yenqubo yokuwohloka. I-disc bulging, uma iphuma phakathi nendawo, ingathinta izimpande ezehlayo ze-cauda equina, uma i-bulges posterolaterally, ingase ithinte izimpande zezinzwa eziphuma emgodini olandelayo ophansi we-intervertebral kanye ne-nerve yomgogodla ngaphakathi kwe-ventral ramus ingathinteka lapho i-disc iphuma. ngaseceleni. Ngokufanayo, ama-osteophyte aphumela emaphethelweni aphezulu naphansi esici sangemuva semizimba yama-vertebral angaphazamisa izicubu ezifanayo zezinzwa ezibangela izimpawu ezifanayo. I-Superior articular process hypertrophy ingase futhi iphazamise izimpande zemizwa kuye ngokuqagela kwazo. Izinzwa zingase zihlanganise izimpande zezinzwa ngaphambi kokuba ziphume emseleni olandelayo ophansi we-intervertebral kanye nezimpande zezinzwa ngaphakathi komsele wempande ongaphezulu kanye nesaka eliphakathi. Lezi zimpawu, ngenxa yokungena kwezinzwa, kufakazelwe izifundo ze-cadaver. I-Neural compromise kucatshangwa ukuthi yenzeke lapho ububanzi be-neuroforaminal buvalwe ngokubucayi ngokuncipha kwama-70%. Ngaphezu kwalokho, i-neural compromise ingakhiqizwa lapho i-posterior disc icindezelwa ngaphansi kwamamilimitha angu-4 ukuphakama, noma lapho ukuphakama kwe-foraminal kuncishiswa kube ngaphansi kwamamilimitha angu-15 okuholela ku-foraminal stenosis kanye ne-nerve impingement. (UTaher, Fadi, et al.)

Indlela Yokuxilonga

Iziguli ziqale zihlolwe ngomlando onembile kanye nokuhlolwa okuphelele komzimba nophenyo olufanele nokuhlolwa okuvusa inkanuko. Kodwa-ke, umlando uvame ukungaqondakali ngenxa yobuhlungu obungapheli obungenakutholakala endaweni ngendlela efanele kanye nobunzima ekunqumeni indawo eqondile ye-anatomical ngesikhathi sokuhlolwa okuvusa inkanuko ngenxa yethonya lezakhiwo eziseduze ze-anatomical.

Ngomlando wesiguli, imbangela yobuhlungu obuphansi emuva ingabonakala njengevela kuma-nociceptors kuma-intervertebral discs. Iziguli zingase futhi zinikeze umlando wesimo esingamahlalakhona sezimpawu kanye nokuba ndikindiki kwesifunda se-gluteal, ukuntweza kanye nokuqina komgogodla okuvame ukuba kubi kakhulu ngomsebenzi. Ubumnene bungase buvezwe ngokushaya kancane phezu komgogodla. Ngenxa yesimo sesifo esingapheli futhi esibuhlungu, iziguli eziningi zingase zibe nokuphazamiseka kwemizwa nokukhathazeka. Ukucindezeleka kucatshangwa ukuthi kunomthelela omubi emthwalweni wesifo. Kodwa-ke, abukho ubudlelwane obucacile phakathi kobunzima besifo kanye nemizwa noma ukuphazamiseka kokukhathazeka. Kuhle ukuqaphela nalezi zimo zempilo yengqondo. Ukuze ungabandakanyi amanye ama-pathologies angathi sína, kufanele kubuzwe imibuzo ephathelene nokukhathala, ukuncipha, umkhuhlane, nokugodola, okungase kubonise ezinye izifo. (Jason M. Highsmith, MD)

Enye i-etiology yobuhlungu obuphansi emuva kufanele ikhishwe lapho ihlola isiguli ngesifo se-disc degenerative. Izifo zesisu, ezingadala ubuhlungu beqolo njenge-aortic aneurysm, i-renal calculi, nesifo se-pancreatic, kufanele zikhishwe.

Isifo se-disc degenerative sinezinhlobo eziningana zokuxilongwa okufanele zicatshangelwe lapho isiguli sibonisa ubuhlungu emuva. Lokhu kubandakanya; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, kanye ne-lumbar radiculopathy. (�I-Degenerative Disc Disease � Physiopedia�)

Uphenyo

Uphenyo lusetshenziselwa ukuqinisekisa ukutholakala kwesifo se-disc degenerative. Lezi zingahlukaniswa zibe izifundo zaselabhorethri, izifundo ze-imaging, ukuhlolwa kokuqhutshwa kwemizwa, kanye nezinqubo zokuxilonga.

Izifundo Zokuthwebula

I-imaging in degenerative disc disease isetshenziselwa kakhulu ukuchaza ubudlelwano be-anatomical kanye nezici ze-morphological zama-disc athintekile, anenani elikhulu lokwelapha ekuthathweni kwezinqumo ezizayo zezinketho zokwelashwa. Noma iyiphi indlela yokucabanga, njenge-plain radiography, CT, noma i-MRI, inganikeza ulwazi oluwusizo. Kodwa-ke, imbangela eyinhloko ingatholakala kuphela ku-15% yeziguli njengoba kungekho zinguquko ezicacile ze-radiological ezibonakala esikhumbeni se-disc degenerative lapho kungabikho i-disc herniation kanye nokuntuleka kwe-neurological. Ngaphezu kwalokho, akukho ukuhlobana phakathi kwezinguquko ze-anatomical ezibonwa ezithombeni kanye nobukhulu bezimpawu, nakuba kukhona ukuhlobana phakathi kwenani lama-osteophyte kanye nobukhulu bobuhlungu be-back. Izinguquko eziwohlokayo ku-radiography zingabonakala nakubantu abangenazimpawu zokubonisa izimpawu eziholela ebunzimeni bokuhambisana nokufaneleka komtholampilo nokuthi kufanele kuqale nini ukwelashwa. (�I-Degenerative Disc Disease � Physiopedia�)

I-Plain Radiography

Le radiography yomlomo wesibeletho engabizi futhi etholakala kabanzi inganikeza ulwazi olubalulekile ngokukhubazeka, ukuqondanisa, kanye nezinguquko zethambo eliwohlokayo. Ukuze kutholakale ukuthi kukhona ukungazinzi komgogodla kanye nebhalansi ye-sagittal, i-flexion eguquguqukayo, noma izifundo zokwandisa kufanele zenziwe.

Magnetic resonance imaging (MRI)

I-MRI iyindlela evame ukusetshenziswa kakhulu yokuxilonga izinguquko eziwohlokayo ku-disc intervertebral ngokunembile, ngokwethembeka, futhi ngokuphelele. Isetshenziselwa ukuhlolwa kokuqala kweziguli ezinezinhlungu zentamo ngemva kwe-radiography ecacile. Ingahlinzeka ngezithombe ezingahlaseli emathafeni amaningi futhi inikeze izithombe zekhwalithi ezinhle kakhulu zediski. I-MRI ingabonisa i-disc hydration kanye ne-morphology-based based density proton, imvelo yamakhemikhali, nokuqukethwe kwamanzi. Isithombe somtholampilo kanye nomlando wesiguli kufanele kucatshangelwe lapho kuchazwa imibiko ye-MRI njengoba kuye kwaboniswa ukuthi cishe amaphesenti angu-25 ama-radiologists ashintsha umbiko wawo lapho idatha yomtholampilo itholakala. I-Fonar ikhiqize isithwebuli sokuqala esivulekile se-MRI esinekhono lesiguli lokuskenwa ezindaweni ezihlukene njengokuma, ukuhlala, nokugoba. Ngenxa yalezi zici eziyingqayizivele, lesi sithwebuli se-MRI esivulekile singasetshenziselwa ukuskena iziguli ekumiseni okuthwala isisindo nokuma ukuma ukuze kutholwe izinguquko eziyisisekelo ze-pathological ezivame ukunganakwa ekuhlolweni kwe-MRI evamile njengesifo se-lumbar degenerative disc nge-herniation. Lo mshini futhi muhle ezigulini ezine-claustrophobic, njengoba zithola ukubuka isikrini esikhulu sikamabonakude ngesikhathi sokuskena. (�Isifo Sediski Esiwohlozayo: Isizinda, I-Anatomy, I-Pathophysiology.�)

I-Nucleus pulposus kanye ne-annulus fibrosus ye-disc ngokuvamile ingabonakala ku-MRI, okuholela ekutholweni kwe-disc herniation njengoba kuqukethwe futhi kungatholakali. Njengoba i-MRI ingaphinda ibonise izinyembezi ze-annular kanye ne-posterior longitudinal ligament, ingasetshenziswa ukuhlukanisa i-herniation. Lokhu kungase kube ukuqhuma okulula kwe-annular kuma-fragment disc herniations mahhala. Lolu lwazi lungachaza amadiski e-pathologic afana ne-extruded disc, ama-protruded disc, nama-migrated discs.

Kunezinhlelo eziningana zokubala ezisekelwe kukuqina kwesignali ye-MRI, ukuphakama kwediski, umehluko phakathi kwe-nucleus ne-annulus, kanye nesakhiwo sediski. Indlela, nguPfirrmann et al, isetshenziswe kabanzi futhi yamukelwa emtholampilo. Ngokusho kwesistimu eguquliwe, kukhona amamaki angu-8 we-lumbar disc degenerative disease. Ibanga le-1 limelela i-disc intervertebral evamile futhi ibanga le-8 lihambisana nesigaba sokugcina sokuwohloka, esibonisa ukuqhubeka kwesifo se-disc. Kukhona izithombe ezihambisanayo ukusiza ukuxilongwa. Njengoba zinikeza ukuhlukaniswa kwezicubu ezinhle kanye nencazelo enemininingwane yesakhiwo sediski, izithombe ze-sagittal T2 ezinesisindo zisetshenziselwa inhloso yokuhlukanisa. (Pfirrmann, Christian WA, et al.)

I-Modic ichaze izinguquko ezenzeka emizimbeni yama-vertebral eseduze nama-discs awohlokayo njengezinguquko ze-Type 1 kanye ne-Type 2. Ezinguqukweni ze-Modic 1, kukhona ukushuba okunciphile kwezithombe ezinesisindo se-T1 kanye nokuqina okukhuphukile kwezithombe ezinesisindo ze-T2. Lokhu kucatshangwa ukuthi kwenzeka ngenxa yokuthi amapuleti okuphela aye abhekana ne-sclerosis futhi umnkantsha wethambo oseduze ubonisa impendulo yokuvuvukala njengoba i-coefficient yokusabalalisa inyuka. Lokhu kwanda kwe-coefficient yokusabalalisa kanye nokumelana okuphelele nokusabalalisa kubangelwa izinto zamakhemikhali ezikhishwe ngomshini we-autoimmune. Izinguquko zohlobo lwe-Modic 2 zihlanganisa ukubhujiswa komnkantsha we-vertebral endplates eseduze ngenxa yempendulo yokuvuvukala kanye nokungena kwamafutha emnkantsheni. Lezi zinguquko zingase ziholele ekukhuleni kokuminyana kwesignali ezithombeni ezinesisindo se-T1. (Modic, MT et al.)

I-Computed Tomography (CT)

Uma i-MRI ingatholakali, i-Computed tomography ibhekwa njengesivivinyo sokuxilonga esingakwazi ukubona i-disc herniation ngoba inomehluko ongcono phakathi kwemingcele ye-posterolateral ye-bony vertebrae eseduze, i-perineal fat, kanye ne-disc material ye-herniated. Noma kunjalo, lapho kuhlolwa ama-lateral herniations, i-MRI ihlala iyindlela yokuzikhethela yokucabanga.

I-CT scan inezinzuzo ezimbalwa kune-MRI njengokuthi inendawo encane ye-claustrophobic, izindleko eziphansi, nokutholwa okungcono kwezinguquko ze-bonny ezicashile futhi ezingase ziphuthelwe kwezinye izindlela. I-CT ingathola izinguquko zokuqala eziwohlokayo zamalunga e-facet kanye ne-spondylosis ngokunemba okwengeziwe. Ubuqotho bamathambo ngemva kokuhlanganiswa bubuye buhlolwe kangcono yi-CT.

I-Disc herniation kanye ne-nerve impingement ehlotshaniswa nayo ingatholwa ngokusebenzisa indlela yokunquma eyenziwe ngu-Gundry no-Heithoff. Kubalulekile ukuthi i-disc protrusion ilale ngokuqondile phezu kwezimpande zenzwa ezidabula i-disc futhi igxile futhi i-asymmetrical nge-dorsolateral position. Kufanele kube nokucindezelwa kwezimpande zenzwa okukhonjiswayo noma ukugudluzwa. Okokugcina, i-nerve distal to the impingement (indawo ye-herniation) ivame ukunwetshwa futhi iqhume nge-edema ephumela, ukugqama kwemithambo ye-epidural eseduze, nama-exudates avuvukalayo okuholela ekufiphazeni umkhawulo.

Lumba Di-iscography

Le nqubo iyimpikiswano futhi, ukuthi ukwazi indawo yezinhlungu kunenzuzo mayelana nokuhlinzwa noma cha, akuzange kufakazelwe. Amanga amanga angenzeka ngenxa ye-hyperalgesia ephakathi ezigulini ezinobuhlungu obungapheli (ukuthola i-neurophysiologic) nangenxa yezici zengqondo. Kuyangabaza ukusungula ngqo lapho ubuhlungu be-discogenic bubaluleka emtholampilo. Labo abasekela lolu phenyo bakhuthaza izindlela eziqinile zokukhethwa kweziguli futhi lapho behumusha imiphumela futhi bakholelwa ukuthi lokhu kuwukuphela kokuhlolwa okungahlola ubuhlungu be-discogenic. I-Lumbar discography ingasetshenziswa ezimweni eziningana, nakuba ingasungulwa ngokwesayensi. Lokhu kubandakanya; ukuxilongwa kwe-lateral herniation, ukuhlonza i-disc ye-symptomatic phakathi kokungavamile okuningi, ukuhlola okungavamile okufanayo okubonwa ku-CT noma i-MRI, ukuhlolwa komgogodla ngemva kokuhlinzwa, ukukhethwa kwezinga le-fusion, nezici ezisikiselayo zokuba khona kobuhlungu be-discogenic.

I-discography ikhathazeke kakhulu ngokuphakamisa i-pathophysiology kunokunquma i-anatomy ye-disc. Ngakho-ke, ukuhlolwa kobuhlungu be-discogenic kuyinhloso ye-discography. I-MRI ingase yembule i-disc ebukeka ngendlela engavamile engenabuhlungu, kuyilapho ubuhlungu obukhulu bungabonakala ku-discography lapho okutholakala khona kwe-MRI kumbalwa. Phakathi nomjovo we-saline evamile noma into ehlukile, indawo yokugcina eyisiponji ingenzeka ngamadiski angajwayelekile amukela amanani engeziwe okugqama. Izinto ezihlukile zingadlulela ku-nucleus pulposus ngezinyembezi kanye nemifantu ku-annulus fibrosus kuma-disc angavamile. Ukucindezelwa kwalokhu kuhlanganiswa kwezinto kungadala ubuhlungu ngenxa yokuvinjwa kwenzwa ye-meningeal ephindaphindayo, inzwa yomgogodla exubile, i-rami eyinhloko engaphambili, ne-grey rami communicantes ehlinzeka nge-annulus fibrosus yangaphandle. Ubuhlungu obukhulu bungacasulwa lapho okuhlukile kufinyelela endaweni yezimpande zemizwa ngediski engavamile. Kodwa-ke, lokhu kuhlolwa kwe-discography kunezinkinga eziningana ezifana nokulimala kwezimpande zenzwa, i-diskitis yamakhemikhali noma yebhaktheriya, ukungezwani okuhlukile, kanye nokwanda kobuhlungu. (Bartynski, Walter S., kanye no-A. Orlando Ortiz)

I-Imaging Modality Combination

Ukuze uhlole ukucindezelwa kwezimpande zenzwa kanye ne-stenosis yomlomo wesibeletho ngokwanele, inhlanganisela yezindlela zokucabanga zingadingeka.

I-CT Discography

Ngemuva kokwenza i-discography yokuqala, i-CT discography yenziwa phakathi namahora angu-4. Ingasetshenziswa ekunqumeni isimo se-disc efana ne-herniated, i-protruded, extruded, equkethwe noma i-sequestered. Ingasetshenziswa futhi emgogodleni ukuhlukanisa imiphumela emikhulu yezicubu ezibomvu noma izinto ze-disc ngemva kokuhlinzwa komgogodla.

I-CT Myelography

Lokhu kuhlolwa kubhekwa njengendlela engcono kakhulu yokuhlola ukucindezelwa kwezimpande zezinzwa. Uma i-CT yenziwa ngokuhlangene noma ngemva kwe-myelography, imininingwane mayelana nezindiza ze-bony anatomy ingatholwa kalula.

Izinqubo zokuxilonga

I-Transforaminal Selective Nerve Root Blocks (SNRBs)

Lapho isifo se-multilevel degenerative disc sisolwa ekuhlolweni kwe-MRI, lokhu kuhlolwa kungasetshenziswa ukucacisa impande ethile yezinzwa ethintekile. I-SNRB kokubili ukuhlolwa kokuxilonga nokwelapha okungasetshenziselwa i-lumbar spinal stenosis. Ukuhlola kudala indawo yeleveli ye-demotomal ye-hypoesthesia ngokujova isibulali-zinzwa kanye nezinto ezihlukile ngaphansi kokuqondiswa kwe-fluoroscopic kuya kuleveli yempande yemizwa enentshisekelo. Kukhona ukuhlobana phakathi kwezimpawu zomtholampilo ze-multilevel cervical degenerative disc kanye nokutholwe ku-MRI nokutholwe kwe-SNRB ngokusho kuka-Anderberg et al. Kukhona ukuhlobana kwe-28% nemiphumela ye-SNRB kanye nobuhlungu be-dermatomal radicular kanye nezindawo zokushoda kwe-neurologic. Izimo ezimbi kakhulu zokuwohloka kwe-MRI zitholakala zihlotshaniswa ne-60%. Nakuba ingasetshenziswanga njalo, i-SNRB iyisivivinyo esiwusizo ekuhloleni iziguli ngaphambi kokuhlinzwa ku-multilevel degenerative disc disease ikakhulukazi emgogodleni kanye nezici zomtholampilo kanye nokutholwe ku-MRI. (Narouze, Samer, and Amaresh Vydyanathan)

Izifundo ze-Electro Myographic

Ukuhlolwa kwe-distal motor kanye ne-sensory nerve conduction, okubizwa ngokuthi izifundo ze-electromyographic, ezivamile ngokuhlolwa kwenaliti okungajwayelekile kungase kwembule izimpawu zokucindezelwa kwezinzwa ezitholakala emlandweni womtholampilo. Izimpande ze-nerve ezicasuliwe zingenziwa endaweni ngokusebenzisa imijovo ukuze i-anesthetize izinzwa ezithintekile noma ama-receptors obuhlungu endaweni ye-disc, i-sacroiliac joint, noma ama-facet joints nge-discography. (�I-Journal Of Electromyography & Kinesiology Calendar�)

Izifundo zoLwazi

Ukuhlolwa kwaselabhorethri kuvame ukwenziwa ukuze kungafaki okunye ukuxilonga okuhlukile.

Njengoba i-seronegative spondyloarthropathies, njenge-ankylosing spondylitis, iyimbangela evamile yobuhlungu beqolo, i-HLA B27 immuno-histocompatibility kufanele ihlolwe. Kulinganiselwa ukuthi abantu abangu-350,000 e-US kanye ne-600,000 eYurophu baye bathinteka yilesi sifo esivuthayo se-etiology engaziwa. Kodwa i-HLA B27 ayitholakali kakhulu kubantu base-Afrika baseMelika. Amanye ama-spondyloarthropathies e-seronegative angahlolwa kusetshenziswa lesi sakhi sofuzo ahlanganisa i-psoriatic arthritis, isifo samathumbu esivuvukalayo, nesifo samathambo esisebenzayo noma i-Reiter syndrome. I-Serum immunoglobulin A (IgA) ingakhuphuka kwezinye iziguli.

Ukuhlolwa okufana nesilinganiso se-erythrocyte sedimentation (ESR) kanye nokuhlolwa kwezinga le-C-reactive protein (CRP) kwe-acute phase reactants ebonwa kuzimbangela ezivuvukalayo zezinhlungu ezingezansi ezifana ne-osteoarthritis kanye ne-malignancy. Umthamo wegazi ogcwele nawo uyadingeka, okuhlanganisa izibalo ezihlukene ukuze kutholakale i-etiology yesifo. Izifo ezizimele zisolwa lapho ukuhlolwa kwe-anti-nuclear antibody (ANA) kuba ne-Rheumatoid factor (RF) kanye ne-anti-nuclear antibody (ANA). I-serum uric acid nokuhlaziywa kwe-synovial fluid yamakristalu kungase kudingeke ezimweni ezingavamile ukuze kukhishwe i-gout ne-pyrophosphate dihydrate deposition.

Ukwelashwa

Ayikho indlela yokwelapha eqondile evunyelwe yibo bonke odokotela mayelana nokwelashwa kwesifo se-disc degenerative ngoba imbangela yobuhlungu ingahluka kubantu abahlukene kanye nobukhulu bobuhlungu kanye nokuhlukahluka okubanzi kokwethulwa komtholampilo. Izinketho zokwelapha zingaxoxwa kabanzi ngaphansi; ukwelashwa okuvamile, ukwelashwa, nokwelashwa kokuhlinzwa.

Ukwelashwa Kwe-Conservative

Le ndlela yokwelapha ihlanganisa ukwelapha ngokuzivocavoca ngokungenelela kokuziphatha, izinqubo zomzimba, imijovo, imfundo yasemuva, nezindlela zesikole sokubuyela emuva.

Ukwelashwa Okusekelwe Ekuzilolongeni Ngokungenelela Kokuziphatha

Ngokuya ngokuxilongwa kwesiguli, izinhlobo ezahlukene zokuzivocavoca zinganqunywa. Kubhekwa njengenye yezindlela eziyinhloko zokuphatha okulondolozayo ukuphatha ubuhlungu obungapheli obuphansi emuva. Izivivinyo zingashintshwa ukuze zifake izivivinyo zokuzelula, izivivinyo ze-aerobic, kanye nezivivinyo zokuqinisa imisipha. Enye yezinselelo ezinkulu zalokhu kwelashwa ihlanganisa ukungakwazi kwayo ukuhlola ukusebenza kahle phakathi kweziguli ngenxa yokuhlukahluka okubanzi kwemithi yokuzivocavoca, imvamisa, nokuqina. Ngokusho kwezifundo, ukuphumelela kakhulu kobuhlungu obuphansi obuphansi obunobuhlungu obuphansi obunobude obuhlukahlukene bezimpawu kutholwe ngokwenza izinhlelo zokuzivocavoca ezilinganiselwe ngaphakathi kwesimo somsebenzi wesiguli. Ukuthuthukiswa okuphawulekayo kwabonwa phakathi kweziguli ezinezimpawu ezingapheli nalokhu kwelashwa mayelana nokuthuthukiswa kokusebenza nokunciphisa ubuhlungu. Izindlela zokwelapha ngazinye eziklanyelwe isiguli ngasinye ngaphansi kokuqondiswa okuseduze nokuhambisana nesiguli nazo zibonakala ziphumelela kakhulu kulabo abahlukunyezwa ubuhlungu obungapheli. Ezinye izindlela ezilandelanayo zingasetshenziswa ngokuhlanganyela ukuze kuthuthukiswe le ndlela. (Hayden, Jill A., et al.)

Ukuzivocavoca kwe-Aerobic, uma kwenziwa njalo, kungathuthukisa ukukhuthazela. Ukuze unciphise ukungezwani kwemisipha, izindlela zokuphumula zingasetshenziswa. Ukubhukuda nakho kuthathwa njengokuvivinya umzimba kobuhlungu beqolo. Ukuzivocavoca kwaphansi kungabandakanya ukuvivinya umzimba okunwetshiwe, ukunwebeka kwe-hamstring, ukunwebeka okuphansi emuva, ukwelula amadolo aphindwe kabili kuya esilevini, ukuphakanyiswa kwezihlalo, ukuhlala okulungisiwe, ukuqiniswa kwesisu, nokuzivocavoca kwentaba nokuhlehla.

Izindlela Zokuziphatha

Le ndlela ihlanganisa ukusetshenziswa kwe-electrical nerve stimulation, ukuphumula, amaphakethe eqhwa, i-biofeedback, ama-heaters, i-phonophoresis, ne-iontophoresis.

I-Transcutaneous Electrical Nerve Stimulation (TENS)

Kule ndlela engeyona yokuhlasela, ukugqugquzelwa kukagesi kuhanjiswa esikhumbeni ukuze kugqugquzelwe izinzwa ze-peripheral endaweni ukukhulula ubuhlungu ngezinga elithile. Le ndlela ikhulula ubuhlungu ngokushesha ngemva kokusetshenziswa kodwa ukusebenza kwayo kwesikhathi eside kuyangabazeka. Ngezinye izifundo, kutholakale ukuthi akukho ukuthuthukiswa okuphawulekayo ebuhlungu kanye nesimo sokusebenza uma kuqhathaniswa ne-placebo. Imishini eyenza le TENS ingafinyeleleka kalula emnyangweni weziguli ezilaliswayo. Okuwukuphela komphumela ongase ube nawo ubonakala uwukucasuka kwesikhumba okuncane okwenzeka engxenyeni yesithathu yeziguli. (Johnson, Mark I)

Emuva Isikole

Le ndlela yethulwa ngenhloso yokunciphisa izimpawu zobuhlungu kanye nokuphindaphinda kwazo. Yethulwa okokuqala eSweden futhi icabangela ukuma, i-ergonomics, ukuzivocavoca okufanele emuva, kanye ne-anatomy yesifunda se-lumbar. Iziguli zifundiswa ukuma okufanele ukuhlala, ukuma, ukuphakamisa izinsimbi, ukulala, ukugeza ubuso, nokuxubha amazinyo ukugwema ubuhlungu. Uma kuqhathaniswa nezinye izindlela zokwelapha, ukwelashwa kwesikole sangemuva kuye kwafakazelwa ukuthi kuyasebenza kuzo zombili izikhathi ezisheshayo neziphakathi ukuze kuthuthukiswe ubuhlungu beqolo kanye nesimo sokusebenza.

Imfundo yeziguli

Kule ndlela, umhlinzeki ufundisa isiguli ukuthi singaphatha kanjani izimpawu zabo zobuhlungu emuva. I-anatomy evamile yomgogodla kanye ne-biomechanics ehilela izindlela zokulimala ifundiswa ekuqaleni. Okulandelayo, usebenzisa amamodeli omgogodla, ukuxilongwa kwesifo se-disc degenerative kuchazwa esigulini. Esigulini ngasinye, isimo esilinganiselwe siyanqunywa bese sicelwa ukuthi sigcine leso simo ukuze sigweme ukuthola izimpawu.

Indlela ye-Bio-Psychosocial to Multidisciplinary Back Therapy

Ubuhlungu obungapheli bokubuyela emuva bungabangela ukucindezeleka okukhulu esigulini, okuholela ekuphazamisekeni kwengqondo kanye nomoya ophansi. Lokhu kungaba nomthelela omubi emiphumeleni yokwelapha okwenza amasu amaningi okwelapha abe yize. Ngakho-ke, iziguli kufanele zifundiswe ngamasu afundiwe engqondo abizwa ngokuthi �ukuziphatha� kanye namasu �e-bio-psychosocial� ukuze zithole ukukhululeka ebuhlungwini. Ngaphezu kokwelapha izimbangela zebhayoloji zobuhlungu, izimbangela ezingokwengqondo, nezenhlalo kufanele kubhekwane nazo ngale ndlela. Ukuze kuncishiswe umbono wesiguli ngobuhlungu nokukhubazeka, kusetshenziswa izindlela ezinjengokulindelwe okushintshiwe, amasu okuphumula, ukulawula ukusabela komzimba ngokuziphatha okufundiwe, kanye nokuqinisa.

I-Massage Therapy

Ngobuhlungu obungapheli obuphansi emuva, lokhu kwelashwa kubonakala kunenzuzo. Esikhathini esiwunyaka ongu-1, ukubhucungwa kwe-massage kutholwe kusebenza ngokusesilinganisweni kwezinye iziguli uma kuqhathaniswa nokutshopa nezinye izindlela zokuphumula. Kodwa-ke, ayisebenzi kahle kune-TENS kanye nokwelashwa kokuvivinya umzimba nakuba iziguli ngazinye zingakhetha eyodwa kunezinye. (Furlan, Andrea D., et al.)

Ukuxhaphaza Umgogodla

Lokhu kwelashwa kuhilela ukukhohliswa kwelunga elingaphezu kobubanzi balo obuvamile bokunyakaza, kodwa kungadluli lokho kwebanga elivamile le-anatomical. Lokhu ukwelapha okwenziwa ngesandla okubandakanya ukukhohlisa kwe-lever ende ngesivinini esiphansi. Kucatshangwa ukuthi kuthuthukisa ubuhlungu obuphansi emuva ngokusebenzisa izindlela eziningana ezifana nokukhululwa kwezinzwa eziboshiwe, ukubhujiswa kwe-articular and peri-articular adhesions, kanye nezingxenye ezikhohlisayo zomgogodla osuvele wasuswa. Kungase futhi kunciphise ukuqhuma kwe-disc, uphumule imisipha ye-hypertonic, uvuselele izintambo ze-nociceptive ngokushintsha umsebenzi we-neurophysiological futhi ubeke kabusha i-menisci endaweni ye-articular.

Ukuxhashazwa komgogodla kucatshangwa ukuthi kuphakeme ekusebenzeni uma kuqhathaniswa nezindlela eziningi ezifana ne-TENS, ukwelapha ngokuzivocavoca, izidakamizwa ze-NSAID, nokwelashwa kwesikole sangemuva. Ucwaningo olukhona njengamanje luhle mayelana nokusebenza kwalo esikhathini eside nesifushane. Kuphinde kuphephe kakhulu ukuphatha abelaphi abangaqeqeshwanga kahle ngamacala e-disc herniation kanye ne-cauda equina ebikwa kuphela ngaphansi kwe-1 kubantu abayizigidi ezingu-3.7. (Bronfort, Gert, et al.)

I-Lumbar isekela

Iziguli ezihlushwa ubuhlungu obungapheli obuphansi emuva ngenxa yezinqubo eziwohlokayo emazingeni amaningi anezimbangela eziningana zingase zizuze ekusekelweni kwe-lumbar. Kunobufakazi obungqubuzanayo maqondana nokusebenza kwayo ngocwaningo oluthile oluthi ukuthuthukiswa okusesilinganisweni kwempumuzo esheshayo neyesikhathi eside kuyilapho abanye bephakamisa ukuthi akukho ntuthuko enjalo uma kuqhathaniswa nezinye izindlela zokwelashwa. Izisekelo ze-Lumbar zingazinzisa, zilungise ukukhubazeka, zinciphise amandla emishini, futhi zinciphise ukunyakaza komgogodla. Ingase futhi isebenze njenge-placebo futhi inciphise ubuhlungu ngokuphulula izindawo ezithintekile futhi ifake ukushisa.

I-Lumbar Traction

Le ndlela isebenzisa ihhanisi elixhunywe kwi-iliac crest kanye ne-low rib cage futhi isebenzisa amandla ama-longitudinal eduze nomgogodla we-axial ukuze kukhululwe ubuhlungu obungapheli obuphansi emuva. Izinga nobude besikhathi samandla kulungiswa ngokusho kwesiguli futhi singalinganiswa ngokusebenzisa amadivaysi kokubili ngenkathi uhamba futhi ulele phansi. I-Lumbar traction isebenza ngokuvula izikhala ze-intervertebral disc kanye nokunciphisa i-lumbar lordosis. Izimpawu zesifo se-disc degenerative ziyancipha ngale ndlela ngenxa yokulungiswa kabusha komgogodla wesikhashana kanye nezinzuzo zayo ezihambisanayo. Ikhulula ukucindezelwa kwezinzwa nokucindezeleka kwemishini, iphazamisa ukunamathela ku-facet kanye ne-annulus, kanye nezimpawu zobuhlungu be-nociceptive. Kodwa-ke, abukho ubufakazi obuningi ngokuphathelene nokusebenza kwayo ekunciphiseni ubuhlungu emuva noma ukuthuthukisa umsebenzi wansuku zonke. Ngaphezu kwalokho, izingozi ezihlobene ne-lumbar traction zisangaphansi kocwaningo futhi ezinye imibiko yecala iyatholakala lapho ibangele ukuphazamiseka kwemizwa, ubunzima bokuphefumula, noshintsho lomfutho wegazi ngenxa yamandla amakhulu kanye nokubekwa okungalungile kwehhanisi. (Harte, A et al.)

Ukwelashwa Ngezokwelapha

Ukwelashwa kwezokwelapha kuhilela ukwelashwa kwezidakamizwa ngeziphumlisi zemisipha, imijovo ye-steroid, ama-NSAID, ama-opioid, namanye ama-analgesics. Lokhu kuyadingeka, ngaphezu kokwelashwa okulondolozayo, ezigulini eziningi ezinesifo se-disc degenerative. I-Pharmacotherapy ihloselwe ukulawula ukukhubazeka, ukunciphisa ubuhlungu nokuvuvukala ngenkathi kuthuthukiswa izinga lempilo. Ihlinzekwa ngokwesiguli ngasinye njengoba kungekho ukuvumelana mayelana nokwelashwa.

Ama-Relaxant Muscle

Isifo se-disc degenerative singazuza ekuphumuleni kwemisipha ngokunciphisa i-spasm yemisipha futhi ngaleyo ndlela kukhulule ubuhlungu. Ukusebenza kokuphumula kwemisipha ekuthuthukiseni ubuhlungu nesimo sokusebenza kuye kwasungulwa ngezinhlobo eziningana zocwaningo. I-Benzodiazepine iyisiphumuli semisipha esisetshenziswa kakhulu njengamanje.

Izidakamizwa ezingezona i-Steroidal Anti-Inflammatory (NSAIDs)

Lezi zidakamizwa zivame ukusetshenziswa njengesinyathelo sokuqala se-disc degenerative disease ehlinzeka nge-analgesia, kanye nemiphumela yokulwa nokuvuvukala. Kunobufakazi obuqinile bokuthi kunciphisa ubuhlungu obungapheli obuphansi emuva. Kodwa-ke, ukusetshenziswa kwayo kunqunyelwe ukuphazamiseka kwamathumbu, njenge-acute gastritis. I-COX2 inhibitor ekhethiwe, njenge-celecoxib, inganqoba le nkinga ngokukhomba kuphela ama-COX2 receptors. Ukusetshenziswa kwabo akwamukeleki kakhulu ngenxa yemiphumela emibi engase ibe khona ekwandiseni isifo senhliziyo nemithambo yegazi ngokusetshenziswa isikhathi eside.

Imithi ye-Opioid

Lesi yisinyathelo esikhuphukayo kwiledi lezinhlungu ze-WHO. Igcinelwe iziguli ezihlushwa ubuhlungu obukhulu obungaphenduli kuma-NSAID nalabo abanokuphazamiseka kwe-GI okungabekezeleleki ngokwelashwa kwe-NSAID. Kodwa-ke, imithi yezidakamizwa yokwelapha ubuhlungu be-back ihluka kakhulu phakathi kwabahlengikazi. Ngokusho kwezincwadi, i-3 kuya ku-66% yeziguli ingase ithathe uhlobo oluthile lwe-opioid ukuze ikhulule ubuhlungu babo emuva. Nakuba ukuncipha kwezimpawu zesikhathi esifushane kumakiwe, kunengozi yokusetshenziswa kabi kwezidakamizwa zesikhathi eside, izinga eliphezulu lokubekezelelana, nokucindezeleka kokuphefumula kubantu abadala. Isicanucanu nokuhlanza eminye yemiphumela engemihle yesikhashana okuhlangatshezwana nayo. (�Ukubuyekezwa Okuhlelekile: Ukwelashwa Kwe-Opioid Ngezinhlungu Ezingapheli Emhlane: Ukuvama, Ukusebenza Ngokuphumelelayo, Nokuhlotshaniswa Nokulutheka�)

Ama-Anti-Depressants

Ama-anti-depressants, ngemithamo ephansi, anenani le-analgesic futhi angase abe nenzuzo ezigulini ezibuhlungu ezingapheli ezibuhlungu ezingase ziveze nezimpawu zokucindezeleka ezihambisanayo. Ubuhlungu nokuhlupheka kungase kuphazamise ukulala kwesiguli futhi kunciphise umkhawulo wobuhlungu. Lezi zingaxazululwa ngokusebenzisa ama-anti-depressants ngemithamo ephansi nakuba kungekho bufakazi bokuthi kuthuthukisa umsebenzi.

Ukwelapha Umjovo

Imijovo ye-Epidural Steroid

Imijovo ye-epidural steroid iwuhlobo lomjovo olusetshenziswa kakhulu ekwelapheni isifo esingamahlalakhona se-disc degenerative kanye ne-radiculopathy ehambisanayo. Kukhona ukuhluka phakathi kohlobo lwe-steroid esetshenzisiwe kanye nomthamo wayo. I-8- 10 mL yengxube ye-methylprednisolone kanye ne-saline evamile ibhekwa njengomthamo osebenzayo futhi ophephile. Imijovo inganikezwa ngokusebenzisa imizila ye-interlaminar, caudal, noma i-transforamina. Inaliti ingafakwa ngaphansi kokuqondisa kwe-fluoroscopy. Ukuqhathanisa kokuqala, bese kuba yi-anesthesia yendawo futhi ekugcineni, i-steroid ijojowe endaweni ye-epidural ezingeni elithintekile ngale ndlela. Ukukhululeka kobuhlungu kufinyelelwa ngenxa yokuhlanganiswa kwemiphumela evela kokubili i-anesthesia yendawo kanye ne-steroid. Ukukhululeka ngokushesha kobuhlungu kungafinyelelwa ngokusebenzisa i-anesthetic yendawo ngokuvimbela ukudluliselwa kwesignali yobuhlungu futhi ngenkathi kuqinisekiswa ukuxilongwa. Ukuvuvukala kubuye kuncishiswe ngenxa yesenzo se-steroids ekuvimbeni i-pro-inflammatory cascade.

Kule minyaka eyishumi yakamuva, ukusetshenziswa komjovo we-epidural steroid kunyuke ngo-121%. Kodwa-ke, kukhona impikiswano mayelana nokusetshenziswa kwayo ngenxa yokuhlukahluka kwamazinga okuphendula kanye nemiphumela emibi engase ibe yingozi. Ngokuvamile, le mijovo kukholakala ukuthi ibangela ukukhululeka kwesikhashana nje kwezimpawu. Abanye odokotela bangase bajove imijovo emi-2 kuya kwemi-3 esikhathini esiyisonto elilodwa, nakuba imiphumela yesikhathi eside ifana naleyo yesiguli esinikezwe umjovo owodwa kuphela. Isikhathi sonyaka owodwa, imijovo engaphezu kwemi-4 akufanele inikezwe. Ukuze uthole ukukhululeka kwezinhlungu ngokushesha okukhulu, i-preservative-free morphine ingase yengezwe emjovweni. Ngisho nezibulala-zinzwa zendawo, njenge-lidocaine ne-bupivacaine, zengezwa ngale njongo. Ubufakazi bokuqeda ubuhlungu besikhathi eside bunomkhawulo. (�Isivivinyo Esilawulwa I-Placebo Sokuhlola Ukusebenza Kokuqeda Izinhlungu Ngokusebenzisa I-Ketamine Nge-Epidural Steroids Ngezinhlungu Ezingamahlalakhona Ezisemuva�)

Kunemiphumela engemihle engaba khona ngenxa yalokhu kwelashwa, ngaphezu kwezindleko zayo eziphakeme kanye nokukhathazeka ngokusebenza ngempumelelo. Izinaliti zingalahleka uma i-fluoroscopy ingasetshenziswa cishe ku-25% wamacala, ngisho nokuba khona kwabasebenzi abanolwazi. Ukubekwa kwe-epidural kungabonakala ngokuthi pruritus ngokuthembekile. Ukudangala kokuphefumula noma ukugcineka komchamo kungenzeka ngemva kokujova nge-morphine ngakho isiguli sidinga ukugadwa amahora angu-24 ngemva komjovo.

Imijovo Yebuso

Le mijovo inikezwa amalunga e-facet, abizwa nangokuthi ama-zygapophysial joints, atholakala phakathi kwama-vertebrae amabili ancikene. I-anesthesia ingajovwa ngokuqondile endaweni ehlangene noma egatsheni eliphakathi elihlotshaniswayo le-dorsal rami, eliyivimbelayo. Kunobufakazi bokuthi le ndlela ithuthukisa ikhono lokusebenza, izinga lokuphila, futhi ikhulule ubuhlungu. Bacatshangelwa ukuthi banikeze izinzuzo zesikhathi esifushane nezesikhathi eside, nakuba izifundo zibonise kokubili imijovo ye-facet kanye nemijovo ye-epidural steroid iyafana ekusebenzeni kahle. (Wynne, Kelly A)

Imijovo Ehlangene ye-SI

Leli yijoyinti ye-synovial ye-diarthrodial ene-nerve supply kusuka kokubili ama-axon e-myelinated ne-non-myelin nerve. Umjovo ungaphatha ngokuphumelelayo isifo se-disc esiwohlokayo esihilela ukujoyina kwe-sacroiliac okuholela kukho kokubili impumuzo yesikhathi eside nesifushane ezimpawini ezifana nobuhlungu obuphansi beqolo kanye nobuhlungu obuzwayo emilenzeni, ethangeni nasezinqeni. Imijovo ingaphindaphindwa njalo ezinyangeni ezi-2 kuya kwezi-3 kodwa kufanele yenziwe kuphela uma kunesidingo ngokomtholampilo. (MAUGARS, Y. et al.)�

I-Intradiscal Non-Operative Therapies ye-Discogenic Pain

Njengoba kuchazwe ngaphansi kophenyo, i-discography ingasetshenziswa kokubili njengendlela yokuxilonga neyokwelapha. Ngemuva kokuthi i-disc egulayo ikhonjwe, izindlela ezimbalwa zokuhlasela kancane zingazanywa ngaphambi kokuqala ukuhlinzwa. Amandla kagesi kanye nokushisa kwawo kungasetshenziswa ukuhlanganisa i-posterior annulus ngaleyo ndlela kuqiniswe imicu ye-collagen, i-denaturing futhi ibhubhise abaxhumanisi abavuthayo nama-nociceptors, nezibalo zokuvala. Izindlela ezisetshenziswe kulokhu zibizwa ngokuthi i-intradiscal electrothermal therapy (IDET) noma i-radiofrequency posterior annuloplasty (RPA), lapho i-electrode idluliselwa ku-disc. I-IDET inobufakazi obulinganiselwe ekusizeni izimpawu zeziguli ze-disc degenerative disease, kuyilapho i-RPA inokusekelwa okulinganiselwe mayelana nokusebenza kwayo kwesikhashana kanye nesikhathi eside. Zombili lezi zinqubo zingaholela ezinkingeni ezifana nokulimala kwezimpande ze-nerve, ukungasebenzi kahle kwe-catheter, ukutheleleka, kanye ne-post-procedure disc herniation.

Ukwelapha Okuhlinzekwayo

Ukwelashwa kokuhlinzwa kugcinelwe iziguli ezinokwelashwa okulondolozayo okuhlulekile kucatshangelwa ukuqina kwesifo, ubudala, ezinye izifo ezigulayo, isimo senhlalo-mnotho, kanye nezinga lomphumela elilindelekile. Kulinganiselwa ukuthi cishe i-5% yeziguli ezine-disc degenerative zihlinzwa, noma ngenxa yesifo sabo se-lumbar noma isifo somlomo wesibeletho. (Rydevik, Bjrn L.)

Izinqubo ze-Lumbar Spine

Ukuhlinzwa kwe-Lumbar kuboniswa ezigulini ezinobuhlungu obunzima, ubude bezinyanga ezingu-6 kuya kwezingu-12 zokwelashwa kwezidakamizwa ezingasebenzi, ezinesifo esibucayi somgogodla. Ukuhlinzwa ngokuvamile kuyinqubo yokuzikhethela ngaphandle kwe-cauda equina syndrome. Kunezinhlobo ezimbili zezinqubo ezihlose ukubandakanya ukuhlangana komgogodla noma ukucindezelwa noma kokubili. (�Isifo Sediski Esiwohlozayo: Isizinda, I-Anatomy, I-Pathophysiology.�)

Umswakama wokugwinya kuhilela ukumisa ukunyakaza engxenyeni ebuhlungu yomgogodla ukuze kuncishiswe ubuhlungu ngokuhlanganisa ama-vertebrae amaningana ngokusebenzisa ukuxhunyelelwa kwethambo. Kubhekwa njengokuphumelela esikhathini eside ezigulini ezinesifo se-disc degenerative ezine-malalignment yomgogodla noma ukunyakaza ngokweqile. Kunezindlela eziningana zokuhlinzwa kwe-fusion. (Gupta, Vijay Kumar, et al)

• I-Lumbar spinal posterolateral guttur fusion

Le ndlela ihlanganisa ukubeka i-graft yethambo engxenyeni ye-posterolateral yomgogodla. I-graft yethambo ingavunwa kusukela ku-posterior iliac crest. Amathambo akhishwa ku-periosteum ukuze axhunywe ngempumelelo. Izisekelo zokuqondisa izinyawo ezingemuva ziyadingeka esikhathini sangemva kokuhlinzwa futhi iziguli zingadinga ukuhlala esibhedlela cishe izinsuku ezi-5 kuya kweziyi-10. Ukunyakaza okulinganiselwe kanye nokuyeka ukubhema kuyadingeka ukuze kuhlanganiswe ngempumelelo. Kodwa-ke, izingozi ezimbalwa ezinjengokungewona inyunyana, ukutheleleka, ukopha, nokuhlangana okuqinile nobuhlungu beqolo kungenzeka.

• I-posterior lumbar interbody fusion

Kule ndlela, izindlela zokunciphisa noma ze-diskectomy nazo zingenziwa ngendlela efanayo. Ama-graft amathambo asetshenziswa ngokuqondile endaweni ye-disc futhi i-ligamentum flavum ikhishwe ngokuphelele. Ngesifo se-disc degenerative, isikhala se-interlaminar sinwetshwa ngokungeziwe ngokwenza i-facetectomy eyingxenye ye-medial. Izikaki zangemuva ziyazikhethela ngale ndlela. Inokungalungi okuningana uma kuqhathaniswa nendlela yangaphambili njengama-graft amancane kuphela angafakwa, indawo encishisiwe etholakalayo ukuze ihlanganiswe, nobunzima lapho kwenziwa ukuhlinzwa ezigulini ezikhubazekile zomgogodla. Ingozi enkulu ehilelekile ayiyona inyunyana.

• I-anterior lumbar interbody fusion

Le nqubo ifana nengemuva ngaphandle kokuthi isondela ngesisu esikhundleni somhlane. Inenzuzo yokungaphazamisi imisipha yangemuva kanye nokunikezwa kwezinzwa. I-contraindicated ezigulini ezine-osteoporosis futhi inengozi yokopha, i-retrograde ejaculation emadodeni, okungezona inyunyana, kanye nokutheleleka.

• I-transforaminal lumbar interbody fusion

Lena inguqulo eguquliwe yendlela yangemuva eseyaduma. Ihlinzeka ngengozi ephansi ngokuchayeka okuhle futhi iboniswa inomphumela omuhle kakhulu ngezinkinga ezimbalwa ezifana nokuvuza kwe-CSF, ukukhubazeka kwemizwa yesikhashana, kanye nokutheleleka kwesilonda.

Ingqikithi ye-Disc Arthroplasty

Lokhu kungenye indlela ye-disc fusion futhi isetshenziselwe ukwelapha isifo se-lumbar degenerative disc usebenzisa i-disc yokufakelwa ukuze ithathe indawo ye-disc ethintekile. Ingqikithi yokufakelwa noma i-nuclear prosthesis ingasetshenziswa kuye ngesimo somtholampilo.

Ukunciphisa kuhilela ukukhipha ingxenye yediski yomzimba womgogodla, ocindezela inzwa ukuze ikhulule lokho futhi inikeze indawo yokululama ngezinqubo ezibizwa nge-diskectomy ne-laminectomy. Ukusebenza kahle kwenqubo kuyangabazeka nakuba kuwukuhlinzwa okuvamile. Izinkinga zimbalwa kakhulu ezinethuba eliphansi lokuphindaphinda kwezimpawu ngokugculiseka kwesiguli okuphezulu. (Gupta, Vijay Kumar, et al)

• I-Lumbar discectomy

Ukuhlinzwa kwenziwa ngokusebenzisa indlela yangemuva ye-midline ngokuhlukanisa i-ligamentum flavum. I-nerve root ethintekayo iyahlonzwa futhi i-annulus eqhumayo iyasikwa ukuze iyikhulule. Ukuhlolwa okuphelele kwemizwa kufanele kwenziwe ngemva kwalokho futhi iziguli ngokuvamile zikulungele ukuya ekhaya ngemva kwezinsuku ezingu-1� 5. Ukuvivinya umzimba okuphansi kufanele kuqalwe ngokushesha kulandelwe umsebenzi olula bese kuba umsebenzi osindayo emavikini ama-2 nayi-12 ngokulandelana.

• I-Lumbar laminectomy

Le nqubo ingenziwa ngokuphelele izinga elilodwa, kanye namazinga amaningi. I-Laminectomy kufanele ibe mfushane ngangokunokwenzeka ukugwema ukungazinzi komgogodla. Iziguli ziphawule ukukhululeka kwezimpawu kanye nokuncipha kwe-radiculopathy kulandela inqubo. Izingozi zingase zihlanganise ukungakwazi ukuzithiba kwamathumbu nesinye, ukuvuza kwe-CSF, ukulimala kwezimpande zemizwa, kanye nokutheleleka.

Izinqubo Ze-Cervical Spine

Isifo se-disc degenerative yomlomo wesibeletho siboniswa ukuhlinzwa lapho kukhona ubuhlungu obungenakubekezeleleka obuhambisana nokushoda okuqhubekayo kwezimoto nezinzwa. Ukuhlinzwa kunomphumela omuhle ongaphezu kuka-90% uma kunobufakazi be-radiographic bokucindezelwa kwezimpande zemizwa. Kunezinketho ezimbalwa ezihlanganisa i-anterior cervical diskectomy (ACD), i-ACD, ne-fusion (ACDF), i-ACDF enokulungiswa kwangaphakathi, kanye ne-posterior foraminotomy. (�Isifo Sediski Esiwohlozayo: Isizinda, I-Anatomy, I-Pathophysiology.�)

Ukwelapha Okusekelwe Kumaseli

Ukufakelwa kwe-stem cell kuye kwavela njengendlela yokwelapha inoveli yesifo se-disgenerative esinemiphumela ethembisayo. Ukwethulwa kwe-autologous chondrocyte kutholakale ukunciphisa ubuhlungu be-discogenic phakathi nenkathi ye-2. Lezi zindlela zokwelapha okwamanje zivivinywa ngabantu. (Jeong, Je Hoon, et al.)

I-Gene Therapy

Ukuguqulwa kwe-Gene ukuze kumiswe inqubo ye-disc degenerative ngisho nokufaka ukuvuselelwa kwe-disc okwamanje kungaphansi kocwaningo. Kulokhu, izakhi zofuzo ezizuzisayo kufanele zikhonjwe ngenkathi kwehliswa umsebenzi wokuwohloka okukhuthaza izakhi zofuzo. Lezi zinketho zokwelapha zenoveli zinikeza ithemba lokuthi ukwelashwa kwesikhathi esizayo kuzoqondiswa ekuvuseleleni ama-intervertebral discs. (Nishida, Kotaro, et al.)

Isifo se-disgenerative yinkinga yezempilo ebonakala ngobuhlungu obungapheli ngenxa ye-intervertebral disc eyonakele, njengobuhlungu obuphansi emuva emgodleni we-lumbar noma ubuhlungu bentamo emgodleni womlomo wesibeletho. Kuwukuwohloka kwe-disc intervertebral yomgogodla. Izinguquko eziningana ze-pathological zingenzeka ekuwohlokeni kwe-disc. Ukukhubazeka okuhlukahlukene kwe-anatomical kungenzeka futhi ku-disc intervertebral. Ubuhlungu obuphansi emuva kanye nobuhlungu bentamo yizinkinga ezinkulu ze-epidemiological, okucatshangwa ukuthi zihlobene nesifo se-disc degenerative. Ubuhlungu be-back back yimbangela yesibili ehamba phambili yokuvakashelwa kwehhovisi likadokotela e-United States. Kulinganiselwa ukuthi cishe i-80% yabantu abadala base-US bahlushwa ubuhlungu obuphansi emuva okungenani kanye ngesikhathi sokuphila kwabo. Ngakho-ke, ukuqonda okuphelele kwesifo se-disc degenerative kuyadingeka ekulawuleni lesi simo esivamile. - UDkt Alex Jimenez DC, CCST Insight

Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic, musculoskeletal, imithi yenyama, impilo enhle, nezindaba ezibucayi zezempilo kanye/noma izindatshana zemithi esebenzayo, izihloko, nezingxoxo. Sisebenzisa amaphrothokholi asebenzayo ezempilo nokuphila ukuze selaphe futhi sisekele ukunakekelwa kokulimala noma ukuphazamiseka kwesistimu ye-musculoskeletal. Okuthunyelwe kwethu, izihloko, izihloko, kanye nemininingwane ihlanganisa izindaba zomtholampilo, izingqinamba, nezihloko ezihlobene nezisekela ngokuqondile noma ngokungaqondile ububanzi bomsebenzi wethu womtholampilo.* Ihhovisi lethu lenze umzamo ozwakalayo wokuhlinzeka ngezingcaphuno ezisekelayo futhi likhombe ucwaningo olufanele noma izifundo ezisekela okuthunyelwe kwethu. Senza futhi amakhophi ocwaningo olusekelayo atholakale ebhodini noma emphakathini uma uwacela. Siyaqonda ukuthi sihlanganisa izindaba ezidinga incazelo eyengeziwe yokuthi ingasiza kanjani ohlelweni oluthile lokunakekela noma inqubo yokwelashwa; ngakho-ke, ukuze uqhubeke uxoxa ngesihloko esingenhla, sicela ukhululeke ukubuza uDkt Alex Jimenez noma usithinte ku 915-850-0900. Abahlinzeki Banelayisensi e-Texas* naseNew Mexico*�

Ikhethwe nguDkt. Alex Jimenez DC, CCST

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