Umgogodla wenziwe ngamathambo abizwa ngokuthi ama-vertebrae, nomgogodla ogijima emseleni womgogodla phakathi nendawo. Intambo yakhiwe izinzwa. Lezi zimpande zezinzwa zihlukana nentambo futhi zihamba phakathi kwama-vertebrae ezindaweni ezihlukahlukene zomzimba. Lapho lezi zimpande zemizwa ziba ncwecwe noma zilimale, izimpawu ezilandelayo zaziwa ngokuthi, i-radiculopathy. El Paso, TX. Udokotela weChiropractor, uDkt. Alexander Jimenez wephuka�i-radiculopathies, kanye nabo izimbangela, izimpawu kanye nokwelashwa.

• I-pinched nerve ingenzeka ezindaweni ezahlukene zomgogodla (umlomo wesibeletho, i-thoracic noma i-lumbar).
• Izimbangela ezijwayelekile wukuncipha kwembobo lapho izimpande zemizwa ziphuma khona, okungaba umphumela i-stenosis, i-bone spurs, i-disc herniation nezinye izimo.
• Izimpawu ziyahlukahluka kodwa ngokuvamile zihlanganisa ubuhlungu, ubuthakathaka, ukuba ndikindiki kanye nokuluma.
• Izimpawu zingalawuleka ngokwelashwa ngaphandle kokuhlinzwa, kodwa ukuhlinzwa okuncane nakho kungasiza.

I-Radiculopathy

I-Prevalence & Pathogenesis

• I-disc ye-herniated ingachazwa ngokuthi i-herniation ye-nucleus pulposus ngokusebenzisa imicu ye-annulus fibrosus.
• Iningi le-disc rupture livela phakathi namashumi amathathu namashumi amane eminyaka yokuphila ngenkathi i-nucleus pulposus isalokhu i-gelatinous.
• Isikhathi esingenzeka kakhulu sosuku esihlotshaniswa nokwanda kwamandla kwi-disc ekuseni.
• Esifundeni se-lumbar, ama-perforations ngokuvamile avela ngesici nje esiseceleni kuya kumugqa ophakathi nendawo, lapho umgudu we-longitudinal wangemuva ubuthakathaka kakhulu.

I-Epidemology

I-Lumbar Spine:

• I-Symptomatic lumbar disc herniation kwenzeka phakathi nesikhathi sokuphila cishe 2% labantu jikelele.
• Cishe 80% Inani labantu lizothola ubuhlungu obukhulu emuva ngesikhathi se-disc herniated.
• Amaqembu asengozini enkulu yokukhishwa kwama-intervertebral discs ngabantu abasha (iminyaka yobudala engama-35)
• Yiqiniso sciatica empeleni ikhula kuphela 35% kweziguli ezine-disc herniation.
• Akuvamile, i-sciatica iqala i-6 eminyakeni engu-10 ngemva kokuqala kobuhlungu obuphansi emuva.
• Isikhathi sobuhlungu be-back back singase sihambisane nokulimala okuphindaphindiwe emicu ye-annular ecasula i-sinuvertebral nerve kodwa engabangeli i-disc herniation.

I-Epidemology

Umgogodla wesibeletho:

• Isilinganiso sonyaka sezehlakalo ze-radiculopathies yomlomo wesibeletho singaphansi kuka-0.1 kubantu abayi-1000.
• I-Pure soft disc herniations ayijwayelekile kakhulu kune-hard disk abnormalities (spondylosis) njengembangela yobuhlungu bengalo obukhulu.
• Esicwaningweni seziguli ze-395 ezinezimpande ze-nerve ezingavamile, i-radiculopathies yenzeke emlonyeni wesibeletho kanye ne-lumbar spine ku-93. (24%) futhi 302 (76%)Ngokulandelana.

I-Pathogenesis

• Ukuguqulwa kwe-intervertebral disc biomechanics kanye ne-biochemistry ngokuhamba kwesikhathi kunomthelela omubi ekusebenzeni kwediski.
• I-disc ayikwazi ukusebenza njenge-spacer phakathi kwemizimba ye-vertebral noma njengenhlangano yendawo yonke.

I-Pathogenesis - LUMBAR Spine

• Amazinga amabili avame kakhulu we-disc herniation yi-L4-L5 ne-L5-S1, okuyi-akhawunti 98% izilonda; I-pathology ingenzeka ku-L2-L3 kanye ne-L3-L4 kodwa ayivamile neze.
  Ngokubanzi, 90% ama-disc herniations asemazingeni e-L4-L5 kanye ne-L5-S1.
• I-Disc herniations ku-L5-S1 ngokuvamile izophazamisa impande yokuqala ye-sacral nerve, isilonda esisezingeni le-L4-L5 sizovame ukucindezela impande yesihlanu ye-lumbar, futhi i-herniation ku-L3-L4 ngokuvamile ihilela impande yesine ye-lumbar.

• I-Disc herniation ingase ithuthuke ezigulini ezindala.
• Izicubu ze-Disc ezibangela ukucindezelwa kweziguli esezikhulile zakhiwa i-annulus fibrosus kanye nezingxenye ze-endplate ye-cartilaginous (i-hard disc.)
  I-cartilage ikhishwa emzimbeni we-vertebral.
• Ukuxazululwa kweminye yemiphumela ecindezelayo ezakhiweni ze-neural kudinga ukufakwa kabusha kwe-nucleus pulposus.

• I-disc resorption iyingxenye yenqubo yokuphulukisa yemvelo ehlotshaniswa ne-disc herniation.
• Ikhono elithuthukisiwe lokubuyisela ama-disc linamandla okuxazulula izimpawu zomtholampilo ngokushesha okukhulu.
• Ukufakwa kabusha kwe-herniated disc material kuhlotshaniswa nokwenyuka okuphawulekayo kwama-macrophages angenayo kanye nokukhiqizwa kwe-matrix metalloproteinases (MMPs) 3 kanye ne-7.
• I-Nerlich kanye nabangane bakhombe umsuka wamaseli e-phagocytic kuma-disc intervertebral discs.
• Uphenyo luhlonze amaseli aguquliwe amaseli endawo kunama-macrophage ahlaselwe.
• Ama-degenerative discs aqukethe amaseli anezela ekuhlakazweni kwawo okuqhubekayo.

I-Pathogenesis - I-Cervical Spine

• Ekuqaleni kwawo-1940, imibiko eminingi yavela lapho i-cervical intervertebral disc herniation ne-radiculopathies yachazwa.
• Kukhona ukuhlobana okuqondile phakathi kwe-anatomy yomgogodla womlomo wesibeletho kanye nendawo kanye ne-pathophysiology ye-disc lesion.

• Izimpande zenzwa yomlomo wesibeletho eziyisishiyagalombili ziphuma nge-intervertebral foramina emngceleni we-anteromedially yi-intervertebral disc kanye ne-posterolaterally ngejoyinti le-zygapophyseal.
• Iforamina inkulu ku-C2-C3 futhi iyancipha ngosayizi kuze kufike ku-C6-C7.
• I-nerve root ithatha 25% kuya 33% umthamo we-foramen.
• Umsuka we-C1 uphuma phakathi kwe-occiput ne-atlas (C1)
• Zonke izimpande ezingezansi ziphuma ngaphezu kwe-vertebrae yomlomo wesibeletho ehambisanayo (impande ye-C6 ku-C5-C6 interspace), ngaphandle kwe-C8, ephuma phakathi kwe-C7 ne-T1.
• Izinga lokukhula elihlukile lithinta ubuhlobo bomgogodla kanye nezimpande zemizwa kanye nomgogodla womlomo wesibeletho.

• Iningi le-acute disc herniations livela ngemuva kwe-posterolaterally nasezigulini phakathi neminyaka eyishumi yokuphila, lapho i-nucleus isalokhu i-gelatinous.
• Izindawo ezivame kakhulu ze-disc herniations yi-C6-C7 ne-C5-C6.
• I-C7-T1 kanye ne-C3-C4 disc herniations ayivamile (ngaphansi kuka-15%).
• I-Disc herniation ye-C2-C3 ayivamile.
• Iziguli ezine-disc protrusions engenhla yomlomo wesibeletho esifundeni se-C2-C3 zinezimpawu ezihlanganisa ubuhlungu be-suboccipital, ukulahlekelwa kwe-dexterity yesandla, kanye ne-paresthesias phezu kobuso nengalo ehlangene.
• Ngokungafani ne-lumbar herniated discs, i-cervical herniated discs ingase ibangele i-myelopathy ngaphezu kobuhlungu obukhulu ngenxa ye-anatomy yomgogodla esifundeni somlomo wesibeletho.
• Ukugqama kwe-uncovertebral kudlala indima endaweni yezinto ezibonakalayo ze-discs eziphukile.
• I-joint uncovertebral ijwayele ukuqondisa izinto ze-disc extruded medially, lapho ukucindezelwa kwentambo kungase kwenzeke.

• I-Disc herniations ngokuvamile ithinta impande yenzwa enenombolo ye-caudally yezinga le-disc elinikeziwe; isibonelo, i-C3 C4 disc ithinta impande yesine yomlomo wesibeletho; I-C4- C5, impande yesihlanu yomlomo wesibeletho; C5 C6, impande yesithupha yomlomo wesibeletho; C6 C7, impande yesikhombisa yomlomo wesibeletho; kanye ne-C7 T1, impande yesishiyagalombili yomlomo wesibeletho.

• Akuwona wonke ama-disc e-herniated anezimpawu.
• Ukuthuthukiswa kwezimpawu kuncike kumthamo wokugcina womgogodla womgogodla, ukuba khona kokuvuvukala, ubukhulu be-herniation, nokuba khona kwezifo ezihambisanayo ezifana nokwakheka kwe-osteophyte.
• Ekudabukeni kwediski, ukuphuma kwempahla yenuzi kubangela ukungezwani emicu ye-annular kanye nokucindezelwa kwe-dura noma i-nerve root ebangela ubuhlungu.
• Okunye okubalulekile usayizi omncane we-diameter ye-sagittal, umsele womgogodla wesibeletho onamathambo.
• Abantu lapho i-cervical herniated disc ibangela ukungasebenzi kahle kwezimoto banenkinga ye-cervical disc herniation uma umgogodla womgogodla i-stenotic.

Umlando Womtholampilo - LUMBAR Spine

• Ngokomtholampilo, isikhalazo esikhulu sesiguli wubuhlungu obubukhali, obuhlabayo.
• Ezimweni eziningi kungase kube nomlando wangaphambilini weziqephu zesikhashana zobuhlungu obuphansi be-back back.
• Ubuhlungu abugcini nje kuphela ngemuva kodwa buphinde bukhanye phansi emlenzeni ekusabalaliseni kwe-anatomic yezimpande zemizwa ethintekile.
• Ngokuvamile izochazwa ngokuthi ijulile futhi ibukhali futhi iqhubekela phambili ukusuka phezulu kuya phansi emlenzeni ohilelekile.
• Ukuqala kwawo kungase kube okucashile noma ngokuzumayo futhi kuhlotshaniswe nokudabuka noma ukuhlwithwa komgogodla.
• Ngezinye izikhathi, lapho i-sciatica iqala, ubuhlungu obungemuva bungase buxazulule ngoba uma i-annulus isiqhumile, ingase ingabe isaba ngaphansi kwengcindezi.
• I-Disc herniation kwenzeka ngomzamo womzimba ozumayo lapho i-trunk iguquguquka noma ijikeleza.
• Kwesinye isikhathi, iziguli ezine-L4-L5 disc herniation zinezinhlungu ze-groin. Ocwaningweni lweziguli ezingama-512 ze-lumbar disc, 4.1% waba nobuhlungu benyonga.
• Ekugcineni, i sciatica zingahluka ngamandla; kungase kube nzima kangangokuthi iziguli ngeke zikwazi ukugijima futhi zizwe sengathi umhlane wabo "ukhiyiwe".
• Ngakolunye uhlangothi, ubuhlungu bungase bukhawulelwe kubuhlungu obufiphele obukhula ngamandla ngokuzuma.
• Ubuhlungu buyaqina endaweni eguquguqukayo futhi bukhululeke ngokunwetshwa kwe-lumbar spine.
• Ngokwesimo, iziguli ezine i-discni herniated babe nobuhlungu obandayo ngokuhlala, ukushayela, ukuhamba, ukucambalala, ukuthimula, noma ukudonsa kanzima.

Umlando Womtholampilo - CERVICAL Spine

• Ubuhlungu bengalo, hhayi ubuhlungu bentamo, yisikhalazo esikhulu sesiguli.
• Ubuhlungu buvame ukubonwa njengokuqala endaweni yentamo bese buphuma kuleli phuzu behle bufike ehlombe, ingalo nengalo futhi ngokuvamile bungene esandleni.
• Ukuqala kobuhlungu be-radicular kuvame ukuhamba kancane, nakuba kungase kuvele kungazelelwe futhi kwenzeke ngokuhambisana nokukhala noma ukukhala.
• Njengoba isikhathi sidlula, ubukhulu bobuhlungu bengalo budlula ngokucacile ubuhlungu bentamo noma ihlombe.
• Ubuhlungu bengalo bungase buguquke ngamandla futhi buvimbele noma yikuphi ukusetshenziswa kwengalo; kungase kusuke ebuhlungwini obukhulu kuye ebuhlungwini obufiphele, obucindezelayo emisipha yengalo.
• Ubuhlungu ngokuvamile buba nzima ngokwanele ukuvusa isiguli ebusuku.
• Ukwengeza, isiguli singase sikhononde ngekhanda elihambisanayo kanye ne-muscle spasm, engaphuma emgodleni womlomo wesibeletho kuya ngaphansi kwe-scapulae.
• Ubuhlungu bungase buphumele esifubeni futhi bulingise i-angina (pseudoangina) noma ebeleni.
• Izimpawu ezinjengobuhlungu beqolo, ubuhlungu bomlenze, ubuthakathaka bomlenze, ukuphazamiseka kokuhamba, noma ukungakwazi ukuzilawula kusikisela ukucindezelwa komgogodla (Myelopathy).

Ukuhlolwa Komzimba - LUMBAR Spine

• Ukuhlolwa ngokomzimba kuzobonisa ukwehla kokunyakaza komgogodla we-lumbosacral, futhi iziguli zingase zibhale ohlangothini olulodwa njengoba zizama ukugoba phambili.
• Uhlangothi lwe-disc herniation ngokuvamile luhambisana nendawo yohlu lwe-scoliotic.
• Kodwa-ke, izinga elithile noma idigri ye-herniation ayihambelani nezinga lohlu.
• Lapho bephuthuma, iziguli zihamba ne- i-antalgic gait lapho bebamba khona umlenze othintekayo ukuze babeke isisindo esincane ngangokunokwenzeka ekugcineni.

• Ukuhlolwa Kwezinzwa:

• Ukuhlolwa kwe-neurologic kubaluleke kakhulu futhi kungase kuveze ubufakazi obunenjongo bokucindezelwa kwezimpande zezinzwa (Kufanele sihlole ukuhlolwa kwe-reflex, amandla emisipha, nokuhlolwa kokuzwa kwesiguli).
• Ukwengeza, ukushoda kwezinzwa kungase kube nokuhambisana okuncane kwesikhashana ngoba kungase kuhlobane nokuhlasela kwangaphambilini ezingeni elihlukile.
• Ukucindezelwa kwezimpande zomgogodla ngamunye kubangela ukuguqulwa kwemoto, izinzwa, kanye nokusebenza kwe-reflex.
• Lapho impande yokuqala ye-sacral icindezelekile, isiguli singase sibe nobuthakathaka be-gastrocnemius-soleus futhi singakwazi ukuphakamisa ngokuphindaphindiwe ezinzwaneni zalolo nyawo.
• I-Atrophy yethole ingase ibonakale, futhi i-ankle (Achilles) reflex ngokuvamile iyancipha noma ingekho.
• Ukulahlekelwa kwezinzwa, uma kukhona, kuvame ukuvalelwa kusici esingemuva sethole kanye nohlangothi oluseceleni lonyawo.

• Ukubandakanyeka kwezimpande zesihlanu ze-lumbar kungabangela ubuthakathaka ekwandiseni uzwane olukhulu futhi, ezimweni ezimbalwa, ubuthakathaka be-everters kanye ne-dorsiflexors yonyawo.
• Ukushoda kwezinzwa kungavela ngaphezu kwengaphambili lomlenze kanye nengxenye engemuva yonyawo kwehle kuye kuzwane omkhulu.

• Ngokucindezelwa kwempande yesine ye-lumbar nerve, imisipha ye-quadriceps iyathinteka; isiguli singase siqaphele ubuthakathaka ekwandiseni kwamadolo, okuvame ukuhlotshaniswa nokungazinzi.
• I-Atrophy ye-musculature yethanga ingamakwa. Ukulahlekelwa kwezinzwa kungase kubonakale phezu kwesici se-anteromedial yethanga, futhi i-patellar tendon reflex ingancipha.

 

• Ukuzwela kwezimpande zemizwa kungavuswa nganoma iyiphi indlela edala ukungezwani.
• Ukuhlolwa kwe-straight leg-raising (SLR) yikhona okuvame ukusetshenziswa kakhulu.
• Lokhu kuhlolwa kwenziwa ngesiguli esilele.

Ukuhlolwa Komzimba - CERVICAL Spine

Ukuhlolwa Kwezinzwa:

• Ukuhlolwa kwe-neurologic okubonisa ukungavamile kuyisici esiwusizo kakhulu somsebenzi wokuxilonga, nakuba ukuhlolwa kungase kuhlale kujwayelekile naphezu kwephethini ye-radicular engapheli.
• Ukuba khona kwe-atrophy kusiza ukubhala indawo yesilonda, kanye nokungapheli kwayo.
• Ukuba khona kwezinguquko ezithinta imizwa ngokuvamile kunzima ukukuhumusha futhi kudinga isiguli esivumelanayo nesibambisanayo ukuthi sibe nenani lomtholampilo.

• Lapho impande yesithathu yomlomo wesibeletho icindezelekile, akukho shintsho lwe-reflex kanye nobuthakathaka bemoto obungabonakala.
• Ubuhlungu buphumela ngemuva kwentamo futhi bubheke enqubweni ye-mastoid kanye ne-pinna yendlebe.
• Ukubandakanyeka kwempande yesine yomlomo wesibeletho kuholela ekungabikho kwezinguquko ze-reflex ezitholakala kalula noma ubuthakathaka bemoto.
• Ubuhlungu buphuma ngemuva kwentamo kanye nesici esiphezulu se-scapula.
• Ngezinye izikhathi, ubuhlungu buphumela odongeni lwesifuba sangaphambili.
• Ubuhlungu buvame ukukhushulwa ngokunwetshwa kwentamo.
• Ngokungafani nezimpande zenzwa yomlomo wesibeletho yesithathu neyesine, izimpande ze-nerve ye-cervical yesihlanu kuya kweyesishiyagalombili zinemisebenzi ye-motor.
• Ukucindezelwa kwempande yesihlanu yomlomo wesibeletho kubonakala ngobuthakathaka bokuthunjwa kwehlombe, ngokuvamile ngaphezu kwe-90 degree, kanye nobuthakathaka bokunwetshwa kwehlombe.
• I-biceps reflexes ivame ukucindezeleka futhi ubuhlungu buphuma eceleni kwentamo bufike phezulu ehlombe.
• Ukuncipha kokuzwa kuvame ukuphawulwa engxenyeni engemuva ye-deltoid, emele indawo ezimele ye-axillary nerve.

• Ukubandakanyeka kwempande yesithupha yomlomo wesibeletho kukhiqiza ubuthakathaka bemisipha ye-biceps kanye nokuncipha kwe-brachioradial reflex.
• Ubuhlungu buphinde buphume entanyeni buye phansi engxenyeni engaseceleni yengalo nengalo kuya ohlangothini lwesandla olukhanyayo (umunwe wenkomba, umunwe omude, nesithupha).
• Ukuba ndikindiki kwenzeka ngezikhathi ezithile esihlokweni somunwe wokukhomba, indawo ezimele yempande yesithupha yomlomo wesibeletho.

• Ukucindezelwa kwempande ye-nerve yesikhombisa yomlomo wesibeletho kukhiqiza izinguquko ze-reflex ekuhlolweni kwe-triceps jerk nokulahlekelwa amandla okuhambisana nemisipha ye-triceps, enweba indololwane.
• Ubuhlungu obuvela kulesi silonda buphuma engxenyeni engemuva yentamo yehle phakathi nendawo ukuya emunweni ophakathi.
• Izinguquko zemizwa zenzeka kaningi esihlokweni somunwe ophakathi nendawo, indawo ezimele yenzwa yesikhombisa.
• Iziguli kufanele futhi zihlolelwe i-wingang ye-scapular, okungenzeka nge-C6 noma i-C7 radiculopathies.

• Okokugcina, ukubandakanyeka kwempande yesishiyagalombili yomlomo wesibeletho ngediski ye-C7-T1 ye-herniated kuveza ubuthakathaka obuphawulekayo bemisipha yangaphakathi yesandla.
• Ukubandakanyeka okunjalo kungaholela e-atrophy esheshayo yemisipha ye-introssseous ngenxa yobukhulu obuncane bale misipha.
• Ukulahlekelwa kwe interossei kuholela ekulahlekelweni okukhulu kokuhamba kahle kwesandla.
• Awekho ama-reflexes atholakala kalula, nakuba i-flexor carpi ulnaris reflex ingase yehliswe.
• Ubuhlungu obuyi-radicular obusuka empandeni yenzwa yomlomo wesibeletho yesishiyagalombili buphumela emngceleni we-ulnar esandleni kanye neringi neminwe emincane.
• Ichopho lomunwe omncane ngokuvamile libonisa ukuzwa okunciphile.

• Ubuhlungu obukhulu obuphakathi kwe-herniated cervical disc bungase bukhululeke ngokuthunjwa kwengalo ethintekile.
• Nakuba lezi zimpawu ziwusizo uma zikhona, ukungabi khona kwazo kukodwa akukhiphi isilonda sezimpande zemizwa.

Idatha Yaselabhorethri

• Ukuhlolwa kwelabhorethri yokuhlolwa kwezokwelapha (izibalo zegazi, amaphaneli ekhemikhali i-erythrocyte sedimentation rate [ESR]) kuvamile ezigulini ezine-herniated disc.

• Electro diagnostic Testing

• I-Electromyography(EMG) isandiso se-elekthronikhi sokuhlolwa komzimba.
• Ukusetshenziswa okuyinhloko kwe-EMG ukuxilonga i-radiculopathies ezimeni zemvelaphi engabazekayo ye-neurologic.
• Okutholwe yi-EMG kungase kube kuhle ezigulini ezinezimpande ze-nerve impingement.

Ukuhlolwa kwe-Radiographic - LUMBAR Spine

• I-x-ray engenalutho ingase ibe yinto evamile ngokuphelele esigulini esinezimpawu nezimpawu zokungena kwezimpande zemizwa.

• I-Tomography ehlanganisiwe

• Ukuhlolwa kwe-Radigraphic nge-CT scan kungase kubonise i-disc bulging kodwa kungase kungahambisani nezinga lokulimala kwezinzwa.

• Ukufaniswa kwe-Magnetic Resonance

• I-MR imaging iphinde ivumele ukubonwa kwezicubu ezithambile, kufaka phakathi ama-disc ku-lumbar spine.
• Amadiski e-Herniated atholakala kalula ngokuhlolwa kwe-MR.
• I-MR imaging iyindlela ebucayi yokuthola ama-disc herniations angemuva nangaphambili.

Ukuhlolwa kwe-Radiographic - CERVICAL Spine

• X-ray

• I-x-ray engenalutho ingase ibe yinto evamile ngokuphelele ezigulini ezine-disc ye-cervical herniated acute.
• Ngokuphambene, 70% kwabesifazane abane-asymptomatic kanye 95% amadoda angenayo izimpawu phakathi kweminyaka engu-60 kanye neminyaka engu-65 anobufakazi besifo se-disc degenerative kuma-roentgenograms angenalutho.
• Ukubuka okuzotholwa kuhlanganisa i-anteroposterior, i-lateral, i-flexion, nesandiso.

• I-Tomography ehlanganisiwe

• I-CT ivumela ukuboniswa okuqondile kokucindezelwa kwezakhiwo ze-neural futhi ngakho-ke inembe kakhulu kune-myelography.
• Izinzuzo ze-CT phezu kwe-myelography zifaka ukubonwa okungcono kokungajwayelekile kwe-lateral okufana ne-foraminal stenosis kanye nokungajwayelekile kwe-caudal block to myelographic block, ukuchayeka emisebeni encane, kanye nokulaliswa esibhedlela.

• I-Magnetic Resonance

• I-MRI ivumela ukubonwa okuhle kakhulu kwezicubu ezithambile, kufaka phakathi ama-discs e-herniated emgodleni womlomo wesibeletho.
• Ukuhlola akukona.
• Esicwaningweni seziguli ze-34 ezinezilonda zomlomo wesibeletho, i-MRI yabikezela 88% yezilonda ezifakazelwe ngokuhlinzwa ngokumelene 81% i-myelography-CT, 58% ye-myelography, kanye 50% nge-CT kuphela.

Ukuxilongwa Okuhlukile - LUMBAR Spine

• Ukuxilongwa kokuqala kwe-disc ye-herniated ngokuvamile kwenziwa ngesisekelo somlando nokuhlolwa komzimba.
• Ama-radiographs angenalutho omgogodla we-lumbosacral ngeke angezelele ekuxilongweni kodwa kufanele atholakale ukusiza ukukhipha ezinye izimbangela zobuhlungu ezifana nokutheleleka noma isisu.
• Okunye ukuhlola okufana no-MR, CT, kanye ne-myelography kuwukuqinisekisa ngokwemvelo futhi kungadukisa uma kusetshenziswa njengezivivinyo zokuhlola.

Ukuqina kwesisu

• Isiguli esine-spinal stenosis singase futhi sihlupheke ngenxa yobuhlungu beqolo obuphumela emaphethelweni aphansi.
• Iziguli ezine-spinal stenosis zivame ukuba zindala kunalabo okwakhiwa kuzo ama-disc herniated.
• Ngokwesici, iziguli ezine-spinal stenosis zithola ubuhlungu obuphansi bomkhawulo (pseudoclaudication=neurogenic claudication) ngemva kokuhamba ibanga elingashiwongo.
• Baphinde bakhononde ngobuhlungu obubhebhetheka ngokuma noma ukwelula umgogodla.
• Ukuhlolwa kwe-Radiographic ngokuvamile kuyasiza ekuhlukaniseni abantu abane-disc herniation kulabo abane-bony hypertrophy ehambisana ne-spinal stenosis.
• Ocwaningweni lweziguli ze-1,293, i-lateral spinal stenosis kanye nama-disc intervertebral herniated ahlala ndawonye. 17.7% kwabantu ngabanye.
• Ubuhlungu be-Radicular bungabangelwa inqubo ye-pathologic engaphezu kweyodwa kumuntu ngamunye.

I-Facet Syndrome

• I-Facet syndrome kungenye imbangela yobuhlungu obuphansi obungase buhlotshaniswe nemisebe yobuhlungu ezakhiweni ezingaphandle kwemingcele yomgogodla we-lumbosacral.
• Ukuwohloka kwezakhiwo ze-articular ekuhlanganyeleni kwe-facet kubangela ubuhlungu ukuthi bukhule.
• Ezimweni eziningi, ubuhlungu bubekwe endaweni yendawo ehlangene ethintekile futhi buthuthukiswa ngokunwetshwa komgogodla (ukuma).
• Ukungakhululeki okujulile, okungachazwanga kahle, okubuhlungu kungase kuphawulwe ekuhlanganyeleni kwe-sacroiliac, ezinqeni, nasemilenzeni.
• Izindawo ze-sclerotome ezithintekile zibonisa imvelaphi yombungu efanayo nelunga le-facet elonakele.
• Iziguli ezinobuhlungu besibili kuya ku-facet joint disease zingase zibe nokukhululeka kwezimpawu ngomjovo we-apophyseal we-anesthetic yendawo ethatha isikhathi eside.
• Indima yeqiniso yesifo esihlangene se-facet ekukhiqizeni ubuhlungu be-back and emlenzeni kusazonqunywa.
• Ezinye izimbangela zemishini ye-sciatica zihlanganisa ukungahambi kahle kwe-congentenial yezimpande ze-lumbar nerve, ukucindezelwa kwangaphandle kwe-nerve sciatic (isikhwama sesikhwama esikhwameni sebhulukwe elingemuva), nokucindezelwa kwemisipha ye-nerve (piriformis syndrome).
• Ezimweni ezingavamile, isilonda somlomo wesibeletho noma se-thoracic kufanele sicatshangelwe uma i-lumbar spine icacile ngokungavamile.
• Izimbangela zezokwelapha ze-sciatica (izicubu ze-neural noma izifo, isibonelo) zivame ukuhlotshaniswa nezimpawu zesistimu ngaphezu kobuhlungu bezinzwa ekusabalaliseni kwe-sciatic.

Ukuxilongwa Okuhlukile - I-CERVICAL Spine

• Azikho izindlela zokuxilonga ezikhona zokuxilongwa komtholampilo kwe-disc yomlomo wesibeletho ye-herniated.
• Ukuxilongwa kwesikhashana kwe-disc yomlomo wesibeletho ye-herniated kwenziwa umlando nokuhlolwa ngokomzimba.
• I-x-ray esobala ngokuvamile ayiyona i-nondiagnostic, nakuba ngezinye izikhathi isikhala se-disc siyancipha endaweni okusolakala ukuthi i-interspace noma ukuncishiswa kwe-foraminal kumafilimu e-oblique kubonakala.
• Inani lama-x-reyi liwukuba likhiphe ezinye izimbangela zobuhlungu bentamo nengalo, njengokutheleleka kanye nesimila.
• I-MR imaging kanye ne-CT-myelography yizivivinyo ezingcono kakhulu zokuqinisekisa i-disc herniation.
• I-Cervical disc herniations ingase ithinte izakhiwo ngaphandle kwezimpande zezinzwa.
• I-Disc herniation ingabangela ukucindezelwa komkhumbi (umthambo we-vertebral) ohlotshaniswa nokungasebenzi kahle komthambo we-vertebrobasilar futhi ubonakale njengombono ofiphele kanye nesiyezi.

• Ezinye izimbangela zemishini zobuhlungu bengalo akufanele zifakwe.
• Okuvame kakhulu uhlobo oluthile lokucindezelwa ku-peripheral nerve.
• Ukucindezelwa okunjalo kungenzeka endololwaneni, engalweni, noma esihlakaleni. Isibonelo ukucindezelwa kwenzwa ephakathi nge-carpal ligament eholela ku-carpal tunnel syndrome.
• Isivivinyo sokuxilonga esingcono kakhulu sokukhipha lawa ma-peripheral neuropathies yi-EMG.
• Ukudonsa ngokweqile engalweni yesibili kuya kwezisindo ezinzima kungase kubangele ubuhlungu obukhulu ngaphandle kokucindezelwa kwe-disc yezimpande zemizwa.
• Ukungajwayelekile komgogodla kufanele kucatshangelwe uma izimpawu ze-myelopathy zikhona ngokuhambisana ne-radiculopathies.
• Izilonda zomgogodla ezifana ne-syringomyelia zikhonjwa nge-MRI, kanti isifo se-motor neuron sibonakala nge-EMG.
• I-Multiple sclerosis kufanele icatshangelwe esigulini esine-radiculopathies uma izimpawu zomzimba zibonisa izilonda ngaphezu kwe-foramen magnum. (i-optic neuritis).
• Ezimweni ezingavamile kakhulu, izilonda ze-parietal lobe ezihambisana nengalo zingalingisa okutholwe kwe-radiculopathies yomlomo wesibeletho.

Umtholampilo Wezokwelapha Wokulimala: Ukwelapha Ngomzimba & I-Chiropractic