Ulawulo lwe-Sciatica: Unyango lwe-Nonsurgical & Surgical Therapy

Qwalasela oku kulandelayo, I-sciatica ligama lezonyango elisetyenziselwa ukuchaza iqela elihlangeneyo leempawu ezibangelwa ukucaphuka okanye ukunyanzeliswa kwe-nerve ye-sciatic, ngokuqhelekileyo ngenxa yokulimala okanye imeko enzima. I-Sciatica idla ngokubonakala ngokukhupha iintlungu kwi-nerve ye-sciatic, ehla imilenze enye okanye yomibini ukusuka kumqolo osezantsi. I-case vignette ilandelayo ixubusha imeko yezempilo kaMnu Winston, umqhubi webhasi oneminyaka engama-50 ubudala oye wabika ukuba ujongene nentlungu engapheliyo, ephantsi kunye nomlenze ohambelana ne-sciatica ngexesha leeveki ze-4. URamya Ramaswami, MB, BS, MPH, Zoher Ghogawala, MD, kunye noJames N. Weinstein, DO, babonelela ngohlalutyo olubanzi lweendlela ezahlukeneyo zonyango ezikhoyo ukunyanga i-sciatica, kubandakanywa utyando lwediski ye-lumbar kunye nokufumana unyango olungenamsebenzi.

 

Kwinqaku lomntu siqu, njengogqirha osebenzayo we-chiropractic, ukukhetha unyango oluchanekileyo naluphi na uhlobo lokulimala okanye imeko ingaba sisigqibo somntu kunye nesinzima. Ukuba iimeko ziyavuma, umguli usenokugqiba ukuba loluphi uhlobo lonyango olufanelekileyo kumbandela wabo wezonyango. Ngelixa iindlela zonyango ezingenanto, ezifana nokunyamekela kwe-chiropractic, zihlala zisetyenziselwa ukuphucula iimpawu ze-sciatica, iimeko ezinzima kakhulu ze-sciatica zingadinga ukungenelela kokuhlinzwa ukunyanga umthombo womcimbi. Kwiimeko ezininzi, unyango olungenalo utyando kufuneka luqwalaselwe kuqala, ngaphambi kokuba luguqukele kwiindlela zonyango zonyango lwe-sciatica.

 

Case Vignette

 

Indoda eneSciatica Eqwalasela uTyando lweLumbar Disk

 

URamya Ramaswami, MB, BS, MPH

 

UMnumzana Winston, umqhubi webhasi wase-50 oneminyaka engama-50 ubudala, wanikela kwiofisi yakho nge-4 yeveki yeembali zeentlungu ezisekhohlo zakhe kwaye ezantsi. Wachaza ukudibanisa kweentlungu ezibukhali kwaye ezibuhlungu ezivela kwisitye sakhe sasekhohlo kwaye zatshitshiswa kwisimo se-dorsolateral esikhwameni sakhe sobunxele, kunye nokugquma okungaqhelekanga phezu kwengcongolo engaphantsi. Ekuhloliseni, ukuphakanyiswa kwentloko ekhohlo kwinqanaba le-45 idigri kubangele ubuhlungu obukhulu obuye benza uphawu lwakhe oluphambili, kwaye intlungu yayinzima kangangokuthi awukwazi ukuphakamisa umlenze wakhe ngakumbi. Kwakungekho nweleka lomlenze okanye unyawo. Isalathisi somzimba wakhe (ubunzima kwiikhilogram ezahlulwe ngesikwere sokuphakama kwiimitha) yi-35, kwaye wayenezifo ezinokuphefumula ezingapheliyo zokuphefumula ngenxa yokubhema ipakethi enye yemigodi imihla ngemihla ye-22. UMnu Winston uthathe ikhefu lokungabikho emsebenzini wakhe ngenxa yeempawu zakhe. Unqume u-150 mg we-pregabalin ngosuku, okwenziwe ngokunyuka ukuya kwi-600 mg imihla ngemihla ngenxa yokuba iimpawu azizange zinciphise.

 

Ngoku, kwiiveki ezili-10 emva kokuqala kweempawu zakhe, ubuyela kuvavanyo. Iyeza linikeze ukuthomalalisa okuncinci kwintlungu yakhe ye-sciatic. Kufuneka abuyele emsebenzini kwaye uxhalabele amandla akhe okugqiba imisebenzi yakhe emsebenzini wakhe. Ufumana i-imaging resonance magnetic, ebonisa idiski ye-herniated kwicala lasekhohlo kwingcambu ye-L4�L5. Uxoxa ngeenketho zamanyathelo alandelayo ekulawuleni i-sciatica yakhe. Akaqinisekanga malunga neenkqubo ezihlaselayo ezifana nokuhlinzwa kwediski ye-lumbar kodwa uziva elinganiselwe ngeempawu zakhe zentlungu.

 

Izinyango Zonyango

 

Yikuphi kwezi zinto ezilandelayo ongasincoma kuMnu Winston?

 

1. Ngaphantsi kwe-disk ukuhlinzwa.
2. Ukufumana unyango olungenasigqeba.

 

Ukuncedisa ekwenzeni izigqibo, nganye yale ndlela ikhuselwe kwisicatshulwa esifutshane ngongcali entsimini. Ukunikezela ngolwazi lwakho ngesigulane kunye neengongoma ezenziwe yiingcali, yiyiphi ikhetho onokuyikhetha?

 

Option 1: Ngaphantsi kwe-Undergo Lumbar Disk Surgery
Option 2: Fumana unyango lwezonyango

 

1. Ngaphantsi kwe-Undergo Lumbar Disk Surgery

 

Zoher Ghogawala, MD

 

Ityala likaMnu Winston limele imeko eqhelekileyo ekulawuleni i-symptomatic lumbar disk herniation. Kule meko, iimpawu zesigulana kunye nokuhlolwa komzimba kuhambelana nokunyanzeliswa kwe-nerve-root kunye nokuvuvukala ngokuthe ngqo kwi-L4 L5 ye-herniated disk kwicala lakhe lasekhohlo. Isigulane asinakho ubuthathaka kodwa sinentlungu eqhubekayo kwaye asikwazanga ukusebenza kwiiveki ze-10 ezidlulileyo nangona sifumana i-pregabalin. Imibuzo emibini ivela: okokuqala, ngaba utyando lwe-lumbar disk (microdiskectomy) lubonelela ngeziphumo eziphezulu kunezo ziqhubeka nonyango olungasebenziyo kwizigulane ezineempawu ezingaphezu kweeveki ze-6; kwaye okwesibini, ngaba i-lumbar microdiskectomy iphucula amathuba okubuyela emsebenzini kwizigulane ezinezi mpawu?

 

Idatha ephezulu yeyona mxholo ivela kwiZiphumo zoPhando lweziPhumo zoPhando (SPORT). Iziphumo zoluvavanyo olulinganisiwe, olulawulwayo lunzima ukutolika kuba ukulandelelana kwesicwangciso sonyango esabelwe sisigxina. Ngesiqingatha sezigulane ezaziselwa ngesohlwayo iqela lotyando ngokwenene lafumana unyango phakathi kweenyanga ze-3 emva kokubhaliswa, kwaye i-30% yezigulane ezabelwe ukunyanga ezingekho nonyango zikhethe ukuwela kwiqela elisebenzayo. Kule sifundo, izigulane ezathi zenziwa ukuhlinzwa zineziphuculo ezinkulu kwiziphumo ezizaliswe zizigulane. Impembelelo yonyango ye-microdiskectomy yayingaphezulu kweyonyango engasebenziyo kwiinyanga ze-3, iminyaka ye-1, kunye ne-2 iminyaka. Ngaphezu koko, ekuhlalutyweni okuphenjisiweyo, iziphumo kwizigulane ezenza ukuhlinzwa zaziphezulu kunezo zigulane ezithe zafumana unyango olungasebenzi. Ngokubanzi, iziphumo ze-SPORT zixhasa ukusetyenziswa kwe-microdiskectomy kule meko.

 

Iziphumo zezilingo zeekliniki zisekelwe ekuthelekisweni kwonyango lwezonyango kwiindawo zokufunda kwaye zinokuthi zisebenze okanye zingenakwenzeka kwizigulane ngabanye. I-SPORT ayizange icacise ukuba luhlobo luni lwe-non-treatment. Ulwaphulo lwamaziko lwalusetyenziswa kwi-73% yezigulane, ii-injection epidural kwi-50%, kunye neyeza zonyango (umz., Iziyobisi ezingekho komlilo) ezingaphezu kwe-50%. Kwimeko kaMnumzana Winston, i-pregabalin iye yazama, kodwa unyango lomzimba kunye neenjini zangasese ze-glucocorticoid azange zenziwe. Nangona kusetyenziswe ukusetyenziswa kwonyango lonyango ekwenzeni unyango lwe-lumbar disk, ububungqina obuxhasa ukuphumelela kwayo akuhambelani, ngokwemiqathango epapashwe nguMbutho we-North American Spine Society. Ngakolunye uhlangothi, kukho ubungqina bokuthi i-transforaminal epidural glucocorticoid injection inikeza inkululeko yesikhashana (iintsuku ze-30) kwizigulane ezineempawu ezinengcambu ezihambelana ngqo nediski ye-herniated. Ngokubanzi, kukho ubungqina, ukusuka kwi-SPORT nakwiilingo ezingenangqondo ukusuka eNetherlands eshicilelwe kwiNcwadi, ukuba ukuhlinzwa kwangaphambili phakathi kwe-6 kunye ne-12 iveki emva kokuqala kweempawu kunceda kakhulu ukunciphisa intlungu yomlenze kunye nokuphuculwa kabuhlungu obukhulu kunokuba unyango olulondoloze ixesha elide.

 

Ukukwazi ukubuyela emsebenzini akuzange kufundwe ngokusemthethweni ngokuthelekiswa kokusebenza kunye nokunyanga okungekho unyango kwi-lumbar disk herniation. Idatha yeRejista evela kwi-NeuroPoint-SD yabonisa ukuba ngaphezu kwe-80% yezigulane ezazisasebenza ngaphambi kokuba i-disk herniation ibuyele emsebenzini emva kokuhlinzwa. Ukukwazi ukubuyela emsebenzini kunokuba kuxhomekeke kuhlobo lolwazi, kuba izigulane ezisebenzayo zingasebenzisa ixesha elingakumbi lokubuyisela ukunciphisa umngcipheko wokubuyiselwa.

 

Kuyaqondwa kakuhle ukuba izigulane ezininzi ezine-symptomatic lumbar disk herniation ziya kuphucula ngokukhawuleza kwiinyanga ezininzi. Utyando lunokunciphisa iimpawu ngokukhawuleza ngokukhawuleza ngokususa i-disk herniation ephosakeleyo kwingcambu ye-nerve echaphazelekayo. I-Risk Benefit equation iyakwahluka kwisigulana ngasinye. Kwimeko kaMnu Winston, ukukhuluphala kunye nesifo esincinci se-pulmonary kunokunyusa umngcipheko weengxaki ezivela kukuhlinzwa, nangona kwi-SPORT, i-95% yezigulane zokuhlinzwa zazingenayo nayiphi na ingxaki yokusebenza okanye emva kokuhlinzwa. KuMnu Winston, isigulane esinentlungu eqhubekayo ngaphezu kweeveki ze-6, i-microdiskectomy iyindlela enengqondo exhaswa bubungqina obuphezulu.

 

2. Fumana unyango lwezonyango

 

UJames N. Weinstein, WENZA

 

Eli tyala libandakanya umboniso oqhelekileyo weentlungu ezisezantsi eziphuma kwi-buttock kunye nethanga le-posterolateral elinokuthi libonise intlungu yomatshini okanye i-radiculopathy. I-radiculopathy ye-Classic ebangelwa ukunyanzeliswa kwe-root lumbar nerve root (L4, L5, okanye i-S1) ibangela intlungu ekhupha i-distal ukuya emadolweni kwaye ihlala ihamba nobuthathaka okanye ukuphazamiseka kwi-myotome okanye i-dermatome. Kule meko, intlungu isondele emadolweni kwaye ayihambelani nobuthathaka okanye ukuphazamiseka. Kwi-SPORT, utyando lubangele ukubuyiswa ngokukhawuleza kunye nenqanaba eliphezulu lokuphucula kunonyango olungasebenziyo kwizigulane ezinentlungu ekhupha i-distal emadolweni kwaye ihamba kunye neempawu ze-neurologic okanye iimpawu. Nangona kunjalo, ekubeni uMnumzane Winston akayi kuhlangabezana neendlela zokufakwa kwe-SPORT, iziphumo ze-diskectomy kule meko ziya kuba yinto engalindelekanga. Akanayo i-radiculopathy ephuma ngaphantsi kwedolo, kwaye ayinakho ubuthathaka okanye i-numbness; unyango olungasebenziyo lufanele lugqitywe ngaphambi kokuba naluphi na uqwalaselo lwenkqubo yotyando kwiimeko ezininzi aluzange luboniswe ukuba lusebenza kakuhle kwizigulane ezinolu hlobo lokubonisa. Kulo mbandela weJournal, uMathieson kunye noogxa bakhe babika iziphumo zovavanyo olungahleliwe, olulawulwayo olubonisa ukuba i-pregabalin ayizange inciphise kakhulu intlungu ehambelana ne-sciatica. UMnu Winston uye waphathwa kuphela nge-pregabalin; ngoko ke, ezinye iindlela zokulondoloza kufuneka zijongwe.

 

I-Saal kunye ne-Saal ibike ukuba ngaphezu kwe-80% yezigulane ezine-radiculopathy ezinxulumene ne-lumbar disk herniation ziye zaphuculwa kwimiba yeenyanga kunye nonyango olusekelwe kumzimba. Kwiqela le-SPORT elingasebenziyo, izigulane ziye zaphucula kakhulu ukusuka kwisiseko, kwaye malunga ne-60% yalabo abane-radiculopathy ye-classic abaqale bafumana unyango olungasebenziyo bagweme utyando. UMnu Winston uye wafumana unyango oluncinci kwaye uneempawu kwiiveki ze-10 kuphela. Kufuneka enze ikhosi yonyango lomzimba olusekelwe kwi-exercise kunye nolingo lweyeza elichasene ne-nonsteroidal antiinflammatory kwaye unokuqwalasela inaliti ye-lumbar epidural glucocorticoid. Nangona kukho ubungqina obuncinane bokusebenza kolu khetho lungasebenziyo lulodwa, indibaniselwano yolu nyango kunye nembali yendalo enobungozi yemeko yesigulana inokukhokelela ekuthotyweni okanye ekusonjululweni kweempawu. Ukuba olu ngenelelo � kunye nexesha � azizisombululi iimpawu zakhe, utyando lunokuthathwa njengokhetho lokugqibela, kodwa alunakusebenza ixesha elide kwaye lunokuthi ngokwalo lubangele ukwenzakala okungaphezulu kunokulunga. UMnu Winston unemingcipheko, njengokutyeba kakhulu kunye nembali yokutshaya, eziye zaboniswa ukuba negalelo kwiziphumo zotyando ezimbi zeenkqubo ezithile zomgogodla.

 

UMnu Winston unempawu zeentlungu ezithintekayo eziphazamisa umgangatho wobomi. Uya kufuneka ukuba aqonde, ngokwenza iinqunto ezenziwe ngokubambisana, ukuba indlela engabonakaliyo iyasebenza ngakumbi kunokuba utyunjiswe ngexesha.

 

Ulwazi olubhekiselele kwiZiko leSizwe loLwazi lwe-Biotechnology (NCBI) kunye neNew England Journal of Medicine (NEJM). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komgogodla kunye neemeko. Ukuxoxa ngombandela, nceda uzive ukhululekile ukubuza uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhankanywe nguDkt. Alex Jimenez

 

 

Imixholo eyongezelelweyo: Ubungakanani

 

Impilo kunye nokuphila kakuhle kubalulekile ekugcineni ukulinganisela kwengqondo kunye nomzimba emzimbeni. Ukutya ukutya okunokulinganisela kunye nokuthatha inxaxheba kwimisebenzi engokwenyama, ukulala ixesha elinempilo ngokuqhelekileyo, ukulandela iziphumo ezingcono zezempilo kunye neempilweni zokugcina unokukunceda ekugcineni ulondoloze impilo yonke. Ukutya ezininzi iziqhamo nemifuno kunokuhamba ixesha elide ekuncedeni abantu ukuba baphile.

 

 

INGXELO EBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukunyanga i-Sciatica Pain