Yintoni isifo seDegenerative Disc (DDD)?

Isifo se-Disgenerative Disc sisigama esiqhelekileyo semeko apho idiski ye-intervertebral eyonakeleyo ibangela iintlungu ezingapheliyo, ezinokuba ziintlungu ezisezantsi kumqolo we-lumbar okanye entlungu kwintamo yomqolo wesibeleko. Ayisiyo isifo ngomntu ngamnye, kodwa eneneni kukwaphuka kwediski yomnqonqo. Idiski ye-intervertebral sisakhiwo esineqwalaselo enkulu egxile kutshanje, ngenxa yeempembelelo zeklinikhi. Utshintsho lwezifo olunokuthi lwenzeke kwi-disc degeneration lubandakanya i-fibrosis, ukunciphisa kunye nokuchithwa kwe-disc. Iziphene ezahlukeneyo ze-anatomical zinokubakho kwi-disc ye-intervertebral efana ne-sclerosis ye-endplates, i-fissuring kunye ne-mucinous degeneration ye-annulus, kunye nokwenziwa kwe-osteophytes.

 

Ubuhlungu obuphantsi ngasemva kunye nentlungu yentamo ziingxaki ezinkulu zezifo, ekucingelwa ukuba zinxulumene notshintsho oluphakathi kwidiski. Ubuhlungu obungasemva sesona sizathu siphambili sokutyelela ugqirha e-USA. Kuqikelelwa ukuba malunga neepesenti ezingama-80 zabantu abadala base-US abanesifo esibuhlungu esisezantsi ubuncinci kanye ngexesha lokuphila kwabo. (UModic, uMichael T., kunye noJeffrey S. Ross) Ke ngoko, ukuqonda okuqinisekileyo kwesifo se-disc esibuhlungu kuyadingeka ukulawula imeko eqhelekileyo.

 

I-Anatomy yeZakhiwo eziNxulumene noko

 

Inatomy of the Spine

 

Umgogodla sisona sakhiwo siphambili, esigcina isigxina kwaye sibangela iingxaki ezahlukeneyo ngeenkqubo zezifo. Umgogodla ubunjwe nge-vertebrae yomlomo wesibeleko, i-vertebrae elishumi elinambini, vertebrae emihlanu, kunye ne-vertebrae yecalcy kunye ne-coccygeal vertebrae. Ukuqina komgogodla kugcinwa ziikholamu ezintathu.

 

Ikholamu yangaphambili yenziwa ligament yangaphakathi ye-longitudinal kunye nenxalenye yangaphandle yomzimba we-vertebral. Ikholamu ephakathi yenziwa licandelo elingasemva lomzimba we-vertebral kunye ne-posterior longitudinal ligament. Ikholamu engasemva inesithuba somzimba esingasemva esineenkqubo ezinqamlezileyo, i-laminae, iinkalo, kunye neenkqubo ezijikelezayo. ( Isifo seDiserative Disk: Imvelaphi, iAnatomy, iPathophysiology)

 

I-Anatomy ye-Intervertebral Disc

 

I-disc ye-intervertebral ilele phakathi kwemizimba emibini ye-vertebral esondelene kwikholamu ye-vertebral. Malunga nekota enye yobude bonke bekholamu yenziwa ziidiski eziphakathi kwendlela. Le disc yakha indibaniselwano ye-fibrocartilaginous, ekwabizwa ngokuba yi-symphysis edibeneyo. Ivumela intshukumo encinci kwi-vertebrae kwaye ibambe i-vertebrae kunye. I-disc ye-intervertebral ibonakaliswa kukungahambelani kwayo kunye nokunyanzeliswa kweempawu. I-disc ye-intervertebral idityaniswa ikakhulu ngamalungu amathathu; Ingaphakathi le-gelatinous nucleus pulposus, i-annulus fibrosus yangaphandle, kunye ne-cartilage endplates ebekwe ngaphezulu kwaye iphantsi kwindawo yokudibana kwemizimba ye-vertebral.

 

I-pulposus yeNucleus yinxalenye engaphakathi ye-gelatinous. Ineprotoglycan kunye nejeli zamanzi ezihlanganiswe ngohlobo lwe-II Collagen kunye neefayile ze-elastin ezilungelelaniswe ngokuzimeleyo nangokungahambi kakuhle. I-Aggrecan yiproteoglycan enkulu efumaneka kwi-nucleus pulposus. Inomyinge wama-70% we-nucleus pulposus kunye neepesenti ezimalunga ne-25% yefudusus yonyaka. Ingagcina amanzi kwaye inikeze iipropathi ze-osmotic, eziyimfuneko ukumelana nokunyanzelwa kunye nokwenza njengesixhobo sokufunxa. Eli nani liphezulu le-aggrecan kwi-disc eqhelekileyo ivumela izicubu ukuba zixhase uxinzelelo ngaphandle kokuwa kwaye imithwalo isasazwa ngokulinganayo kwi-annulus fibrosus kunye nomzimba we-vertebral ngexesha lokuhamba komgogodla. (Isondo, uPaul R, et al.)

 

Inxalenye yangaphandle ibizwa ngokuba yi-annulus fibrosus, enodidi oluninzi lwe-collagen fibers ezilungiswe njengobubanzi besangqa. Iintsinga ze-collagen zihamba ngendlela ebenqabileyo phakathi kwe-lamellae ye-annulus kwiindlela ezihambelanayo ezinika amandla okuxhathisa amandla anobunzima. I-liguments ejikelezayo yomeleza i-annulus fibrosus rhoqo. Kwinqanaba le-anterior, i-ligament enkungu qinisa ngakumbi i-annulus fibrosus kunye ne-ligament encinci eqinisa icala lomva. (Choi, Yong-Soo)

 

Ngokwesiqhelo, kukho idiski enye phakathi kwesibini somqolo ngaphandle kwe-atlasi kunye ne-axis, eyokuqala neyesibini yomlomo wesibeleko emzimbeni. Ezi diski zinokuhamba malunga nesi-6? Kuzo zonke izembe zokuhamba kunye nokujikeleza ujikeleze i-axis nganye. Kodwa le nkululeko yokuhamba iyahluka phakathi kweendawo ezahlukeneyo zekholamu ye-vertebral. I-vertebrae yomlomo wesibeleko inoluhlu olukhulu lokuhamba ngenxa yokuba ii-discs ze-intervertebral zikhulu kwaye kukho indawo ebanzi engaphantsi kunye ne-convex ephezulu yomzimba womzimba. Banokudityaniswa ngokudibeneyo kokudityaniswa kwamalungu. I-vertebrae ye-Thoracic ineyona nqanaba lincinci lokuhamba kwi-flexion, ukwandiswa, kunye nokujikeleza, kodwa ube nokuhamba ngokukhululekileyo kwangoko njengoko kunamathele kwimbambo. I-vertebrae ye-lumbar ine-flexion elungileyo kunye nokwandiswa, kwakhona, kuba ii-discs zabo ze-intervertebral zinkulu kwaye iinkqubo ze-spinous zibekwe mva. Nangona kunjalo, ukujikeleza kwe-lumbar esecaleni kunqunyelwe kuba amalungu e-facet abekwe ngokungaqhelekanga. ( Isifo seDiserative Disk: Imvelaphi, iAnatomy, iPathophysiology)

 

Ubonelelo lwegazi

 

I-disc ye-intervertebral yenye yezona zakhiwo zikhulu ze-avascular emzimbeni kunye ne-capillaries ephela kwii-endplates. Izicubu zifumana izondlo kwiinqanawa ezikwithambo le-subchondral elilele ecaleni kwe-hyaline cartilage kwindawo yokugqibela. Ezi zinongo ezifana neoksijini kunye neglucose zihanjiswa kwi-disc ye-intervertebral ngokusebenzisa usasazo olulula. (-Idiski ye-Intervertebral Disc, Ispine, ii-Orthobullets.Com )

 

Isibonelelo soNyango

 

Ukugcinwa okungapheliyo kweediski ze-intervertebral kunzima kwaye kuyahluka ngokwendawo ekwikholamu yomqolo. Ukuhanjiswa kweemvakalelo kucingelwa ukuba kungahambelana nesiyobisi P, calcitonin, VIP, kunye neCPON. I-Sinu vertebral nerve, evela kwingcambu ye-dorsal ganglion, ikhusela imicu engaphezulu ye-annulus. Imicu yamathambo ayidluli ngaphaya kwemisonto engaphezulu.

 

Iidiski ze-lumbar intervertebral disc ziye zongezwa ngokubonakalayo kumva wamva kunye namasebe avela kwi-rral yecral yangaphakathi kunye nakwi-grey ricommicantes esondele kwindibaniselwano yabo kunye ne-ventral rami eyintloko. Amanqaku e-discal anikezelwa ngamasebe avela kwi-rami communicantes. Ezinye zee-rami communicantes zinokuwela i-discs eziphakathi kunye nokungena kwi-inclusive izicubu, ezilele nzulu kwimvelaphi yepsoas. (IPalmgren, iTove, et al.)

 

Ii-discs zesibeleko somlomo wesibeleko zongezwa ngokubonakalayo kumalungu alandelayo ngamasebe e-nervebral nerve. Iimpawu zesifo sezintso zesibeleko somlomo wesibeleko kufunyenwe zinesifundo esingaphezulu kwi-vertebral canal enikezela i-disc kwindawo yabo yokungena kunye nale ingentla. (I-BOGDUK, NIKOLAI, et al.)

 

I-pathophysiology yesifo seDesgenerative Disc

 

Phantse iipesenti ezingama-25 zabantu ngaphambi kobudala beminyaka engama-40 zibonisa utshintsho oluzenzekelayo kwinqanaba elithile. Ngaphezulu kweminyaka engama-40 yobudala, ubungqina be-MRI bubonisa utshintsho kubantu abangaphezu kwama-60%. (Suthar, Pokhraj) Ke ngoko, kubalulekile ukuba kufundwe inkqubo yokuwohloka kwee-discs zangaphakathi kuba kufunyanwe ukuba ziwohloke ngokukhawuleza kunayo nayiphi na enye izicubu zomzimba emzimbeni, ezikhokelela kubuhlungu basemva nasemqaleni. Utshintsho kwii-discs eziphakathi kwe-intervertebral zinxulunyaniswa notshintsho kumzimba we-vertebral kunye nokudibana okubonisa inkqubo eqhubekayo kunye namandla.

 

 

Inkqubo yokwehla kweediski ze-intervertebral yahlulwe yangamanqanaba amathathu, ngokwe-Kirkaldy-Willis kunye neBernard, ebizwa ngokuba yi-gendegenerative cascade . Ezi nqanaba zinokudibana kwaye zinokwenzeka kwisithuba samashumi eminyaka. Nangona kunjalo, ukuchonga la manqanaba eklinikhi akunakwenzeka ngenxa yokuhlangana kweempawu kunye neempawu.

 

Inqanaba loku-1 (iSigaba esiHlaziyiweyo)

 

Eli nqanaba libonwa ngokuduka. Kukho utshintsho olwenzeka embalini, olubonisa ukuba iinyembezi zilungelelanisa kunye nefissure kwi-annulus fibrosus. Ezi nyembezi zijikelezayo zingajika zibe ziinyembezi zeradi kwaye ngenxa yokuba i-pulposus ye-annulus ibhalwe kakuhle, eziinyembezi zinokubangela iintlungu zangasemva okanye zentamo, ezithi zibekhona ekhaya kunye nokuhamba okuhlungu. Ngenxa yengozi ephindaphindiweyo kwii-discs, i-endplates ingahlukanisa ikhokelela ekuphazamiseni ukubonelelwa kwegazi kwi-disc kwaye ngenxa yoko, ukuphosa amandla ayo okuhambisa izondlo kunye nokususwa kwenkunkuma. I-annulus inokuqulatha i-micro-fractures kwi-collagen fibrils, enokubonwa kwi-microscopy ye-elektroni kunye nokuskena kwe-MRI kunokubhengeza ukutyeshelwa, ukubetheka kwe-disc, kunye nomphezulu wobunzulu be-annulus. Ukudityaniswa kwe-facet kunokubonisa ukusabela okuhambelana kunye kwaye kunokubangela ukuba buhlungu okungathethekiyo okunxulumene ne-synovitis kunye nokungakwazi ukushenxisa ukudibanisa kwezihlanganisi ze-zygapophyseal. Olu tshintsho alunakuba lwenzeka kumntu ngamnye. (UGupta, uVijay Kumar, et al.)

 

I-nucleus pulposus ikwabandakanyeka kule nkqubo njengoko umthamo wayo wokubambisa wamanzi uncitshiswa ngenxa yokuqokelelwa kweeprotoglycans eziguqulwe ngokuchwephesha. Olu tshintsho luziswa ikakhulu zii-enzymes ezimbini ezibizwa ngokuba yi-matrix metalloproteinase-3 (MMP-3) kunye ne-tishu inhibitor ye-metalloproteinase-1 (TIMP-1). (I-Bhatnagar, Sushma, neMaynak Gupta) Ukungalingani kwabo kukhokelela ekutshatyalalisweni kwe-proteinoglycans. Umthamo othotyiweyo wokufunxa amanzi kukhokelela ekunciphiseni koxinzelelo lwe-hydrostatic kwi-nucleus pulposus kwaye ibangele i-lamularayo ye-bellle. Oku kunokunyusa ukuhambisa kwesahlulo esikhokelela kuxinzelelo lwe-shear kudonga olusebenzayo. Zonke ezi nguqu zinokukhokelela kwinkqubo ebizwa ngokuba yi-annular delamination kunye nefissing kwi-annulus fibrosus. Ezi nkqubo zimbini ze-pathological ezahlukileyo kwaye zombini kunokukhokelela kwintlungu, ububele bendawo, hypkidility, izihlunu zesivumelwano, ukunyakaza okudibeneyo. Nangona kunjalo, uvavanyo lwe-neurological okweli nqanaba liqhelekile.

 

Inqanaba 2 (iSigaba sokuFezeka)

 

Inqanaba lokungasebenzi kakuhle lilandelwa linqanaba lokungazinzi, elinokubangelwa kukuwohloka okuqhubekayo kokunyaniseka kokusebenza koomatshini abadibeneyo. Kunokubakho utshintsho oluninzi oluqubisene ngeli nqanaba, kubandakanywa ukuphazamiseka kunye nokuphinda u-resorption, oku kunokukhokelela ekuphulukaneni nokuphakama kwendawo ye-disc. Iinyembezi ezininzi eziphindaphindiweyo zingavela kwinqanaba leli nqanaba kunye neenguqu ezenzeka ngokudibeneyo kuma-zagopophyseal joints. Zingaquka ukuwohloka koxinzelelo kunye ne-facet capular laxity ekhokelela kwi-subluxation. Olu tshintsho lwebhayiloji lubangela ukungazinzi kwecandelo elichaphazelekayo.

 

Iimpawu ezibonwe kwesi sigaba ziyafana nezo zibonwa kwisigaba sokungasebenzi kakuhle njenge- giving way yomqolo, iintlungu xa umi ixesha elide, kunye 'nokubanjwa' ngasemva ngokuhamba. Zihamba kunye neempawu ezinje ngokuhamba okungaqhelekanga kumalungu ngexesha lokucofa kunye nokujonga ukuba umqolo uyajikeleza okanye utshintshele ecaleni emva kokuma nkqo okwethutyana emva kokujika. (UGupta, uVijay Kumar et al.)

 

Inqanaba 3 (iSigaba sokuZinza ngokutsha)

 

Kweli nqanaba lesithathu nelokugqibela, ukuphucuka komzimba okuqhubela phambili kukhokelela kwindawo enqamlezileyo ye-disc kunye ne-fibrosis kunye nokwenziwa kwe-osteophyte kunye ne-transdiscal bridal. Intlungu ebangelwa zezi nguqu inzima xa ithelekiswa namanqanaba amabini angaphambili, kodwa ezi zinokwahluka phakathi kwabantu. Oku kuncitshiswa kwendawo ene disc kunokuba neempembelelo ezininzi kumqolo. Oku kunokubangela ukuba i-canver e-intervertebral icekeke kwicala elingaphezulu-eliphantsi kunye nokufikelelwa kwee-pedicles ezikufuphi. I-longitudinal ligaments, exhasa umqolo we-vertebral, isenokukhubazeka kwezinye iindawo ezikhokelela kukungabikho koxinzelelo kunye nokuqina komgogodla. Ukuhamba komgogodla kunokubangela i-ligamentum flavum ukuba ibambe kwaye kunokubangela ukuvela kwe-aricular process subluxation. Oku ekugqibeleni kukhokelela ekunciphiseni kwedayimitha kwicala le-anteroposterior yendawo ye-intervertebral space kunye ne-stenosis yemiqolo engaphezulu yempumlo.

 

Ukudalwa kwee-osteophytes kunye ne-hypertrophic yeempawu zobuso zinokwenzeka ngenxa yenguqu kumthwalo we-axial kumgogodla nakwimizimba ye-vertebral. Ezi zinokubumba kwiinkqubo ezibalaseleyo kunye eziphantsi ze-expressionular kunye ne-osteophytes zinokuphuma kumsele we-intervertebral ngelixa iindawo ze-hypertrophied zingaphumela kumsele ophakathi. I-Osteophytes kucingelwa ukuba yenziwe ukusuka kokukhula kwenqwelomoya ocacileyo kwi-periosteum emva kokuba behlelwe yi-endochondral calcation kunye ne-ossation. I-osteophytes nayo iyenziwa ngenxa yeenguqu kuxinzelelo lweoksijini nangenxa yotshintsho kuxinzelelo lwamanzi ukongeza kwisiphene sokuhambisa. I-osteophytes kunye ne-periarticular fibrosis inokubangela ukuqina kwamalungu. Iinkqubo ze -ularular zingajikeleza kwicala le-oblique elikhokelela ekubuyiselweni komsele we-intervertebral, umsele weengcambu, kunye nomgogodla womgogodla. (KIRKALDY-WILLIS, WH et al.)

 

Zonke ezi nguqu zikhokelela kwintlungu ephantsi yasemva, encipha ngokuqatha. Ezinye iimpawu ezinje ngokuhamba okunciphileyo, ukuthamba kwemisipha, ukuqina, kunye nesifo se-scoliosis zinokwenzeka. Iiseli ze-synovial stem kunye ne-macrophages zibandakanyeka kule nkqubo ngokukhulula izinto zokukhula kunye neemolekyuli zangaphandle ze-matrix, ezisebenza njengabalamli. Ukukhutshwa kwee-cytokines kufunyenwe kunxulunyaniswe nalo lonke inqanaba kwaye kunokuba neempembelelo zonyango kunyango lwexesha elizayo.

 

I-Etiology yeziNgozi zoMngcipheko weSifo seDesgenerative Disc

 

Ukwaluphala kunye Nokwenza izinto

 

Kunzima ukwahlula ukwaluphala kwiinguqu eziguqukayo. U-Pearce et al ucebise ukuba ukwaluphala kunye nokuwohloka kumela amanqanaba alandelayo kwenkqubo enye eyenzeka kubo bonke abantu kodwa ngamanani ahlukeneyo. Ukwehla kobunzima, nangona kunjalo, kwenzeka rhoqo ngesantya esikhawulezayo kunokwaluphala. Ke, kuyahlangatyezwa nakwizigulana zobudala bokusebenza.

 

Kubonakala ngathi kukho ubudlelwane phakathi kokuguga kunye nokuwohloka, kodwa akukho sizathu siphambili sele sisekiwe. Izifundo ezininzi zenziwe ngokubhekisele kwisondlo, ukufa kweseli, kunye nokuqokelelwa kweemveliso ze-matrix ezonakalisiweyo kunye nokungaphumeleli kwe-nucleus. Umxholo wamanzi we-disc ye-intervertebral uyancipha ngokukhula. I-pulposus yeNucleus ingafumana iintshulube ezinokuthi zidlulele kwi-annulus fibrosus. Ukuqala kwale nkqubo ibizwa ngokuba yi-chondrosis inter vertebralis, enokuthi iphawule ukuqala kokutshatyalaliswa okuguqukayo kwe-disc ye-intervertebral, i-endplates, kunye nemizimba ye-vertebral. Le nkqubo ibangela iinguqu ezintsonkothileyo kwimolekyuli ye diski kwaye ine-biomeological and clinela sequelae ezinokuthi zikhokelele ekungonakali kakhulu komntu ochaphazelekayo.

 

Ukuxinana kweseli kwirhoxiso kuyancipha ngokukhula kweminyaka. Oku ikakhulu kungenxa yokuba iiseli ezikwi-disc zixhomekeke kwi-senescence kwaye baphulukana namandla okukhula. Ezinye izizathu ezinxulumene nokwehla kobudala obuthile beediski ze-intervertebral kubandakanya ukulahleka kweseli, ukunciphisa isondlo, ukuguqulwa emva kokuguqulelwa kweeprotein ze-matrix, ukuqokelelwa kweemveliso zeemolekyuli ezihlazileyo zematriki, kunye nokusilela kokukhathala kwematrix. Ukwehla kwesondlo kwi-disc esembindini, evumela ukuba ingqokelela yeemveliso zenkunkuma yeseli kunye neemolekyuli ezihlazileyo zematriki kubonakala ngathi lolona tshintsho lubaluleke kakhulu kuzo zonke ezi nguqu. Oku kuthintela ukondla kwaye kubangele ukuwa kwinqanaba le-pH, elinokuthi liqhubeke nomsebenzi weeseli kwaye kungakhokelela ekufeni kweseli. Ukonyuka kwe-catabolism kunye nokuhla kwe-anabolism yeeseli zesisu kunokukhuthaza ukonakala. (UBuckwalter, uJoseph A.) Ngokutsho kolunye uphando, kukho iiseli ze-senescence ezininzi kwi-nucleus pulposus xa kuthelekiswa ne-annulus fibrosus kunye ne-disniated discs zazinethuba eliphezulu le-cell senescence. (URoberts, S. et al.)

 

Xa inkqubo yokwaluphala iqhubeka kangangexesha elithile, ugxininiso lwe-chondroitin 4 sulfate kunye ne-chondroitin 5 sulfate, ene-hydrophilic enamandla, iyancipha ngelixa i-keratin sulfate ukuya kwi-chondroitin sulfate ratio iyanda. I-Keratan sulfate inobuncinci be-hydrophilic kwaye ikwanayo nomkhwa omncinci wokwenza uzinzo oluzinzileyo nge-hyaluronic acid. Njengoko i-aggrecan yahlulwe, kwaye ubunzima bayo beemolekyuli kunye nenani liyancitshiswa, imbonakalo kunye nokuhanjiswa kwe-hydrophilicity ye-nucleus pulposus iyancipha. Utshintsho olusebenzayo kwiidiski eziphakathi kunye nezikhawulezayo luye lonyuswe ngoxinzelelo lwe-hydrostatic lwe-nucleus pulposus kunye nokuncipha kokubonelela kwezakha mzimba ngokuhambisa. Xa umxholo wamanzi we-matrix we-extracellular uyancipha, ukuphakama kwe-disc ye-intervertebral kuya kuncitshiswa. Ukuchasana kwe-disc kumthwalo we-axial nako kuya kuncitshiswa. Ngenxa yokuba umthwalo we-axial emva koko udluliselwa ngqo kwi-annulus fibrosus, i-annulus clefts inokuqhekezwa ngokulula.

 

Zonke ezi nkqubo zikhokelela kutshintsho lolwakhiwo olubonwa kwisifo se-disc. Ngenxa yomxholo wamanzi oncitshisiweyo kwi-annulus fibrosus kunye nokulahleka okuhambelana nokuthotyelwa, umthwalo we-axial unokwabiwa kwakhona kwindawo yecala lobuso endaweni yecandelo le-anterior eliqhelekileyo kunye nephakathi. Oku kunokubangela i-arhente ye-facet, i-hypertrophic ye-vertebral ejikeleze imizimba, kunye ne-bony spurs okanye i-bony overgrowths, eyaziwa ngokuba yi-steophytes, njengesiphumo sokudodobala komzimba. (Choi, Yong-Soo)

 

Imfuza kunye nokuzalwa

 

Icandelo lemfuza lifunyenwe njengeyona nto iphambili kwizifo ze-disenerative disc. Izifundo ezingamawele, kunye nezifundo ezibandakanya iimpuku, zibonise ukuba iijini zidlala indima ekuguqulweni kweediski. (UBoyd, uLawrence M., et al.) Imfuza ikhowudi ye-collagen I, IX, kunye ne-XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP-3), kunye nezinye iiprotein ziphakathi kwemfuza Kucetyiswa ukuba ubandakanyeke kwisifo sediserative degenerative. Iipolymorphism kwi-5 A kunye ne-6 A alleles eyenzeka kwingingqi yokunyusa yemfuza elawula imveliso ye-MMP 3 ifunyanwa njengeyona nto iphambili ekwandeni kwe-lumbar disc degeneration kubantu abadala. Ukusebenzisana phakathi kwezi ntlobo ezahlukeneyo zofuzo kunegalelo elibonakalayo kwisifo esiqhekezayo se-disvertebral disc sisonke.

 

Isondlo kunye nokuhluma

 

Ukudilizwa kwesidenge kukwayinto eyenzeka ngenxa yokungaphumeleli kokunikezelwa kwesondlo kwiiseli zangaphakathi ze-disc. Ngaphandle kwenkqubo yokuguga yesiqhelo, ukunqongophala kwesondlo kweeseli zediski kuchaphazeleka kakubi kukupheliswa kokubala, ukutshaya, kunye nemeko yezempilo ngokubanzi. Ukusilela kwesondlo kunokukhokelela ekubunjweni kwe-lactic acid kunye noxinzelelo lweoksijini esezantsi. Isiphumo esisezantsi se-pH sinokuchaphazela amandla eeseli ze-disc ukwenza kunye nokugcina imatrix yangaphandle ye-discs kunye nokubangela ukwahlulwa kwe-disc ye-disc. Iidiski ezonakalisiweyo azinakho ukuphendula ngendlela eqhelekileyo kumandla angaphandle kwaye oko kungakhokelela ekuphazamisweni nokuba kukuncinanana okuncinci. (Taher, Fadi, et al.)

 

Izinto zokukhula zivuselela i-chondrocyte kunye nefibroblasts ukuvelisa inani elingaphezulu le-matrix ye-extracellular. Ikwathintela ukuxubeka kwematrix metalloproteinases. Umzekelo wezinto zokukhula zibandakanya ukuguqula ukukhula kwezinto, ukukhula njenge-insulin, kunye nesiseko sokukhula kwefibroblast. Imatrix eyonakalisiweyo ilungiswa ngumgangatho owandayo wokuguqula ukukhula kunye nesiseko sokukhula kwefibroblast.

 

Imo engqongileyo kunye nokuphucuka

 

Nangona zonke iidiski zikubudala obufanayo, iidiski ezifumaneka kumacandelo e-lumbar asemngciphekweni zisengozini yotshintsho olonakeleyo kuneediski ezifumaneka kwicandelo eliphezulu. Oku kuphakamisa ukuba ayisiyiyo kuphela ukuguga kodwa, kunye nokulayishwa kwemitshini, yinto ebangela. Umanyano phakathi kwesifo sediserative disc kunye nemeko yokusingqongileyo ichazwe ngendlela ebanzi nguWilliams noSambrook ngo-2011. (Williams, FMK, kunye nePN Sambrook) Ukulayishwa okunzima komzimba okunxulunyaniswa nomsebenzi wakho yinto yomngcipheko enegalelo kwidiski isifo esiye sisiba mandundu. Kukho ukubakho kweekhemikhali ezibangela ukonakala kwediski, njengokutshaya, ngokokufunda okuthile. (Batti , Michele C.) I-Nicotine inyanzelisiwe kwizifundo ezingamawele ukubangela ukungahambi kakuhle kwegazi kwi-disc ye-intervertebral, ekhokelela ekonakaleni kwe-disc. (BATTI , MICHELE C., et al.) Ngaphezu koko, umbutho ufunyenwe phakathi kwezilonda ze-atherosclerotic kwi-aorta kunye neentlungu ezisezantsi ezikhankanya ikhonkco phakathi kwe-atherosclerosis kunye nesifo se-disenerative disc. (Kauppila, LI) Ubunzima be-disc degeneration buchaphazelekile kukutyeba kakhulu, ukutyeba kakhulu, isifo se-metabolic syndrome, kunye nokwanda kwesalathiso sobunzima bomzimba kwezinye izifundo. (StudyUphononongo olusekwe kubemi lokuDalwa kwabaNtu abaDala kunye noMbutho walo ngokuTyeba kakhulu kunye nokuTyeba kakhulu, iintlungu ezisezantsi, kunye nokuPhela kweMeko yokuSebenza.USamartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Ndingu-2011; 93 (7): 662-70 )

 

Ubuhlungu kwiDis Degeneration (iDiscogenic Pain)

 

Intlungu ye-Discogenic, eluhlobo lwentlungu ye-nociceptive, ivela kwi-nociceptors kwi-annulus fibrosus xa inkqubo ye-neva ichaphazeleka sisifo sediserative disc. I-Annulus fibrosus iqulethe ii-fibre zemithambo-luvo esebenzayo kumaleko wangaphandle wediski kunye nezinye iikhemikhali ezinje nge-vasoactive intestinal polypeptide, i-calcitonin peptide enxulumene nofuzo, kunye ne-P. (KONTTINEN, YRJ T., et al.) Xa utshintsho luguquka Iidiski ze-intervertebral zenzeka, ulwakhiwo oluqhelekileyo kunye nomthwalo woomatshini zitshintshiwe zikhokelela kwiintshukumo ezingaqhelekanga. Ezi disc nociceptors zinokufumana ukukhuselwa ngokungaqhelekanga kwisistim somatshini. Intlungu inokucaphukiswa yindawo esezantsi ye-pH ebangelwa bubukho be-lactic acid, ebangela ukwanda kwemveliso yabalamli beentlungu.

 

Ubuhlungu kwisifo se-disc esibuthathaka sinokuvela kwimvelaphi emininzi. Inokwenzeka ngenxa yomonakalo wolwakhiwo, uxinzelelo, kunye nokucaphukisa kwimithambo yomqolo. I-disc ngokwayo iqulethe kuphela imicu yemithambozo embalwa, kodwa nakuphi na ukwenzakala kuyaziva ezi nkozo, okanye ezo zikwindawo engemva yendawo enkulu, ukubangela iintlungu. Iintshukumo ezincinci kwi-vertebrae zinokwenzeka, ezinokubangela ukuqaqamba kwemisipha ye-Reflex kuba i-disc yonakalisiwe kwaye idinekile phantsi kunye nokulahleka kwengxwabangxwaba kunye nokuphakama. Iintshukumo ezibuhlungu zivela ngenxa yokuba i-nerve ebonelela le ndawo icinezelwayo okanye icatshukisiwe kukudibana kwendawo kunye nemisipha kwiforamu ekhokelela kubuhlungu bomlenze nasemva. Ezi ntlungu zinokwandiswa kukukhutshwa kweeprotein ezinokuvuvukala ezisebenza kwimithambo-luvo kwifamen okanye ukuhla kweeseli kumthambo womgogodla.

 

Iimpawu zembonakalo ye discs eziwohlokayo, xa ibonwa phantsi kwemakroskopu, ityhila ukuba kukho izicubu zomzimba ezivokothekileyo kunye nokungeniswa okubanzi kufunyanwa kumaleko wangaphandle wengubo yangaphakathi ye-annulus efikelela kwi-nucleus pulposus. Indawo yeethishu yomzimba igxunyekwe ziiseli zemasisi ezininzi kwaye zihlala zinegalelo kwinkqubo ye-pathological ekhokelela ekugqibeleni kubuhlungu be-discogenic. Oku kubandakanya ukuhamba kwe-neovascularisation, discvertebral disc degeneration, disc disc immune, kunye nokwenziwa kwe-fibrosis. Iiseli ze-Mast zikhupha izinto, ezinjenge-tumor necrosis factor kunye ne-interleukins, ezinokubonisa ukwenziwa kwendlela ezithile ezithi zidlale indima ebangela ukuba kubuhlungu umva. Ezinye izinto ezinokubangela ezi ndlela ziquka i-phospholipase A2, eveliswa kwi-arachidonic acid Cascade. Ifunyanwa ekunyuseni koxinzelelo kwisithathu esingaphandle se-annulus ye-disc degenerative kwaye kucingelwa ukuba ivuselela ii-nociceptors ezikhoyo ukuba zikhuphe izinto ezosulelayo zibangela iintlungu. Ezi zinto zizisa ukulimala kwe-axonal, i-edema yangaphakathi kunye nokudalwa. (IBrisby, i-Helena)

 

Intlungu ebuyayo icingelwa ukuba ivela kwi-disc ye-intervertebral ngokwayo. Yiyo loo nto iintlungu ziya kuncipha ngokuthe chu ngokuhamba kwexesha xa idiski eguqulwayo iyeka ukubangela iintlungu. Nangona kunjalo, iintlungu zivela kwi-disc ngokwayo kwi-11% yezigulana ngokwezifundo ze-endoscopy. Oyena nobangela weentlungu zangasemva kubonakala ngathi kungenxa yokuvuselelwa komda we-medial we-nerve kunye neentlungu ekubhekiswa kuzo engalweni okanye emlenzeni kubonakala ngathi ziyavela ngenxa yokuvuselelwa kwesiseko se-nerve. Unyango lokonakala kwe-disc kufuneka lujolise ikakhulu ekupheliseni iintlungu ukunciphisa ukubandezeleka kwesigulana kuba lolona phawu luphazamisayo kubomi besigulana. Ngoko ke, kubalulekile ukuseka indlela yentlungu kuba ayenzeki kuphela ngenxa yotshintsho olwenziwe kwiidiski ze-intervertebral kodwa nangenxa yezinye izinto ezinjengokukhutshwa kweekhemikhali kunye nokuqonda ezi ndlela kunokukhokelela ekunciphiseni iintlungu. (Choi, Yong-Soo)

 

Ukubonakaliswa kwonyango lweSifo seDesgenerative Disc

 

Izigulana ezinesifo se-disc esibuthathaka zijongana neqela leempawu ezibonakalayo kuxhomekeka kwindawo yesifo. Abo bane-lumbar disc degeneration bafumana iintlungu ezisezantsi zokubuyela emuva, iimpawu ezinobunzima, kunye nobuthathaka. Abo banesifo se-disc yomlomo wesibeleko baneentlungu zentamo kunye nehlombe.

 

Iintlungu ezisezantsi ezinokubuya zinokunyuswa kukushukuma kunye nesikhundla. Ngokwesiqhelo, iimpawu ziba mandundu kukuhamba, ngelixa ulwandiso luhlala lubakhulula. Ukonzakala okuncinci okujijekileyo, nokuba ushukuma iklabhu yegalufa, kunokubangela iimpawu. Intlungu ihlala ibonwa ukuba incinci xa uhamba okanye ubaleka, xa utshintsha indawo rhoqo naxa ulele. Nangona kunjalo, iintlungu zihlala zizithoba kwaye kwiimeko ezininzi, ziyahluka kakhulu ukusuka emntwini ziye emntwini kwaye uninzi lwabantu luya kubandezeleka ukusuka kwinqanaba eliphantsi leentlungu ezingapheliyo zommandla osezantsi ngokuqhubekayo ngelixa ngamanye amaxesha ubandezeleka ngenxa ye-groin, i-hip, kunye neentlungu zomlenze. Ukuqina kwentlungu kuya kukhula amaxesha ngamaxesha kwaye kuya kuhlala iintsuku ezimbalwa emva koko kuyekelele kancinci kancinci. Olu laflare-up sisiqendu esibuhlungu kwaye kufuneka sinyangwe nge-analgesics ezinamandla. Intlungu ebi kakhulu ifumaneka kwindawo ehleliyo kwaye iyonyuka ngelixa ugoba, uphakamisa kwaye ujikeleza iintshukumo rhoqo. Ubunzima bentlungu buyahluka kakhulu xa abanye benamaxesha athile okuba buhlungu kwabanye abanesifo esibuhlungu nesikhubazekayo ngamaxesha athile. (UJason M. Highsmith, MD)

 

Intlungu yendawo kunye nokuthantamisa kumqolo we-axial uhlala uvela kwii-nociceptors ezifumaneka kwi-discs intervertebral disc, joet joints, joints sacroiliac, dura mater yeengcambu ze-nerve, kunye nezinto ze-myofascial ezifumaneka ngaphakathi kwe-axial spine. Njengoko kukhankanyiwe kumacandelo adlulileyo, utshintsho olungekenzeki emzimbeni lungakhokelela ekunciphiseni komgogodla obizwa ngokuba yi-spinal stenosis, ukugcwala kweenkqubo zomgogodla ezibizwa ngokuba yi-osteophytes, i-hypertrophy ye-inferior kunye ne-expression ephezulu kakhulu, i-spondylolisthesis, i-bulging ye-ligamentum flavum kunye ne-disc herniation . Olu tshintsho lukhokelela ekuqokeleleni kweempawu ezaziwa njenge-neurogenic claudication. Kunokubakho iimpawu ezinje ngeentlungu ezisezantsi zomqolo kunye nentlungu yomlenze kunye nokuqina okanye ukuqaqanjelwa emilenzeni, ubuthathaka bemisipha, kunye nokwehla kweenyawo. Ukuphulukana kwamathumbu okanye ukulawulwa kweebhlorho kungacebisa ukungasebenzi komthambo kunye nonyango olukhawulezileyo luyafuneka ukukhusela ukukhubazeka okungapheliyo. Ezi mpawu zinokwahluka kubukhali kwaye zinokuthi zibekho ngokwahluka okwahlukeneyo kubantu abohlukeneyo.

 

Intlungu iyakwazi nokuqaqanjelwa ngamanye amalungu omzimba ngenxa yokuba umhlana unika amasebe aliqela kwiindawo ezahlukeneyo zomzimba. Ke ngoko, xa i-disc eguqukayo icinezela kwingcambu ye-spinal nerve, iintlungu zinokubakho nasemlenzeni apho i-nerve ekugqibeleni ifakwa ngaphakathi. Le nto, ebizwa ngokuba yi-radiculopathy, inokuthi ivele kwimithombo emininzi evela, ngenxa yenkqubo yokuwohloka. I-bulging disc, ukuba iphula ngaphakathi, inokuchaphazela ukuhla kweengcambu ze-Cauda equina, ukuba ibopha kakhulu emva kwexesha, inokuchaphazela iingcambu ze-nerve eziphuma kumjelo olandelayo we-intervertebral canal kunye ne-spinal nerve ngaphakathi kwe-ventral ramus echaphazelekayo xa i-disc iphuma kamva. Ngokufanayo, i-osteophytes ehamba ecaleni kwemigca ephezulu nangasemazantsi yecala elingasemva lomzimba we-vertebral inokuba nefuthe kwizicubu zomzimba ezifanayo ezibangela iimpawu ezifanayo. Inkqubo ephezulu ye -ularularular hypertrophy inokuthi ichaphazele iingcambu ze-nerve kuxhomekeka kuqikelelo lwabo. Iiseli zinokubandakanya iingcambu ze-nerve ngaphambi kokuba ziphume kumsele olandelayo we-intervertebral kunye neengcambu ze-nerve ngaphakathi kwingcambu ye-nerve ingcambu kunye ne-dural sac. Eziimpawu, ngenxa yempembelelo ye-nerve, ziye zangqinwa zizifundo ze-cadaver. Ukulungelelaniswa kwe-Neural kucingelwa ukuba kwenzeke xa i-neuro ye-diaminal diam ilungiselelwe ngokubonakalayo ukunciphisa ngo-70%. Ngapha koko, ukungqinelana kwe-neural kunokuveliswa xa i-discterior disc inyanzeliswa ingaphantsi kwe-4 yeemilimitha ukuphakama, okanye xa ukuphakama kwe-foraminal kuncitshiswa kube ngaphantsi kwe-15 yeemilimitha ezikhokelela kwi-stamosis ye-foraminal kunye ne-nerve impingement. (Taher, Fadi, et al.)

 

Inkqubo yoPhononongo

 

Izigulana zivavanywa kuqala zinembali echanekileyo kunye novavanyo oluqinisekileyo lomzimba kunye nophando olufanelekileyo kunye novavanyo oluvuselelayo. Nangona kunjalo, imbali ihlala ingacacanga ngenxa yeentlungu ezingapheliyo ezingabekwa ndawo ngokuchanekileyo kunye nobunzima bokumisela indawo ngqo ngexesha lokuvavanywa okuchaphazelayo ngenxa yempembelelo yezixhobo zomzimba eziseduze.

 

Ngomlando wesigulana, unobangela weentlungu ezisezantsi ezinokuthi zichongwe njengokuvela kwii-nociceptors kwiidiski ze-intervertebral. Izigulana zinokunika nembali yesifo esinganyangekiyo seempawu kunye nokuqina okukhoyo kummandla we-gluteal, ukubetha kunye nokuqina emqolo okuhlala kubi kakhulu ngomsebenzi. Ukuthantamisa kunokubangelwa kukucofa ngaphezulu komqolo. Ngenxa yobume besifo esinganyangekiyo nesibuhlungu, uninzi lwezigulana zinokuba sisifo seemood kunye noxinzelelo loxinzelelo. Uxinzelelo kucingelwa ukuba lunegalelo elibi kumthwalo wezifo. Nangona kunjalo, akukho buhlobo bucacileyo phakathi kobukrakra besifo kunye nemood okanye ukuphazamiseka koxinzelelo. Kulungile ukuba uqaphele malunga nezi meko zempilo yengqondo ngokunjalo. Ukuthintela ezinye izifo ezimbi, imibuzo kufuneka ibuzwe malunga nokudinwa, ukwehla kobunzima, umkhuhlane kunye nokugodola, okunokubonisa ezinye izifo. (UJason M. Highsmith, MD)

 

Enye i-etiology yentlungu ephantsi yasemva kufuneka ingafakwanga xa kuhlolwa isigulana ngenxa yesifo se disc. I-pathologies yesisu, enokubangela iintlungu zangasemva njenge-aortic aneurysm, i-calculi ye-renal, kunye nesifo se-pancreatic, kufuneka ingabandakanywa.

 

Isifo se-disgenerative sesifo sinokuxilongwa okwahlukileyo ekufuneka kuthathelwe ingqalelo xa isigulana sibonisa iintlungu zangasemva. Oku kubandakanya; Intlungu ye-idiopathic ephantsi, i-zygapophyseal degeneration edibeneyo, i-myelopathy, i-lumbar stenosis, i-spondylosis, i-osteoarthritis, kunye ne-lumbar radiculopathy. ( Izifo eziDala iziQinisekiso zeDiski iPhysopedia )

 

uphando

 

Uhlolisiso lusetyenziswa ukuqinisekisa ukufunyanwa kwesifo esibuthathaka. Ezi zinokwahlulahlula kwizifundo zaselabhoratri, kwizifundo zokwenza imiboniso, kuvavanyo lwe-nerve conduction, kunye neenkqubo zokuxilonga.

 

UkuCatshulwa

 

Ukucingelwa kwesifo se-disenerative disc kusetyenziswa ikakhulu ekuchazeni ubudlelwane be-anatomical kunye neempawu ze-morphological zeediski ezichaphazelekayo, ezinexabiso lonyango olukhulu ekuthatheni izigqibo kwixesha elizayo kukhetho lonyango. Nayiphi na indlela yokucinga, enjenge-radiography ecacileyo, i-CT, okanye iMRI, inokubonelela ngolwazi oluluncedo. Nangona kunjalo, oyena nobangela unokufunyanwa kuphela kwi-15% yezigulana njengoko kungekho lutshintsho lucacileyo lwe-radiological lubonakalayo kwisifo se-disenerative disc xa kungabikho disc disc kunye ne-neurological deficit. Ngaphezu koko, akukho nxu lumano phakathi kweenguqu ze-anatomiki ezibonwe kwi-imaging kunye nobukhulu beempawu, nangona kukho ukudibanisa phakathi kwenani le-osteophytes kunye nobunzima beentlungu zangasemva. Utshintsho oluguqukayo kwi-radiografi lunokubonakala nakubantu abangenasifo esikhokelela kubunzima bokuhambelana nokubaluleka kweklinikhi kunye nokuqala nini unyango. ( Izifo eziDala iziQinisekiso zeDiski iPhysopedia )

 

I-Pudiyo yeRadiography

 

Le radiografi engabizi kakhulu kwaye ifumaneka ngokubanzi kumlomo wesibeleko inokunika ulwazi olubalulekileyo malunga nokusilela, ulungelelwaniso kunye notshintsho olungaqhelekanga. Ukwenzela ukumisela ubukho bokungazinzi komgogodla kunye nokuzinza kwe-sagittal, ukuguquguquka kwamandla, okanye izifundo ezongezelelweyo kufuneka zenziwe.

 

Ukujonga umfanekiso weMagnetic Resonance (MRI)

 

I-MRI yeyona ndlela ixhaphakileyo yokuchonga utshintsho kwi-disc ye-intervertebral ngokuchanekileyo, ngokuthembekileyo, nangokucacileyo. Isetyenziswa kuvavanyo lokuqala lwezigulana ezineentlungu zentamo emva kwerejografi ecacileyo. Inokubonelela ngemifanekiso engafunekiyo kumathafa amaninzi kwaye inike imifanekiso esemgangathweni yediski. I-MRI ingabonisa i-disc hydration kunye ne-morphology esekwe kubuninzi beproton, imeko yemichiza kunye nomxholo wamanzi. Imifanekiso yeklinikhi kunye nembali yesigulana kufuneka kuthathelwe ingqalelo xa kutolikwa iingxelo ze-MRI njengoko kubonisiwe ukuba kangange-25% yeeradiology ziyayitshintsha ingxelo yazo xa kufumaneka idatha yeklinikhi. UFonar uvelise iskena sokuqala seMRI esivulekileyo esinesigulana sokukrwaqulwa kwiindawo ezahlukeneyo njengokuma, ukuhlala, nokugoba. Ngenxa yezi zinto zizodwa, esi skena seMRI sivulekileyo sinokusetyenziselwa ukuskena izigulana kwimo yokuthwala ubunzima kunye nokuma ngokuma ukuze kufumaneke utshintsho oluphantsi kwesifo esihlala singahoywanga kwiskena esiqhelekileyo seMRI esifana nesifo se-lumbar degenerative disc kunye ne-herniation. Lo matshini ulungile kwizigulana ze-claustrophobic, njengoko beza kubukela isikrini esikhulu sikamabonwakude ngexesha lokuskena. ( Isifo seDiserative Disk: Imvelaphi, iAnatomy, iPathophysiology. )

 

I-pulposus yeNucleus kunye ne-annulus fibrosus ye-disc idla ngokuchongwa kwi-MRI, ekhokelela ekufumaneni i-disc herniation njengoko iqulethwe kwaye ingekho. Njengoko i-MRI ikwanokubonisa iinyembezi ezinobuncinci kunye ne-posterior longitudinal ligament, inokusetyenziselwa ukwahlula i-herniation. Oku kunokuba yinto elula ye-annular bulging kukhulula i-disc ye-disc herniations. Olu lwazi lunokuchaza i-disc ye-patologic enjenge-disc eyongezelelweyo, i-discs ezihanjiswayo, kunye ne-disc efudukayo.

 

Kukho iinkqubo zokulinganisa ezisekwe kwisibonakaliso sobukhulu be-MRI, ubude be-disc, umahluko phakathi kwe-nusus kunye ne-annulus, kunye nesakhiwo se-disc. Indlela, nguPfirrmann et al, isetyenziswe ngokubanzi kwaye yamkelwe yikliniki. Ngokwenkqubo eguqulweyo, kukho ama-8 amabanga esi sifo se-lumbar disc degenerative. Ibanga loku-1 limela i-disc ye-intervertebral disc eqhelekileyo kunye nehlelo lesi-8 lihambelana nenqanaba lokugqibela lokuwohloka, okubonisa ukuqhubeka kwesifo se-disc. Kukho imifanekiso ehambelanayo ukunceda isifo. Njengoko zibonelela ngokwahlula izicubu kunye nenkcazo eneenkcukacha zesakhiwo sediski, imifanekiso enesisindo ye-sagittal T2 isetyenziselwa injongo yokuhlela. (UPfirrmann, u-Christian WA, et al.)

 

I-Modic ichaze utshintsho olwenzeka kwimizimba e-vertebral ejongene ne-discgenerating discs njengohlobo 1 kunye nohlobo lwe-2. Kwiinguqu zeModic 1, kuncitshiswe ubukhulu beemifanekiso ezinesisindo seT1 kunye nokunyusa ubungakanani bemifanekiso enesisindo T2. Oku kucingelwa ukuba kwenzeka ngenxa yokuba iiplates zokugqibela zenziwe sisifo sephepha kwaye umongo wethambo osecaleni ubonakalisa impendulo yokuvuvukala njengoko ukunyuka komlinganiso kusanda. Oku kunyuka kokuphambuka kokungqinelani kunye nokuxhathisa kokugqibela kukuziswa zizinto zeekhemikhali ezikhutshwe ngumatshini we-autoimmune. Uhlobo lweModic 2 Utshintsho lubandakanya ukutshabalaliswa komongo wamathambo weendawo ezihlala zihleliweyo ngenxa yempembelelo yokuvuvukala kunye nokungeniswa kwamafutha kumqukumbelo. Olu tshintsho lungakhokelela ekunyukeni koxinano lomqondiso kwimifanekiso enesisindo yeT1. (Imodeli, MT et al.)

 

IComputer Tomography (EC)

 

Xa i-MRI ingafumaneki, i-compact tomography ithathwa njengeluvavanyo lokuxilonga olukwaziyo ukubona i-disc herniation kuba in umahluko ongcono phakathi kwemida yasemva komgaqo osondeleyo we-vertebrae, amanqatha e-perineal, kunye nezixhobo ze-herniated disc. Nangona kunjalo, xa kufunyaniswa i-herniation ye-lateral, i-MRI ihlala iyindlela yokucinga ekhethiweyo.

 

Ukuskena kwe-CT kuneengenelo ezininzi ngaphezulu kwe-MRI enje ngokuba nendawo engacacanga kakhulu, indleko eziphantsi, kunye nokubona okungcono zotshintsho lwe-bonny olungabonakaliyo kwaye lunokuphoswa kwezinye iindlela. I-CT inokufumana utshintsho oluqala ngokudibeneyo lwamalungu e-facet kunye ne-spondylosis ngokuchanekileyo ngakumbi. Ukunyaniseka kweBony emva kwe-fusion kukwavavanywa kakuhle yi-CT.

 

I-Disc herniation kunye ne-nerve impingement enokubakho inokuchongwa ngokusebenzisa indlela ephuhliswe nguGundry kunye noHeithoff. Kubalulekile ukuba i-disc protrusion ilale ngqo ngaphaya kweengcambu ze-nerve ezihamba nge-disc kwaye zigxile kwaye zingalinganisanga kwindawo yesikhundla sedorsolateral. Kuya kufuneka kubonakaliswe uxinzelelo lweengcambu zemithambo-luvo okanye ukufuduswa. Okokugqibela, i-nerve distal to the impingement (indawo ye-herniation) ihlala ikhulisa kwaye i-bulges ine-edema ebangelwa, ukuvezwa kwamadlala asondeleneyo e-epidural veins, kunye nokuvuvukala okubangelwa kukufiphaza umda.

 

ULumbar DIscography

 

Le nkqubo iyaphikiswa kwaye, ukuba ngaba isazi sentlungu yentlungu elinexabiso malunga nokuhlinzwa okanye cha, akuqinisekanga. Iiposta ezingeyonyani zinokwenzeka ngenxa ye-hyperalgesia esembindini kwizigulana ezineentlungu ezingapheliyo (ukufumanisa kwe-neurophysiologic) nangenxa yeempawu zengqondo. Kuyathandabuzeka ukuba kumiselwe ngokuthe ngqo xa iintlungu ze-discogenic ziba zibaluleke kakhulu ngokwekliniki. Abo baxhasa olu phando baxhasa iikhrayitheriya ezingqongqo zokukhetha abaguli kwaye xa beguqula iziphumo kwaye bekholelwa ukuba olu luvavanyo kuphela olunokufumanisa iintlungu zentliziyo. I-Lumbar discography inokusetyenziswa kwiimeko ezininzi, nangona ingasekwanga ngokwesayensi. Oku kubandakanya; Ukuxilongwa kwe-heralation ye-lateral, ukufumanisa uphawu lweempawu ezibonakalayo phakathi kwezinto ezixhalabisayo ezininzi, kuvavanywa uxinzelelo olufanayo olubonwa kwi-CT okanye kwi-MRI, kuvavanywa umgogodla emva koqhaqho, ukukhethwa kwenqanaba le-fusion, kunye neempawu ezibonisa ubukho beentlungu zengqondo.

 

I-discography ixhalabele kakhulu ukufumana i-pathophysiology kunokumisela i-anatomy ye-disc. Ke, uvavanyo lweentlungu ze-discogenic yinjongo ye-discography. I-MRI inokuveza i-disc engaqhelekanga engajonganga kubuhlungu, ngelixa iintlungu eziqatha zinokubonwa kwi-discography apho iziphumo ze-MRI zimbalwa. Ngexesha lokulimala i-saline eqhelekileyo okanye izinto ezichaseneyo, isiphelo esisesidlangalaleni sinokwenzeka ngokukhupha okungaqhelekanga ukwamkela izixa ezininzi zokuchasana. Izixhobo ezichaseneyo zinokungena kwi-nucleus pulposus ngokusebenzisa iinyembezi kunye nokuqhekeka kwi-annulus fibrosus kwii-disc ezingaqhelekanga. Uxinzelelo lwezi zixhobo zingafaniyo zinokuvuselela iintlungu ngenxa yokufakwa ngaphakathi kwamalungu emithambo yangaphakathi, uxinzelelo lomgogodla ohlanganisiweyo, rami eyintloko kunye negrey ricommicantes ebonelela nge-annulus fibrosus yangaphandle. Intlungu e-radicular inokucaphukiswa xa umaleko wezinto ezingafaniyo ufika kwindawo yempembelelo ye-nerve ye-disc. Nangona kunjalo, olu vavanyo lwe-discography luneengxaki ezininzi ezinje ngokulimala kweengcongconi, ikhemikhali okanye i-bacterial diskitis, umahluko ngokuchaseneyo, kunye nokwanda kwentlungu. (UBartynski, uWalter S., no-A. Orlando Ortiz)

 

Ukudibanisa Ukulinganisa uModolo

 

Ukuvavanya ukunyanzelwa kwengcambu ye-nerve kunye nokuqina kwesibeleko ngokufanelekileyo, indibaniselwano yeendlela zokucinga inokufuneka.

 

I-CT Discography

 

Emva kokwenza i-discography yokuqala, i-disc discography yenziwa kwiiyure ezi-4. Ingasetyenziselwa ekumiseleni imeko ye-disc enje nge-herniated, protruded, extruded, equlathe okanye ehlaziyiweyo. Ingasetyenziswa emthanjeni ukwahlula imiphumo yobuninzi bezicubu ezincinci okanye izinto zediski emva kokuhlinzwa komhlana.

 

I-CT Myelography

 

Olu vavanyo luthathwa njengeyona ndlela yokuvavanya ukunyanzelwa kwengcambu ye-nerve. Xa i-CT yenziwa ngokudibeneyo okanye emva kwembonakalo yam, iinkcukacha malunga neesystem anatomy ezahlukeneyo zingafumaneka ngokulula.

 

Inkqubo yeDiagnostic

 

I-Transforaminal Selection Nour Root block (ii-SNRBs)

 

Xa isifo se-multilevel degenerative disc sisolwa kwiskena se-MRI, olu vavanyo lungasetyenziselwa ukufumanisa ingcambu ye-nerve echaphazelekayo. I-SNRB zombini zovavanyo lokuxilonga kunye nonyango olunokusetyenziselwa i-lumbar spinal stenosis. Uvavanyo lwenza indawo yenqanaba le-demotomal ye-hypoesthesia ngokufaka i-anesthetic kunye nezinto ezichaseneyo phantsi kwesikhokelo se-fluoroscopic kwinqanaba leengcambu ezinomdla. Kukho unxibelelwano phakathi kweempawu zeklinikhi yesifo se-multilevel degenerative disc kunye neziphumo zophando kwi-MRI kunye neziphumo ze-SNRB ngokuka-Anderberg et al. Kukho ulungelelwaniso lwe-28% eneziphumo ze-SNRB kunye nentlungu ye-dermatomal radicular kunye neendawo zokusilela kwe-neurologic. Uninzi lweemeko ezinzima zokudodobala kwi-MRI kufunyanwa ukuba zidityaniswe ne-60%. Nangona ingasetyenziswanga rhoqo, i-SNRB luvavanyo oluluncedo ekuvavanyweni kwezigulana ngaphambi kokuhlinzwa kwisifo se-multilevel degenerative disc ikakhulu kumqolo kunye neempawu zonyango kunye nezinto ezifunyenweyo kwi-MRI. (UNarouze, uSamer, no-Amaresh Vydyanathan)

 

I-Electro Myographic yezifundo

 

Iimoto ezisecaleni kunye neemvavanyo zokuqhutywa kwemithambo-luvo, ezibizwa ngokuba zii-electromyographic studies, eziqhelekileyo nezivavanywayo zenaliti ezingaqhelekanga zinokubonisa iimpawu zoxinzelelo lwe-nerve eziye zafunyanwa kwimbali yezonyango. Iingcambu ze-nerrrrrrrrrrrrrrrrrrrRrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr.Ingcambu zentsholongwane ezicatshulwayo zingenziwa kwindawo ethile ngokusebenzisa ii-injection ukuze zenze i-anesthetize i-nerves echaphazelekayo okanye i-pain receptors kwi-disk space, i-joint sacroiliac, okanye i-facet joints by discography. (OurnalIjenali ye-Electromyography kunye neKinesiology Calendar )

 

Izifundo zeLebhu

 

Uvavanyo lwelabhoratri luhlala lwenziwa ngaphandle kokuchongwa kolunye umahluko.

 

Njengoko i-spondyloarthropathies ye-seronegative, efana ne-ankylosing spondylitis, zizinto eziqhelekileyo ezibangela ukuba kubuhlungu umva, i-HLA B27 immuno-histocompatibility kufuneka ihlolwe. Kuqikelelwa ukuba bangama-350,000 abantu e-US kunye nama-600,000 eYurophu abachaphazeleka sesi sifo singanyangekiyo esingaziwayo. Kodwa iHLA B27 inqabile kakhulu ukuba ifumaneke kubantu baseMelika baseAfrika. Ezinye i-spondyloarthropathies ze-seronegative ezinokuthi zivavanywe kusetyenziswa le gene zibandakanya isifo samathambo, isifo samathumbu esosulelayo, kunye nesifo samathambo esisebenzayo okanye isifo seReiter. I-Serum immunoglobulin A (IgA) inokunyuka kwezinye izigulana.

 

Uvavanyo olufana ne-erythrocyte sedimentation rate (ESR) kunye ne-C- reactive protein (CRP) yokuvavanya inqanaba lesiphumo esibuhlungu esibonakalayo kwizizathu zokuvuvukala kweentlungu ezisezantsi ezinje nge-osteoarthritis kunye nokuqaqanjelwa sisisu. Ubalo olupheleleyo lwegazi luyafuneka, kubandakanya ukubala okungafaniyo ukuqinisekisa ubukho besi sifo. Izifo ze-Autoimmune zikrokreleka xa uvavanyo lwe-Rheumatoid factor (RF) kunye novavanyo lwe-anti-nukba (ANA) luphela luvavanyo. I-Serum uric acid kunye nohlalutyo lokuhlanjululwa kobungakanani beekristali zinokufuneka kwiimeko ezinqabileyo ukukhipha ukubekwa gout kunye nepyrophosphate dihydrate deposition.

 

impatho

 

Ayikho indlela eqinisekileyo yokunyanga ekuvunyelwene ngayo ngabo bonke ogqirha ngokubhekisele kunyango lwesifo se-disc ngenxa yokuba unobangela wentlungu unokwahluka kubantu abohlukeneyo kwaye kunjalo ukuqina kwentlungu kunye nokwahluka okubanzi kwinkcazo yekliniki. Iindlela zokukhetha zingaxoxwa ngokubanzi phantsi; unyango lokugcina, kunye nonyango.

 

Unyango lwe-Conservative

 

Le ndlela yonyango iquka unyango lokuzivocavoca ngongenelelo lokuziphatha, iindlela zokuma emzimbeni, inaliti, imfundo yasemva, kunye neendlela zesikolo zangasemva.

 

Unyango olusisiseko lwe-Exercise ngokuzibandakanya

 

Kuxhomekeka ekufumanekeni kwesigulana, iindlela ezahlukeneyo zokuzilolonga zinokumiselwa. Ithathwa njengenye yeendlela eziphambili zolawulo lokugcina ukunyanga iintlungu ezisezantsi ezingapheliyo. Imithambo inokutshintshwa ukubandakanya ukulolonga umzimba, imithambo ye-aerobic, kunye nemithambo yokuqinisa izihlunu. Omnye wemiceli mngeni ophambili kolu nyango kubandakanya ukungakwazi kwabo ukuvavanya ukusebenza kakuhle kwabaguli ngenxa yokwahluka okubanzi kwirejimeni yokuzivocavoca, imijikelezo, kunye nobungakanani bomzimba. Ngokwezifundo, ukusebenza kakhulu kweentlungu ezisezantsi ezingezantsi ezinobunzima obuhlukeneyo bexesha leempawu zafunyanwa ngokwenza iinkqubo zokuzivocavoca komgangatho ngaphakathi kokubekwa kwesigulana. Ukuphuculwa okubonakalayo kwaqwalaselwa phakathi kwabaguli abaneempawu ezingapheliyo kolu nyango ngokubhekisele ekuphuculeni ukusebenza kunye nokuncitshiswa kwentlungu. Unyango lomntu ngamnye olwenzelwe isigulana ngasinye phantsi kweliso elikufutshane kunye nokuthotyelwa komguli lukhangeleka lusebenza kakhulu kwizigulo zentlungu ezingapheliyo. Ezinye iindlela zokugcina izinto zinokusetyenziswa ngokudibeneyo ukuphucula le ndlela. (UHayden, uJill A., et al.)

 

Ukuzivocavoca kweAerobic, ukuba yenziwe rhoqo, kunokuphucula unyamezelo. Ukunciphisa uxinzelelo lweemisipha, iindlela zokuphumla zinokusetyenziswa. Ukuqubha kuthathwa njengomthambo wentlungu yangemva. Ukuzilolonga phantsi kungabandakanya imithambo yolwandiso, ukutyibilika kosiko, ukuthoba umva, ukuguqa ngamadolo, ukuphakama kwesihlalo, ukuhlala kwindawo ephezulu, ukufakelwa kwamathumbu esiswini, kunye nokuzivocavoca kwentaba kunye nesosi.

 

Ukutshintsha komzimba

 

Le ndlela ibandakanya ukusetyenziswa kokunyusa amandla ombane, ukuphumla, iipakethi zomkhenkce, i-biofeedback, iipads zokufudumeza, i-phonophoresis, kunye ne-iontophoresis.

 

Ukunyusa amandla ombane ombane oguqukayo (i-Tens)

 

Kule ndlela ingenakusebenzela, ukukhutshwa kombane kuhanjiswa esikhumbeni ukuze kuvuseleleke imithambo-luvo kwindawo leyo yokunciphisa iintlungu ukuya kuthi ga. Le ndlela ikhulula iintlungu ngokukhawuleza emva kokusetyenziswa kodwa ukusebenza kwayo kwexesha elide kuyathandabuza. Ngophando oluthile, kufunyenwe ukuba akukho phuculo lubalulekileyo kwintlungu kunye nokusebenza kwayo xa kuthelekiswa ne-placebo. Izixhobo ezenza ezi Tens zinokufikeleleka ngokulula kwisebe elingaphandle. Iziphumo ezizezinye zibonakala kukucaphukisa ulusu olunobunzima kwisithathu sezigulana. (UJohnson, uMark I)

 

Isikolo sasemva

 

Le ndlela yaziswa ngenjongo yokunciphisa iimpawu zentlungu kunye nokuphindeka kwazo. Yaziswa okokuqala eSweden kwaye ithathela ingqalelo i-posture, i-ergonomics, imisebenzi efanelekileyo yokubuyela umva, kunye ne-anatomy yommandla we-lumbar. Izigulana zifundiswa ngokuma okuqinisekileyo ukuze uhlale, ume, uphakamise iintsimbi, ulale, uhlambe ubuso, kwaye uxubha amazinyo ukuthintela iintlungu. Xa kuthelekiswa nezinye iindlela zonyango, unyango lwasemva kwesikolo sele kungqinwe ukuba lusebenza ngokukuko nangamaxesha aphakathi okuphucula iintlungu zasemva kunye nesimo sokusebenza.

 

Education Patient

 

Ngale ndlela, umboneleli uyalela isigulana ngendlela yokulawula iimpawu zaso esibuhlungu. I-anatomy eqhelekileyo yomgogodla kunye ne-biomechanics ebandakanya iindlela zokulimala ifundiswa kuqala. Okulandelayo, kusetyenziswa imodeli yomgogodla, ukufunyanwa kwesifo esixhalabisayo kuchazwa kwisigulana. Kwisigulana ngasinye, imeko elungelelanisiweyo iyamiselwa kwaye emva koko icelwe ukuba igcine eso sikhundla ukunqanda ukufumana iimpawu.

 

Indlela ye-Bio-Psychosocial kunyango lweMultidisciplinary Back Therapy

 

Ukuqaqanjelwa ngumqolo okungapheliyo kunokubangela uxinzelelo olukhulu kwisigulana, kukhokelela kukuphazamiseka kwengqondo kunye nomoya ophantsi. Oku kunokuchaphazela kakubi iziphumo zonyango ezinikezela ngeendlela ezininzi zonyango. Ke ngoko, abaguli kufuneka bafundiswe ngeendlela ezifundwayo zokuqonda ezibizwa ngokuba ziindlela zokuziphatha kunye neengqondo kunye nezengqondo ukuze bafumane isiqabu kwiintlungu. Ukongeza kunyango lwezinto eziphilayo ezibangela iintlungu, ezengqondo kunye nezentlalo kufuneka nazo ziqwalaselwe ngale ndlela. Ukuze kuncitshiswe imbono yesigulana yentlungu kunye nokukhubazeka, iindlela ezinje ngokulindelweyo, iindlela zokuphumla, ulawulo lweempendulo zomzimba ngokuziphatha okufundwayo, kunye nokomeleza kusetyenziswa.

 

Ukunyanga kwamayeza

 

Kwiintlungu ezisezantsi ezingapheliyo, le nyango ibonakala iluncedo. Ixesha elingaphezulu konyaka, unyango lwe-massage lufunyenwe ukuba lusebenze ngokundilisekileyo kwezinye izigulana xa kuthelekiswa ne-acupuncture kunye nezinye iindlela zokuphumla. Nangona kunjalo, ayisebenzi kangako kune-Tens kunye nokunyanga kokuzilolonga nangona izigulana ezizodwa zinokukhetha enye ngaphezu kwenye. (UFurlan, uAndrea D., et al.)

 

Ukunyanyiswa koMgcini

 

Olu nyango lubandakanya ukuphathwa kwamalungu ngokudlulela ngaphaya koluhlu lwalo lwesiqhelo lokuhamba, kodwa engagqithi kolo luhlu oluqhelekileyo lwe-anatomical. Olu lonyango olusebenzayo olubandakanya ukuxhaphaza okude kwi-lever nge-velocity ephantsi. Kucingelwa ukuba kuphuculwe iintlungu zasemva ezisezantsi kusetyenziswa iindlela ezinje ngokukhutshwa kwemithambo-luvo ebanjiweyo, ukutshabalaliswa kokubambelela ngokucacileyo kunye ne-peri-articular, nangokuchaphazela amacandelo omgogodla obefuduswe. Inokunciphisa ukubetheka kwe-disc, ukuphumla imisipha ye-hypertonic, ukuvuselela imicu ye-nocicilos ngokutshintsha umsebenzi we-neurophysiological kunye nokubeka i-menisci kumphezulu we-articular.

 

Ukuphathwa gadalala kwespinhi kucingelwa ukuba kukhulu ekusebenzeni ngempumelelo xa kuthelekiswa neendlela ezininzi ezinje nge-Tens, unyango lomthambo, iziyobisi zeNSAID, kunye nonyango lwasemva kwesikolo. Olu phando lukhoyo ngoku lusebenzayo malunga nokusebenza kwalo kwixesha elide nelifutshane. Kukhuseleke kakhulu ukuphatha abaqeqeshi bezonyango abangaqeqeshwanga kunye neemeko ze-disc herniation kunye ne-cauda equina ekuxelwa ngayo kungaphantsi komntu omnye kwizigidi ezi-1. (Bronfort, Gert, et al.)

 

Lumbar Supports

 

Izigulana ezineentlungu ezisezantsi ezingapheliyo zibuhlungu ngenxa yeenkqubo zokunganyaniseki kumanqanaba amaninzi anezizathu ezininzi zokuxhamla kwinkxaso ye-lumbar. Kukho ubungqina obuphikisanayo ngokubhekisele ekusebenzeni kwayo kunye nezifundo ezithile ezibanga ukuphuculwa okuphakathi kokukhululeka kwexesha elide kunye nexesha elide ngelixa abanye becebisa ukuba akukho phuculo olunjalo xa kuthelekiswa nezinye iindlela zonyango. Izixhasi zeLumbar zinokuzinza, zichaneke ukuchaneka, zinciphise amandla oomatshini, kwaye zinciphise iintshukumo zomgogodla. Ingasebenza njenge-placebo kwaye inciphise iintlungu ngokufihla iindawo ezichaphazelekayo kunye nokufudumeza ubushushu.

 

Ukutsalwa kwe-Lumbar

 

Le ndlela isebenzisa i-harness eqhotyoshelwe kwi-iliac crest kunye ne-cage yangaphantsi yentsimbi kwaye isebenza kumgama omde ecaleni kwe-axial spine ukukhulula iintlungu ezisezantsi ezingapheliyo. Inqanaba kunye nobungakanani bamandla zihlengahlengiswa ngokwezigulana kwaye zinokulinganiswa ngokusebenzisa izixhobo zombini ngelixa uhamba kwaye ulele. I-Lumbar traction isenzo ngokuvula indawo ye-disc ye-intervertebral kunye nokunciphisa i-lumbar Lordosis. Iimpawu zesifo se-disc esibuthathaka ziyancitshiswa ngale ndlela ngenxa yokulungelelaniswa komqolo wesikhashana kunye nezibonelelo ezinxulumene nazo. Inciphisa uxinzelelo lwezinzwa kunye noxinzelelo loomatshini, iphazamisa ukuqubuka kwindawo kunye ne-annulus, kunye nezibonakaliso zentlungu engabonakaliyo. Nangona kunjalo, akukho bungqina obuninzi ngokubhekisele ekusebenzeni kwayo ekunciphiseni ubuhlungu basemva okanye ekuphuculeni umsebenzi wemihla ngemihla. Ngapha koko, umngcipheko ohambelana nokuhambahamba kwe-lumbar usahleli phantsi kophando kwaye ezinye iimeko zeengxelo ziyafumaneka apho zibangele ukuphazamiseka kwentliziyo, ubunzima bokuphefumla, kunye notshintsho lwexinzelelo lwegazi ngenxa yamandla amakhulu kunye nokubekwa okungalunganga kwe-harness. (IHarte, A et al.)

 

Unyango loNyango

 

Unyango lwezonyango lubandakanya ukunyanga iziyobisi kunye nezihlaziya zehlunu, iinaliti ze-steroid, ii-NSAIDs, ii-opioids, kunye nezinye i-analgesics. Oku kuyadingeka, ukongeza kunyango olugcinayo, kwizigulana ezininzi ezinesifo se disc. I-Pharmacotherapy ijolise ukulawula ukukhubazeka, ukunciphisa intlungu kunye nokudumba ngelixa uphucula umgangatho wobomi. Inikwa ngokwezigulana ngokomntu ngamnye njengoko kungekho mvumelwano malunga nonyango.

 

Ukuxhamla kwemizimba

 

Isifo seDisgenerative disc sinokuxhamla ekuhlaziyeni kwemisipha ngokunciphisa umsipha wezihlunu kwaye ngaloo ndlela kunciphise iintlungu. Ukusebenza kokuhlaziya izihlunu ekuphuculeni iintlungu kunye nokusebenza ngokusekwe ngeendlela ezininzi zophando. IBenzodiazepine yeyona ndawo ihlaziyeke kakhulu yemisipha ngoku esetyenziswayo.

 

Izidakamizwa ezingenzi-Steroidal Anti-Inflammatory (NSAIDs)

 

La machiza aqhele ukusetyenziswa njengenyathelo lokuqala lesifo se-disc degenerative ekuboneleleni nge-analgesia, kunye nefuthe elichasene nokuvuvukala. Kukho ubungqina obuqinisekileyo bokuba iyanciphisa iintlungu ezisezantsi ezingapheliyo. Nangona kunjalo, ukusetyenziswa kwayo kunqunyelwe kukuphazamiseka kwesisu, njenge-gastritis yecala. Ukukhetha i-inhibitors ze-COX2, njenge-celecoxib, kunokohlula le ngxaki ngokujolisa ii-receptors ze-COX2. Ukusetyenziswa kwabo akwamkelwanga ngokubanzi ngenxa yeziphumo ezinokubakho zokunyusa isifo sentliziyo kunye nokusetyenziswa kwexesha elide.

 

Amayeza e-Opioid

 

Eli linyathelo eliphakamileyo phezulu kwileli yeentlungu ze-WHO. Kugcinelwe abaguli abaneentlungu ezingaphenduliyo kwii-NSAID kunye nabo bane-GI enganyamezelekiyo yokuphazamiseka kunyango lwe-NSAID. Nangona kunjalo, ukumiselwa kwee-narcotic zokunyanga iintlungu zasemva kuyahluka kakhulu phakathi kweeklinikhi. Ngokwoncwadi, i-3 ukuya kwi-66% yezigulana zinokuthatha uhlobo oluthile lwe-opioid ukunciphisa iintlungu zangasemva. Nangona ukunciphisa okwethutyana kwiimpawu kuphawuliwe, kukho umngcipheko wokuphathwa gadalala ixesha elide, inqanaba eliphezulu lokunyamezelana, kunye noxinzelelo lokuphefumla kubantu abadala. Isicaphucaphu nokugabha zezinye zeempembelelo zexesha elifutshane ezihlangatyezweyo. (ReviewUkuphononongwa kwenkqubo: Unyango lwe-Opioid kwi-Pain Back Pain: Ukuxhaphaka, ukuSebenza, kunye noMbutho noTywala)

 

Anti-Uxinzelelo

 

Ama-anti-depressants, kwiidosi ezisezantsi, anexabiso le-analgesic kwaye anokuba luncedo kwizigulo zentlungu ezisezantsi ezingezantsi ezinokubonakalisa iimpawu zokudakumba. Intlungu kunye nokubandezeleka kunokuba kukuphazamisa ukulala kwesigulana kunye nokunciphisa umqobo wobuhlungu. Oku kunokuqwalaselwa ngokusebenzisa i-anti-depressants kwiidosi ezisezantsi nangona kungekho bungqina bokuba iyawuphucula umsebenzi.

 

Unyango lwe-Injection

 

Epidural Steroid In sindions

 

Inaliti ye-Epidural steroid yeyona ndlela isetyenziswa kakhulu yealiti lokunyanga isifo esingapheliyo kwisifo sokudakumba kunye ne-radiculopathy. Kukho umahluko phakathi kohlobo lwe-steroid esetyenzisiweyo kunye nedosi yayo. I-8- 10 mL yomxube we-methylprednisolone kunye ne-saline eqhelekileyo ithathwa njengeyona ndlela isebenzayo kwaye ikhuselekile. Inaliti inokunikwa ngokusetyenziswa kwe-interlaminar, caudal, okanye i-trans foramina. Inaliti inokuthi ifakwe phantsi kwesikhokelo se-fluoroscopy. Umahluko wokuqala, emva koko i-anesthesia yendawo kwaye okokugqibela, i-steroid ifakwe kwindawo ye-eprosic kwinqanaba elichaphazelekayo ngale ndlela. Ukukhululeka kwentlungu kufezekiswa ngenxa yokudityaniswa kweziphumo ezivela kwi-anesthesia yendawo kunye ne-steroid. Ukuncitshiswa kwentlungu kwangoko kunokufezekiswa ngokusetyenziswa kwendawo yokubulala intsholongwane ngokuthi kuthintele ukuhanjiswa kwesiginali yeentlungu ngelixa kuqinisekiswa isifo. Ukuvuvukala kuncitshiswa ngenxa yesenzo se-steroids ekuthinteleni umngcipheko we-pro-inflammatory.

 

Kule minyaka ilishumi idlulileyo, ukusetyenziswa kwenaliti ye-epidural steroid kunyuke nge-121%. Nangona kunjalo, kukho impikiswano ngokubhekisele ekusetyenzisweni kwayo ngenxa yomahluko kumanqanaba okuphendula kunye neziphumo ezibi ezinokubakho. Ngokwesiqhelo, ezi zitofu kukholelwa ukuba zibangela ukukhululeka kweempawu zexesha elifutshane. Abanye oogqirha banokufaka inaliti ezi-2 ukuya kwezi-3 kwisithuba seveki enye, nangona iziphumo zexesha elide ziyafana nezesigulana esinikwe inaliti enye kuphela. Kunyaka omnye, ngaphezu kwe-4 iinaliti akufuneki zinikezwe. Ukuphelisa iintlungu kwangoko nangokusebenzayo, i-morphine engenakugcinwa nayo inokongezwa kwisitofu. Nokuba ii-anesthetics zalapha, njenge-lidocaine kunye ne-bupivacaine, ziyongezwa kule njongo. Ubungqina bokupheliswa kwentlungu yexesha elide bukhawulelwe. (TIsilingo esilawulwa yi-Placebo sokuvavanya ukuSebenza koNcedo lweNtlungu usebenzisa i-Ketamine ene-Epidural Steroids ye-Chronic Low Back Pain )

 

Kukho iziphumo ebezinokubakho ngenxa yolu nyango, ukongeza kwiindleko zayo eziphezulu kunye nenkxalabo yokusebenza kwayo. Iinaliti zinokufakwa kwindawo engalunganga ukuba i-fluoroscopy ayisetyenziswanga kwiipesenti ezingama-25, nkqu kubukho babasebenzi abanamava. Ukubekwa kwe-epidural kunokuchongwa ngokunyaniseka. Uxinzelelo lokuphefumla okanye ukugcinwa komchamo unokwenzeka emva kokulimala nge-morphine kwaye ke isigulana kufuneka sibekwe esweni iiyure ezingama-24 emva kwenaliti.

 

Ukufakwa kwamagqabi

 

La machiza anikwa ukudibana kwe-facet, ekwabizwa ngokuba zii-jogapophysial joints, eziphakathi kwe-vertebrae esecaleni. I-anesthesia inokwenzakala ngqo kwindawo edibeneyo okanye kwisebe elichaphazelekayo le-medial ye-dorsal rami, engaphakathi kuyo. Kukho ubungqina bokuba le ndlela iphucula amandla okusebenza, umgangatho wobomi, kunye nokukhulula iintlungu. Kucingelwa ukuba banika izibonelelo zexesha elifutshane nelide, nangona uphononongo lubonise zombini inaliti ye-facet kunye nenaliti yesifo se-epidrosic esifana ngokusebenza. (UWynne, Kelly Kelly)

 

SI Joint Joint

 

Oku kudityaniswa kwe-synovial edibeneyo kunye nokuhanjiswa kwe-nerve ukusuka kumacala omabini e-myelinated and non-myelin nerve. Inaliti inokuthi inyange ngokukuko isifo esibuthathaka esidibanisa ukudibana kwesibeleko kunye nokufumana ukukhululeka kwexesha elide kunye nexesha elifutshane kwiimpawu ezinje ngeentlungu ezisezantsi nasemva kokuhanjiswa kwentlungu emilenzeni, ethangeni nasebusweni. Inaliti zinokuphindwa rhoqo emva kweenyanga ezi-2 ukuya kwezi-3 kodwa kufuneka zenziwe kuphela ukuba kunyanzelekile ukuba zibekhona. (MAUGARS, Y. et al.)

 

Unyango lwe-Intradiscal non-Operative Therapy kwi-Discogenic Pain

 

Njengoko kuchaziwe phantsi kophando, i-discography inokusetyenziswa zombini njengendlela yokuqonda kunye nonyango. Emva kokuchongwa kwe-disc enesifo, iindlela ngeendlela ezincinci zokuhlaselwa zinokuzama ngaphambi kokuqala utyando. Amandla ombane kunye nobushushu bawo bunokusetyenziselwa ukubambisa umaleko wonyaka we-annulus ngokwenza oko kuqinisa imicu ye-collagen, ukubonakalisa kunye nokutshabalalisa abalamli abanokuvuvukala kunye ne-nociceptors, kunye nokukhupha amanani. Iindlela ezisetyenzisiweyo koku zibizwa ngokuba yi-intradiscal electrothermal therapy (IDET) okanye i-radiofrequency posterior annuloplasty (RPA), apho idluliselwa ngombane kwi-disc. I-IDET inobungqina obulinganiselweyo bokukhululeka kweempawu zabaguli besifo se-disc degenerative, ngelixa i-RPA inenkxaso encinci ngokubhekisele kwixesha layo elifutshane kunye nokusebenza kwexesha elide. Zombini ezi nkqubo zingakhokelela kwiingxaki ezinje ngokulimala kweengcongconi, ukungasebenzi kakuhle kwe-catheter, usulelo, kunye ne-post-process disc herniation.

 

Utyando loPhando

 

Unyango lotyando lugcinelwe abaguli abanonyango olungagungqiyo oluthathela ingqalelo ubukrakra besifo, ubudala, ezinye izinto ezihlekisayo, imeko yezentlalo nezoqoqosho, kunye nenqanaba lesiphumo esilindelweyo. Kuqikelelwa ukuba malunga neepesenti ezi-5 zezigulana ezinezifo ezilahlekileyo ezenziwa kukuhlinzwa, nokuba zenzelwe isifo se-lumbar okanye isifo sesibeleko. (URydevik, uBj rn L.)

 

Inkqubo ye-Lumbar Spine

 

Utyando lweLumbar luboniswa kwizigulana ezinentlungu ebuhlungu, ixesha elingangeenyanga ezi-6 ukuya kwezi-12 zonyango olungasebenziyo, olunengxaki yomqolo wesibeleko. Utyando ihlala iyinkqubo yokhetho ngaphandle kokuba imeko ye-cauda equina syndrome. Zimbini iintlobo zenkqubo ezijolise ekubandakanyeni ukungxola komqolo okanye ukudodobala okanye zombini. ( Isifo seDiserative Disk: Imvelaphi, iAnatomy, iPathophysiology. )

 

Umswakama kubandakanya ukumisa iintshukumo kwiseti ye-vertebral ebuhlungu ukuze kuncitshiswe iintlungu ngokudibanisa i-vertebrae eliqela kunye ngokusetyenziswa komthambo. Ithathwa njengesebenzayo kwixesha elide kwizigulana ezinesifo se-disc esibuthathaka esine-spinal malalignment okanye ukunyakaza okugqithisileyo. Kukho iindlela ngeendlela zokunyanga i-fusion. (UGupta, uVijay Kumar, et al)

 

• I-lumbar spinal posterolateral guttur fusion

 

Le ndlela ibandakanya ukubeka ubhalo kumathambo kwindawo yesibini yomqolo. Ukuxhunyezwa kwithambo kunokuvunwa kwi-poster yangaphandleac crest. Amathambo ahluthwe ukusuka kwi-periosteum yakhe ngokuphumelelayo. Isikhephe esibuyayo siyadingeka kwithuba lasemva kokubeleka kwaye abaguli banokufuna ukuhlala esibhedlele kangangeentsuku ezintlanu ukuya kwezili-5. Ukushukuma okulinganiselweyo kunye nokuyeka ukutshaya kuyafuneka ukuze uphumelele. Nangona kunjalo, imingcipheko eliqela efana nokungabumbani, usulelo, ukopha, kunye nomanyano oluluqilima kunye nentlungu yangasemva inokwenzeka.

 

• I-fusion yangaphandle ye-lumbar yokungena komntu

 

Ngale ndlela, ukubola okanye iindlela zediskiyeki zinokwenziwa ngendlela efanayo. Iimpawu zamathambo zisetyenziswa ngokuthe ngqo kwindawo ye-disc kwaye i-ligamentum flavum isondele ngokupheleleyo. Isigulo esiwohlokayo sesithuba, indawo enokunxibelelana yenziwe banzi ngakumbi ngokwenza i-medial facetectomy. Umqolo ongasemva unokukhetha ngale ndlela. Inezinto ezininzi ezimbi xa ithelekiswa nendlela yangaphandle efana nokufakwa nje izinto ezincinci, indawo encitshisiweyo yomhlaba ekhoyo fusion, kunye nobunzima xa usenza utyando kwizigulana ezinesiphene. Umngcipheko omkhulu ochaphazelekayo kukungabumbani.

 

• I-ferior ye-lumbar interbody fusion

 

Le nkqubo iyafana nale yangemva kwangaphambi kokuba iye yasondela ngesisu endaweni yomva. Inenzuzo yokungaphazamisi izihlunu zangemva kunye nokunikezelwa kwentliziyo. Icacisiwe kwizigulana ezinesifo samathambo kwaye inomngcipheko wokopha, ukubuyisa umva kumadoda, ukungabumbani, kunye nosulelo.

 

• I-fforforaminal lumbar interbody fusion

 

Le yinguqulo eguqulweyo yendlela yangasemva ethandwayo. Inika umngcipheko ophantsi ngokuvezwa okuhle kwaye iboniswa inesiphumo esihle kakhulu kwiingxaki ezimbalwa ezinje nge-CSF evuzayo, ukungalungiseki okwethutyana kwemithambo-luvo, kunye nosulelo lwenxeba.

 

Iyonke iDis Arthroplasty

 

Oku kungenye indlela yokuphuma kwi-disc fusion kwaye isetyenziselwe ukunyanga isifo se-lumbar degenerative disc esebenzisa i-disc yokufakelwa endaweni yokutshintsha indawo ye-disc echaphazelekayo. Iyonke i-prosthesis okanye i-prosthesis yenyukli inokusetyenziswa ngokuxhomekeka kwimeko yekliniki.

 

Ukunciphisa kubandakanya ukususwa kwenxalenye ye-disc yomzimba we-vertebral, oku kuthetha ukuba kwisisele sokukhulula oko kunye nokubonelela ngegumbi lokufumana kwakhona ngenkqubo ebizwa ngokuba yi-diskectomy ne-laminectomy. Ukusebenza kwale nkqubo kuyathandabuza nangona kuqhelekileyo kwenziwa utyando. Iingxaki zimbalwa kakhulu ezinethuba eliphantsi lokuphinda ziphinde zibonakalise iimpawu ngokwaneliseka okuphezulu kwesigulana. (UGupta, uVijay Kumar, et al)

 

• I-discumbomy ye-lumbar

 

Olu tyando lwenziwa ngendlela esecaleni yokwahlulahlula i-ligamentum flavum. Ingcambu yentsholongwane echaphazelekayo ichongiwe kwaye i-bulging annulus iyanqunyulwa ukuyikhupha. Uvavanyo olupheleleyo lwe-neurological kufuneka lwenziwe emva kwexesha kwaye izigulana zihlala zilungele ukuya ekhaya emva kweentsuku ezi-1 ukuya kwezi-5. Ukuzivocavoca okuphantsi kufuneka kuqaliswe ngokukhawuleza kulandelwe ngumsebenzi olula kunye nomsebenzi onzima kwiiveki ezi-2 kunye ne-12 ngokulandelanayo.

 

• I-lumbar laminectomy

 

Le nkqubo inokwenziwa ngokuchanekileyo kwinqanaba elinye, kunye nangamanqanaba amaninzi. I-Laminectomy kufuneka ibe mfutshane kangangoko ukunqanda ukungazinzi komgogodla. Iziguli ziphawule ukukhululeka kweempawu kunye nokunciphisa kwe-radiculopathy elandela inkqubo. Umngcipheko unokubandakanya ukubetheka kunye nokungasebenzi kwe-bladder, ukuvuza kwe-CSF, ukonakala kweengcongconi, kunye nosulelo.

 

Inkqubo ye-Cervical Spine

 

Isifo sediski yomlomo wesibeleko siboniswa kuqhaqho xa kukho iintlungu ezinganyamezelekiyo ezinxulunyaniswa nokuqhubela phambili kweemoto kunye nokusilela kwovakalelo. Ugqirha luneziphumo ezingaphezulu kwe-90% xa kukho ubungqina be-radiographic yoxinzelelo lweengcambu. Kukho iindlela ezininzi ezinokubandakanya i-diskectomy yangaphakathi yomlomo wesibeleko (ACD), i-ACD, kunye nefusion (ACDF), i-ACDF ngokulungiswa kwangaphakathi, kunye ne-posterior foraminotomy. ( Isifo seDiserative Disk: Imvelaphi, iAnatomy, iPathophysiology. )

 

Unyango olusekwe kwiseli

 

Ukuhanjiswa kweseli yesisu kuye kwavela njengonyango lwenoveli lwezifo zediski enesiphumo kunye neziphumo ezithembisayo. Ukuqaliswa kwe-chondrocyte ye-autologous kufunyenwe ukunciphisa intlungu ye-discogenic kwisithuba seminyaka emi-2. Ezi ndlela zonyango ngoku ziphantsi kwezilingo zabantu. (UJeong, uJe Hoon, et al.)

 

IGyrapy Therapy

 

Ukutshintshwa komjelo we-Gene ukwenzela ukumisa inkqubo yokutshintshwa kwe-disc kunye nokuphembelela ukuphindiswa kwe-disc okwangoku kuphantsi kophando. Ukulungiselela oku, iintlobo eziyinzuzo kufuneka zichongwe ngelixa kuthathwa umsebenzi wokudalwa komoya okhuthaza ukwenziwa kwemfuza. Olu khetho lonyango lwenoveli linika ithemba kunyango lwexesha elizayo ukuba lujongiswe ekuvuseleleni ii-discs zangaphakathi ze-disc. (INishida, Kotaro, et al.)

 

 

Isifo se-disc esi-degenerative sisifo sempilo esibonakaliswa yintlungu engapheliyo yomqolo ngenxa yento eyonakalisiweyo yediski, efana nentlungu ephantsi yomqolo kubuhlungu kumqolo wesibeleko okanye kubuhlungu wentamo kumqolo wesibeleko. Kukuqhekeka kwe-disc ye-intervertebral disc yomgogodla. Utshintsho oluninzi lwe-pathological lunokwenzeka ekuguqukeni kwe-disc. Iimpawu ezahlukeneyo ze-anatomical zinokwenzeka nakwi-disc ye-intervertebral disc. Ubuhlungu obuphantsi ngasemva kunye nentlungu yentamo ziingxaki ezinkulu zezifo, ekucingelwa ukuba zihlobene nesifo se-degenerative disc. Ubuhlungu obungasemva sisizathu sesibini esikhokelayo sokutyelelwa kweofisi ngugqirha eUnited States. Kuqikelelwa ukuba malunga neepesenti ezingama-80 zabantu abadala base-US abanesifo esibuhlungu esisezantsi ubuncinci kanye ngexesha lokuphila kwabo. Ke ngoko, ukuqonda okuqinisekileyo kwesifo se-disc esiguqukayo kuyadingeka ukulawula imeko eqhelekileyo. -Gqr Alex Jimenez DC, CCST Insight

 

Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic, musculoskeletal, amayeza omzimba, impilo, kunye nemicimbi yezempilo ebuthathaka kunye / okanye amanqaku amayeza asebenzayo, izihloko kunye neengxoxo. Sisebenzisa iinkqubo zempilo kunye nezempilo ukunyanga kunye nenkxaso yokhathalelo lokonzakala okanye ukuphazamiseka kwenkqubo yemisipha. Izithuba zethu, izihloko, izifundo, kunye nokuqonda kugubungela imicimbi yeklinikhi, imiba, kunye nezihloko ezinxulumene kwaye zixhasa ngokuthe ngqo okanye ngokungathanga ngqo indawo yethu yeklinikhi yokusebenza. Izifundo ezixhasa iiposti zethu. Senza ikopi yezifundo zophando ezixhasayo ukuba zifumaneke ebhodini nakuluntu xa kuceliwe. Siyaqonda ukuba sigubungela imicimbi efuna inkcazo eyongezelelweyo malunga nendlela enokunceda ngayo kwisicwangciso esithile sokhathalelo okanye kwinkqubo yonyango; Ke, ukuqhubeka nokuxoxa ngalo mbandela ungentla, nceda ukhululeke ukubuza uGqirha Alex Jimenez okanye unxibelelane nathi kwa 915-850-0900. Umboneleli (s) unelayisensi eTexas * naseNew Mexico *

 

Ikhutshwe nguGqr Alex Jimenez DC, CCST

 

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