Gịnị bụ Degenerative Disc Disease (DDD) ?: Nnyocha

by Dr Alex Jimenez | Azụ Mgbu, Chiropractic, Ahụla azụ azụ oge, -adịghị ala ala Pain, Health, Diski nke Herniated, Ndaghachi azụ azụ, olu mgbu, Sciatica, Sciatica Nerve Pain, Scoliosis, Ọkụ Spinal Hygiene, Ntinye ntinye, Ọgwụ, Wellness

Ọrịa diski Degenerative bụ okwu n'ozuzu maka ọnọdụ nke diski intervertebral mebiri emebi na-akpata mgbu na-adịghị ala ala, nke nwere ike ịbụ ma ọ bụ ihe mgbu dị ala na spine lumbar ma ọ bụ olu mgbu na spine cervical. Ọ bụghị ọrịa kwa otu, kama ọ bụ nbibi nke diski intervertebral nke spain. Diski intervertebral bụ nhazi nke nwere ọtụtụ nlebara anya na-elekwasị anya n'oge na-adịbeghị anya, n'ihi ihe ọ pụtara na ụlọ ọgwụ. Mgbanwe pathological nke nwere ike ime na disiki degeneration gụnyere fibrosis, mbelata, na diski diski. Nrụrụ dị iche iche anatomical nwekwara ike ime na diski intervertebral dị ka sclerosis nke endplates, fissuring na mucinous degeneration nke annulus, na nhazi nke osteophytes.

Obere mgbu na olu mgbu bụ nnukwu nsogbu ọrịa, nke echere na ọ na-emetụta mgbanwe mgbanwe na diski. Ọkpụkpụ azụ bụ ihe nke abụọ na-akpata nleta ndị dọkịta na USA. A na-eme atụmatụ na ihe dị ka 80% nke ndị okenye US na-arịa mgbu azụ ala ọ dịkarịa ala otu oge na ndụ ha. (Modic, Michael T., na Jeffrey S. Ross) Ya mere, achọrọ nghọta zuru oke banyere ọrịa diski degenerative dị mkpa maka ijikwa ọnọdụ a na-ezukọkarị.

Anatomy of My Structures

Anatomy nke Spine

Ọkpụkpụ bụ nnukwu ihe owuwu, nke na - ejide ọnọdụ ya ma na - enye nsogbu dị iche iche na usoro ọrịa. Ọkpụkpụ ahụ nwere asaa akụkụ akwara ozi, akwara vertebrae iri na abụọ, vertebrae lumbar ise, yana fyl sacral na coccygeal vertebrae. Ogwe atọ na-ejigide nkwụsi ike nke spain.

A na-emepụta kọlụm dị n'ihu site na eriri ogologo ogologo oge na akụkụ ihu nke vertebral ahụ. A na-etolite kọlụm dị n'etiti site n'akụkụ azụ nke vertebral ahụ na n'azụ longitudinal ligament. Kọlụm dị n'azụ nwere mgbaba ahụ dị n'azụ nke nwere usoro ntụgharị, laminae, akụkụ, na usoro spinous. (�Ọrịa Diski Degenerative: ndabere, Anatomi, Pathophysiology�)

Anatomy nke Intervertebral Disc

Ihe di n’ime intervertebral diski di n’etiti abuo n’akụkụ uzo abuo na uzo vertebral. Ihe dị ka otu ụzọ n'ụzọ anọ nke ngụkọta nke ogwe aka site na diski dị iche iche. Diski a na –emepụta nkwonkwo fibrocartilaginous, nke a na-akpọkwa nkwonkwo symphysis. Ọ na - ahapụ ntakịrị ije na vertebrae ma na - ejide vertebrae ọnụ. A na-eji diski intervertebral mara maka esemokwu ya na-emegide ya na mkpali na-emegide àgwà. Ihe mejupụtara diski intervertebral nwere akụkụ atọ bụ isi; n'ime gelatinous nucleus pulposus, ihe dị n’afọ annulus fibrosus, na mpekere cartilage nke dịkarịsịrị elu ma dịkwa ala na njikọ nke ahụ akụkụ akụkụ ahụ.

Nucleus pulposus bụ akụkụ dị n'ime nke ahụ gelatinous. Ọ mejupụtara proteoglycan na gel mmiri jikọtara ọnụ nke ụdị II Collagen na eriri elastin haziri n'ụzọ adịghị otu oge. Aggrecan bụ proteinoglycan bụ nke a na-ahụ n’ime akwara amamịghe. O nwere ihe dị ka 70% nke akwara ndị metụtara akwara na ihe dị ka 25% nke annulus fibrosus. O nwere ike idowe mmiri ma nye osmotic akụrụngwa, nke achọrọ iji guzogide mkpakọ ma mee dị ka ihe na-eme mkpọtụ. Nnukwu aggrecan a na diski nkịtị na-enye anụ ahụ aka ịkwado mkpakọ na-enweghị mgbadokarị ma na-ekesa ihe ndị dị otu aka ka annulus fibrosus na ahụ vertebral n'oge mmegharị nke spain. (Ugwu, Paul R, et al.)

A na-akpọ akụkụ nke dị na mpụta annulus fibrosus, nke nwere ụdị ụyọkọ m ụyọkọ ụyọkọ nke ahaziri nke ahaziri dịka akwa okirikiri. Eriri collagen na-agba n'usoro oru n'etiti lamellae nke annulus na uzo ozo na-enye ya ikike iguzogide ike nke ngwa agha. Ihe akwara dị iche iche na - eme ka annulus fibrosus nke aka na -agwu. N’ime akụkụ ihu, akwara dị larịị na-agbakwunye ike annulus fibrosus ma ligament dị gịrịgịrị na-emesi akụkụ ahụ ike. (Choi, Yong-Soo)

Ọtụtụ mgbe, a na-enwe otu diski n'etiti ụzọ abụọ ọ bụla nke vertebrae ma e wezụga n'etiti atlas na axis, nke bụ nke mbụ na nke abụọ cervical vertebrae n'ime ahụ. Diski ndị a nwere ike ibugharị ihe dịka 6? na niile axes nke ije na ntụgharị gburugburu onye ọ bụla axis. Ma nnwere onwe imegharị a dịgasị iche n'etiti akụkụ dị iche iche nke kọlụm vertebral. Oghere cervical nwere ụdị mmegharị ahụ kachasị ukwuu n'ihi na diski intervertebral dị ukwuu ma nwee nnukwu concave ala na convex elu vertebral ahụ. Ha nwekwara nkwonkwo ihu na-agbanwe agbanwe. Vertebrae thoracic nwere opekempe mmegharị ahụ na ntụgharị, ndọtị, na ntụgharị, mana enwere ngbanwe mpụta n'efu ka ejikọtara ha na oghere ọgịrịga. Akpụkpọ ụkwụ lumbar nwere ezigbo ntụgharị na mgbatị ahụ, ọzọ, n'ihi na diski intervertebral ha dị ukwuu na usoro spinous dị n'azụ. Otú ọ dị, ntụgharị akụkụ lumbar dị n'akụkụ dị oke n'ihi na nkwonkwo facet dị na sagitally. (�Ọrịa Diski Degenerative: ndabere, Anatomi, Pathophysiology�)

Inye ọbara

Diski intervertebral bụ otu n'ime akụkụ avaskụla kachasị ukwuu n'ime ahụ nke nwere capillaries na-akwụsị na nsọtụ. Anụ ahụ na-enweta nri sitere na arịa dị na ọkpụkpụ subchondral nke dị n'akụkụ cartilage hyaline na njedebe. A na-ebuga nri ndị a dị ka oxygen na glucose na diski intervertebral site na mgbasa ozi dị mfe. (�Intervertebral Disc � Spine � Orthobullets.Com�)

Inye Nlekọta

Sensory innervation nke intervertebral discs dị mgbagwoju anya ma dị iche iche dabere na ọnọdụ dị na kọlụm spinal. A na-eche na ọ bụ ihe P, calcitonin, VIP, na CPON na-edozi nnyefe ihe mmetụta. Sinu vertebral irighiri akwara, nke na-ebilite site na mgbọrọgwụ ganglion azụ azụ, na-abanye n'ime eriri elu nke annulus. Ihe irighiri akwara adịghị agafe karịa eriri elu.

A na-enyekwa ihe ngosi nke Lumbar intervertebral diski site na mgbe ebiri ahu ya na alaka site na ventral Prim rami na site na kọntinenti rami nke di nso na njikọta ha na ventral rami isi. A na-ewepụta akụkụ nke diski na ngalaba site na ngalaba sitere na rami communicantes. Offọdụ n'ime ndị na-ahụ maka rami nwere ike ịgafe diski intervertebral ma banye na anụ ahụ na - ejikọta, nke miri emi na mmalite nke psoas. (Palmgren, Tove, et al.)

A na-enyekwa diski cervical intervertebral diski na n'akụkụ akụkụ site na ngalaba nke akwara vertebral. A chọpụtakwara na irighiri akwara ahụ na-enwe ụzọ agbagoro na ọwa mmiri vertebral na-ebute diski ahụ na ntinye ha na nke dị n'elu. (BOGDUK, NIKOLAI, et al.)

Pathophysiology nke Degenerative Disc Disease

Ihe ruru 25% nke ndị mmadụ tupu afọ iri anọ na-egosi mgbanwe nke diski na ọkwa ụfọdụ. N'ime afọ 40, akara MRI na-egosi mgbanwe n'ime ihe karịrị mmadụ 40%. (Suthar, Pokhraj) Ya mere, ọ dị mkpa iji mụọ usoro nbibi nke diski intervertebral diski ka achọpụtarala na ọ na - emebi ngwa ngwa karịa anụ ahụ ndị ọzọ na - ejikọta ahụ, na - eduga azụ na mgbu mgbu. Mgbanwe ndị a na diski intervertebral atọ metụtara mgbanwe na anụ ahụ vertebral na nkwonkwo na-atụ aro maka usoro na-aga n’ihu.

E kewara usoro mmebi nke diski intervertebral ụzọ atọ, dị ka Kirkaldy-Willis na Bernard si kwuo, nke a na-akpọ � degenerative cascade��. Usoro ndị a nwere ike ịgbakọta ma nwee ike ime n'ime ọtụtụ iri afọ. Agbanyeghị, ịchọpụta ọkwa ndị a n'ụlọ ọgwụ agaghị ekwe omume n'ihi nchikota nke mgbaàmà na akara.

Ọkwa 1 (Oge Ọkwa)

Ihe e ji mara ogbo a bụ nbibi. Enwere mgbanwe nke akụkọ ihe mere eme, nke na-egosi anya mmiri na sọlfụ na-adị na fibrosus annulus. Anya mmiri ndị a nwere ike bụrụ anya mmiri ọ bụla, ebe ọ bụ na ọwara mmiri dị na nsochi a, anya mmiri a nwere ike ibute azụ mgbu ma ọ bụ olu olu, bụ nke dị nso yana ya na mmegharị mgbu. N'ihi mkpaghasị ugboro ugboro na diski, ihe ndebiri nwere ike ikewapụ na-ebute ọgba aghara ọbara na diski ya, ya mere, ịnapụ ya ihe oriri na-edozi ya na iwepu ihe mkpofu. Oge annulus nwere ike ịnwe mmebi micro na fọklan collagen, nke enwere ike ịhụ na microscopy electron na nyocha MRI nwere ike ikpughe mbibi, bulging diski ahụ, na mpaghara siri ike na annulus. Nkwonkwo ihu nwere ike igosi mmeghachi omume synovial ma ọ nwere ike ibute ihe mgbu na synovitis metụtara ya na enweghị ike ịmegharị nkwonkwo ahụ na nkwonkwo zygapophyseal. Mgbanwe ndị a nwere ike ọgaghị adị na mmadụ niile. (Gupta, Vijay Kumar, et al.)

Ngwongwo akwara na - etinyekwa aka na usoro a ka ikike ịmịcha mmiri ya belatara n'ihi nnabata nke ihe nchekwa ndụ gbanwere nke mmiri. Ọ bụ enzymes abụọ akpọrọ matriks ironloproteinase-3 (MMP-3) na mgbochi anụ ahụ nke metalloproteinase-1 (TIMP-1) na-ebute mgbanwe ndị a. (Bhatnagar, Sushma, na Maynak Gupta) Enweghi ike ha na-eduga mbibi nke proteoglycans. Ike a belata iji nweta mmiri na-eduga n'ịbelata mgbali hydrostatic na akwara nucleus ma na-eme ka lamellae na-eme kwa afọ. Nke a nwere ike iwelie agagharị nke akụkụ ahụ nke na-ebute nrụgide eriri na mgbidi nke afọ. Mgbanwe ndị a niile nwere ike ibute usoro a na-akpọ delarros fibrosus n'ime annlarus na fissuring. Ihe ndị a bụ usoro ọnụọgụ abụọ dị iche iche ma ha abụọ nwere ike ibute mgbu, nro ime obodo, hypomobility, akwara azụtara, mmegharị nkwonkwo mgbu. Ma, nyocha nke akwara ozi n’oge a na-abụkarị nke nkịtị.

Nzọụkwụ 2 (Oge Na-adịghị Anya)

Uzo nke dysfunction na-esote nsogbu nke enweghi ike, nke puru isi na onodu ogwugwu nke usoro nkwonkwo na-aga n'ihu. Enwere ike inwe mgbanwe dị iche iche zutere n'oge a, gụnyere mgbakasị nkwanye na ndozi, nke nwere ike ibute ịdị elu oghere diski. Ọtụtụ anya mmiri kwa afọ nwekwara ike ime na ọkwa a yana mgbanwe nke otu na nkwonkwo zagopophyseal. Ha nwere ike ịgụnye nbibi nke cartilage na mkpochapu agịga ihu ma nwee ọdịdị ihu. Mgbanwe ndị a na-eme biomechanical na-ebute enweghị ike nke mpaghara emetụtara.

Mgbaàmà ndị a na-ahụ n'oge a yiri nke a na-ahụ n'oge a na-adịghị arụ ọrụ dị ka inye ụzọ n'azụ, mgbu mgbe ị na-eguzo ogologo oge, na ijide n'azụ na mmegharị ahụ. A na-esonyere ha na ihe ịrịba ama dị ka mmegharị ahụ na-adịghị mma na nkwonkwo n'oge palpation na ịhụ na ọkpụkpụ azụ na-emegharị ma ọ bụ na-atụgharị n'akụkụ ma guzosie ike ruo oge ụfọdụ mgbe mgbanwe ahụ gasịrị. (Gupta, Vijay Kumar et al.)

Agba 3 (Ndozigharị usoro)

N'ime ọkwa nke atọ na nke ikpeazụ, ngwangwa nke na-aga n'ihu na-eduga n'ịbe oghere na fibrosis na usoro osteophyte na njikọ transdiscal. Mgbu nke na-esite na mgbanwe ndị a siri ike ma e jiri ya tụnyere ọkwa abụọ gara aga, mana ndị a nwere ike ịdị iche n'etiti ndị mmadụ n'otu n'otu. Ibelata oghere diski a nwere ike inwe ọtụtụ ihe ọghọm n’ọkpụkpụ. Nke a nwere ike ime ka oghere mmiri dị warara dị warara na ụzọ kachasị elu yana njigide nke ogige dị n'akụkụ. Ogologo ụdọ ogologo oge, nke na-akwado kọlụm vertebral, nwekwara ike daa ọrụ n'akụkụ ụfọdụ na - eduga n'inwe akp ụdị na ọghọm azụ. Ọkpụkpụ azụ nwere ike ime ka akwara ligamentum na-ebu ọkụ ma nwee ike ibute subluxation usoro kachasị elu. Nke a na - ebute ngwụcha dayameta na ntụpọ nke anteroposterior nke oghere intervertebral na stenosis nke ọwara akwara dị n’elu.

Okpụkụ osteophytes na hypertrophy nke ihu nwere ike ime n'ihi mgbanwe ahụ na ntanetị dị na akwara na akụkụ ahụ. Ndị a nwere ike itolite na ma usoro dị elu ma dị ala na usoro articular osteophytes nwere ike ịgbanye n'ọwa mmiri dị n'akụkụ ebe akụkụ mgbali elu nwere ike ịgbanye n'ọwa mmiri etiti. A na-eche na a ga-eme ihe ndị ga-adị na osteophytes site na ịbawanye ike nke artilatiiki artisica na adịte uchesteum mgbe emesịa ha na -akpọ olu na mkpụrụedemede endochondral. Osteophytes na-etolitekwa n'ihi mgbanwe nke esemokwu oxygen na n'ihi mgbanwe mgbanwe nke mmiri mmiri mgbakwunye na ntụpọ nkesa nkesa. Osteophytes na periarticular fibrosis nwere ike ibute nkwonkwo ụkwụ ike. Usoro articular nwere ike tinyekwa aka na ụzọ oblique na-akpata retrospondylolisthesis na-eduga na warara nke oghere intervertebral, akwara mgbọrọgwụ akwara, na akụkụ azụ. (KIRKALDY-WILLIS, WH et al.)

Mgbanwe ndị a niile na-eduga na mgbu azụ, nke na-ebelata na ogo. Ihe mgbaàmà ndị ọzọ dị ka ngaghari ije, akwara ike, isi ike, na scoliosis nwere ike ibute. Mkpụrụ ndụ synovial stem na macrophages na-esonye na usoro a site na ịhapụ ihe ndị na-eto eto na ụmụ irighiri akwara extracellular, nke na-eme dị ka ndị ogbugbo. Nchọpụta nke cytokines achọpụtawo na ọ na-esonye na ọkwa ọ bụla ma nwee ike ịnwe mmetụta ọgwụgwọ na mmepe ọgwụgwọ n'ọdịnihu.

Etiology nke ihe ndị dị Iche Iche nke Ọrịa Degenerative Disc

Ka nká na ogo

O siri ike ịmata ọdịiche dị iche na ịka nká na mgbanwe mgbanwe. Pearce et al na-atụ aro na ịka nká na nbibi na-anọchi anya ọkwa dị n'etiti otu usoro na-esite na mmadụ niile mana na ọnụego dị iche iche. Ọ bụrụ nbibi Disc, na-apụta ọtụtụ mgbe, ọ na - eme ngwa ngwa karịa ihe mere agadi. Ya mere, a na-ezute ya na ndị ọrịa nke afọ ọrụ.

Odi adi na nmekorita di n’etiti ime agadi na odi nkpa, ma onwebeghi ihe ebughi uzo emebebeghị. E duzila ọtụtụ ọmụmụ banyere nri, mkpụrụ ndụ nwụrụ, yana nnakọta nke ngwaahịa matriks ndị mebiri emebi na ọdịda nke akwara. Ihe mmiri nke intervertebral diski na-ebelata ka afọ na-abawanye. Nucleus pulposus nwere ike ịnweta nrụpụta nwere ike ịgbatị na annulus fibrosus. A na - akpọ mmalite nke usoro a chondrosis inter vertebralis, nke nwere ike akara mmalite nke mbibi degenerative nke intervertebral diski, ngwụcha, na akụkụ ahụ nke akụkụ ahụ. Usoro a na - ebute mgbanwe dị omimi na mejupụtara molikuliki nke diski ahụ ma nwee semelae nke biomechanical na nke nwere ike ibute nsụhọ mmadụ niile metụtara ya.

Ntinye uche cell na annulus na-ebelata ka afọ na-abawanye. Nke a bụ n'ihi na sel ndị dị na diski ahụ na-edo onwe ha n'ahụ anya na ha na-efunahụ ike ịmụba. Ihe ndị ọzọ metụtara ya na-akpata mbelata afọ nke diski intervertebral gụnyere mfu cell, mbelata oriri na-edozi ahụ, mgbanwe mgbanwe nke protein matrix post-translational, nchịkọta nke ngwaahịa nke mkpụrụ ndụ matriks mebiri emebi, na ike ọgwụgwụ nke matrix. Mbelata ihe oriri na-edozi ahụ na diski etiti, nke na-enye ohere nchịkọta nke ngwaahịa mkpofu sel na mkpụrụ ndụ matriks mebiri emebi yiri ka ọ bụ mgbanwe kachasị mkpa na mgbanwe ndị a niile. Nke a na-emebi ihe oriri na-edozi ahụ ma na-ebute ọdịda na ọkwa pH, nke nwere ike imebi ọrụ cell ma nwee ike ibute ọnwụ cell. Mmụba catabolism na mbelata anabolism nke mkpụrụ ndụ senescent nwere ike ịkwalite mmebi. (Buckwalter, Joseph A.) Dị ka otu nnyocha si kwuo, e nwere ọtụtụ mkpụrụ ndụ senescence na nucleus pulposus ma e jiri ya tụnyere annulus fibrosus na diski herniated nwere ohere dị elu nke senescence cell.� (Roberts, S. et al.)

Mgbe usoro ịka nká na-aga ruo oge ụfọdụ, nchịkọta nke chondroitin 4 sulfate na chondroitin 5 sulfate, nke nwere ike hydrophilic, belatara ebe keratin sulfate na chondroitin sulfate na-abawanye. Keratan sulfate dị nwayọọ hydrophilic yana o nwekwara obere agwa iji mepụta nchịkọta siri ike na hyaluronic acid. Dika aggrecan gbawara ekeji, ma otutu ihe ya na onu ogugu ya na-ebelata, viscosity na hydrophilicity nke nucleus pulposus na-ebelata. Mgbanwe Degenerative na diski intervertebral na-eme ka nrụgide hydrostatic belata nke akwara nucleus na mbelata nke inye nri site na mgbasa. Mgbe mmiri nke matriks extracellular ibelata belata, ogo diski intervertebral ga-ebelata. A ga-ebelata nguzogide diski ahụ na otu axial. N'ihi na a na-ebufezi axial na aka ahụ na annulus fibrosus, mgbaji annulus nwere ike ịdọrọ ngwa ngwa.

Usoro ndị a niile na - eduga na mgbanwe mgbanwe nke a na - ahụ na ọrịa diski degenerative. N'ihi ntakịrị ihe dị n'ime mmiri ana - eme ka ihe dị n'ime ụkọ annulus fibrosus yana mwepu nke nnabata, ibu axial nwere ike kesaa ya n'ọdịdị nke akụkụ ihu kama ihu ihu nkịtị na akụkụ etiti. Nke a nwere ike ibute ọrịa ogbu na nkwonkwo, mgbali nke akụkụ ahụ, yana ọnya ma ọ bụ akpịrị mmachi, ndị a maara dị ka osteophytes, n'ihi diski degenerative. (Choi, Yong-Soo)

Jenetik na ogo

Achọpụtala akụkụ mkpụrụ ndụ ihe nketa ka ọ bụrụ isi ihe na-ebute ọrịa diski degenerative. Ọmụmụ ejima, na ọmụmụ gbasara ụmụ oke, egosila na mkpụrụ ndụ ihe nketa na-ekere òkè na mmebi diski. (Boyd, Lawrence M., et al.) Genes nke koodu maka collagen I, IX, na XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP � 3), na protein ndị ọzọ so na mkpụrụ ndụ ihe nketa ndị bụ tụrụ aro ka itinye aka na ọrịa diski degenerative. Polymorphisms na 5 A na 6 A alleles na-eme na mpaghara nkwalite nke mkpụrụ ndụ ihe nketa nke na-achịkwa mmepụta MMP 3 bụ isi ihe na-eme ka ọkpụkpụ lumbar na-abawanye na ndị agadi. Mmekọrịta dị n'etiti mkpụrụ ndụ ihe nketa dị iche iche na-enye aka nke ukwuu na ọrịa intervertebral disc degeneration n'ozuzu ya.

Oriri na erimeri

A na-ekwenye na ngbanwe diski ga-adị n'ihi ọdịda nke akụrụngwa ọkọnọ nke mkpụrụ ndụ diski intervertebral disc. Ewezuga usoro ịka nkata nkịtị, ụkọ nri nke sel diski na-emetụta oke mmebi anụ ahụ, ị ​​smokingụ sịga, na ọnọdụ nri n'ogo. Enweghị ihe oriri na-edozi ahụ nwere ike iduga ịmepụta nguzobe lactic acid yana nrụgide oxygen dị ala metụtara. PH dị ala na-esite na ya nwere ike imetụta ike nke mkpụrụ ndụ diski ịkpụzi ma dozie matriks extracellular nke diski ahụ ma mee ka nbibi intervertebral disc. Ihe diski emebi emebi enweghi ikike ịza oku nke oma site na mpụga ahụ ma ọ nwere ike ibute ọgba aghara ọbụlagodi obere azụ azụ. (Taher, Fadi, et al.)

Ihe na-etolite na-akpali chondrocytes na fibroblasts iji mepụta ego nke matriks extracellular ọzọ. Ọ na - egbochi njikọ nke matriks metalloproteinases. Ihe omuma atu nke uto ndi a gunyere igbanwe uto, ihe ogugu nke insulin, na ihe itolite fibroblast. A na-emezi matrik ahụ emebi emebi site na ọkwa dị elu nke na-agbanwe ihe na-eto ngwa ngwa na ihe na-akpata fibroblast.

Gburugburu ebe obibi na ogo

Ọ bụ ezie na diski niile dị otu afọ, diski ndị a na-ahụ n'akụkụ akụkụ lumbar dị ala na-adị mfe na mgbanwe mmebi karịa diski ndị dị na akụkụ elu. Nke a na-egosi na ọ bụghị nanị ịka nká kamakwa, na-ebukwa ígwè ọrụ, bụ ihe na-akpata ya. Njikọ dị n'etiti ọrịa diski degenerative na ihe ndị metụtara gburugburu ebe obibi akọwawo n'ụzọ zuru ezu site na Williams na Sambrook na 2011. (Williams, FMK, na PN Sambrook) Ibu arọ anụ ahụ dị arọ nke jikọtara ya na ọrụ gị bụ ihe ize ndụ nke nwere ụfọdụ onyinye na diski. ọrịa degenerative. Enwekwara ohere nke kemịkalụ na-ebute mmebi diski, dị ka ise siga, dịka nchọpụta ụfọdụ siri kwuo. (Batti�, Michele C.) Nikotine etinyela aka na ọmụmụ ejima iji mee ka ọbara na-erugharị na diski intervertebral, na-eduga nbibi diski. (BATTI�, MICHELE C., et al.) Ọzọkwa, a chọtara otu mkpakọrịta n'etiti ọnya atherosclerotic na aorta na obere ihe mgbu na-ekwu maka njikọ dị n'etiti atherosclerosis na ọrịa diski degenerative. (Kauppila, LI) Mbelata mmebi diski ahụ metụtara na oke ibu, oke ibu, ọrịa metabolic, yana mmụba nke oke ahụ na nyocha ụfọdụ. (�Ihe Ọmụmụ dabere na ọnụ ọgụgụ ndị mmadụ nke mmebi diski ụmụaka na mkpakọrịta ya na oke ibu na oke ibu, obere mgbu azụ, yana ọnọdụ arụ ọrụ belatara. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Ọkpụkpụ Joint Surg. Abụ 2011;93 (7):662–70�)

Ihe mgbu na Disc Degeneration (Ahụhụ Discogenic)

Mgbu discogenic, nke bụ ụdị mgbu nociceptive, na-esite na nociceptors na annulus fibrosus mgbe usoro nhụjuanya na-emetụta ọrịa diski degenerative. Annulus fibrosus nwere eriri akwara na-emeghachi omume na-alụso ọrịa ọgụ na oyi akwa nke diski ahụ nwere kemịkalụ ndị ọzọ dị ka polypeptide intestinal vasoactive, peptide metụtara mkpụrụ ndụ calcitonin, na ihe P. (KONTTINEN, YRJ� T., et al.) Mgbe mmebi mmebi na-agbanwe. diski intervertebral na-eme, a na-agbanwe usoro nkịtị na ibu ọrụ na-eduga na mmegharị ahụ na-adịghị mma. Ndị nociceptors diski ndị a nwere ike nweta nghọta na-ezighi ezi na mkpali igwe. A pụkwara ịkpasu mgbu ahụ site na mpaghara pH dị ala kpatara ọnụnọ nke lactic acid, na-eme ka mmepụtawanye nke ndị ogbugbo mgbu.

Mgbu site na ọrịa diski degenerative nwere ike ibilite site n'ọtụtụ ụzọ. O nwere ike ime n'ihi mmebi nhazi, nrụgide, na mgbakasị ahụ na akwara ndị dị na spain. Diski ahụ n'onwe ya nwere naanị eriri akwara ole na ole, mana mmerụ ahụ ọ bụla nwere ike ịchọpụta irighiri akwara ndị a, ma ọ bụ ndị nọ na ogologo oge, iji mee ka ihe mgbu. Ntugharị micro na vertebrae nwere ike ime, nke nwere ike ibute ọgbụgba akwara na-egbu mgbu n'ihi diski ahụ mebiri emebi ma gwụsịa ike n'ihi nrụgide na ịdị elu. Mmegharị ahụ na-egbu mgbu na-ebilite n'ihi na akwara na-ebute mpaghara ma ọ bụ na-ewe iwe site na nkwonkwo ihu na akwara ndị dị na akwara na-eduga na ụkwụ na azụ mgbu. Ihe mgbu a nwere ike ịka njọ site na mwepụta nke protein na-enye nsogbu na-eme ihe na akwara ndị dị na mkpokọ ahụ ma ọ bụ na-agbadata irighiri akwara ndị dị n’oghere nke azụ.

Ihe atụ nke ọrịa ụbụrụ nke diski emebi, mgbe a na-ahụ ya n'okpuru mikroskopu ahụ, na-ekpughe na anụ ahụ sitere na oghere anụ ahụ na oghere dị ukwuu dị n'ime akwara nke afọ anusus fibrosus na-agbasa n’ime akwara dị n’ime akwara nke ikuku. Ọbara mkpụrụ ndụ mastill na-abata na mkpụrụ ndụ mast na ha na-esokarị na-akpata usoro nke na - eduga na mgbu mgbu. Ndị a gụnyere neovascularisation, deghasị intervertebral disc, mbufụt anụ ahụ diski, na nguzobe nke fibrosis. Mkpụrụ ndụ Mast na-ahapụkwa ihe, dịka tumor necrosis factor na interleukins, nke nwere ike igosipụta maka ịgbalite ụfọdụ okporo ụzọ nke na-ekere òkè na-akpata mgbu azụ. Ihe ndị ọzọ nwere ike ịkpalite ụzọ ndị a gụnyere phospholipase A2, nke a na-esite na arachidonic acid cascade. A na - achọta ya site na ịbawanye ụba na mpụta nke atọ nke annulus nke diski degenerative ma na - eche na ọ ga - akpali ndị nociceptors dị ebe ahụ iji hapụ ihe mkpali na - akpata ihe mgbu. Ihe ndị a na-eweta mmerụ ahụ akụkụ akụkụ, ọnya ọgbụgba, na demyelination. (Brisby, Helena)

A na-eche na mgbu azụ na-esite na diski intervertebral n'onwe ya. Ya mere ihe mgbu ahụ ga-eji nwayọọ nwayọọ na-ebelata ka oge na-aga mgbe diski na-emebi emebi kwụsịrị ime ihe mgbu. Otú ọ dị, ihe mgbu na-apụta n'ezie site na diski n'onwe ya naanị na 11% nke ndị ọrịa dịka nchọpụta endoscopy. Ihe kpatara ihe mgbu azụ yiri ka ọ bụ n'ihi mkpali nke etiti etiti akwara na-ezo aka na mgbu n'akụkụ ogwe aka ma ọ bụ ụkwụ yiri ka ọ na-ebili n'ihi mkpali nke isi akwara. Ọgwụgwọ maka mmebi diski kwesịrị ilekwasị anya na enyemaka mgbu iji belata nhụjuanya nke onye ọrịa n'ihi na ọ bụ ihe mgbaàmà kachasị nwee nkwarụ na-akpaghasị ndụ onye ọrịa. Ya mere, ọ dị mkpa ịmepụta usoro ihe mgbu n'ihi na ọ na-eme ọ bụghị nanị n'ihi mgbanwe nhazi na diski intervertebral kamakwa n'ihi ihe ndị ọzọ dị ka ntọhapụ nke kemịkal na ịghọta usoro ndị a nwere ike ime ka mgbu mgbu dị irè. (Choi, Yong-Soo)

Ngosipụta adakarị ọrịa nke Degenerative Disc Disease

Ndị ọrịa nwere ajọ diski na-eche ihu n'ọtụtụ mgbaàmà na-adabere na saịtị nke ọrịa ahụ. Ndị nwere nsogbu nke lumbar disc na-enwe azụ mgbu azụ, mgbaàmà radicular, na adịghị ike. Ndị nwere nsogbu diski cervical nwere mgbu olu na mgbu olu.

Ihe mgbu dị ala nwere ike ịka njọ site na mmegharị na ọnọdụ. Ọtụtụ mgbe, mgbaàmà ahụ na-akawanye njọ site na ntụgharị, ebe mgbatị ahụ na-ebelatakarị ha. Obere mmerụ ahụ na-agbagọ agbagọ, ọbụlagodi site na ịgbanye klọb golf, nwere ike ịkpalite mgbaàmà ahụ. A na-ahụkarị ihe mgbu ka ọ dị ntakịrị mgbe ị na-eje ije ma ọ bụ na-agba ọsọ, mgbe ọ na-agbanwe ọnọdụ ugboro ugboro na mgbe ị dinara ala. Otú ọ dị, ihe mgbu na-abụkarị ihe gbasara onwe ya na n'ọtụtụ ọnọdụ, ọ na-adịgasị iche iche site n'aka onye ọ bụla na ọtụtụ ndị mmadụ ga-ata ahụhụ site na obere mgbu na-adịghị ala ala nke mpaghara azụ azụ na-aga n'ihu mgbe ụfọdụ na-ata ahụhụ site na ukwu, hip, na ụkwụ mgbu. Mmetụta mgbu ahụ ga-abawanye site n'oge ruo n'oge ma na-adịru ụbọchị ole na ole wee jiri nwayọọ nwayọọ daa. Nke a �flare up� bụ nnukwu ihe omume na ekwesịrị ka ejiri ọgwụ analgesics gwọọ ya. A na-enweta ihe mgbu ka njọ n'ọnọdụ a na-anọdụ ala ma na-akawanye njọ mgbe ọ na-ehulata, na-ebuli, na mmegharị na-emegharị ugboro ugboro. Ogo nke ihe mgbu nwere ike ịdịgasị iche iche na ụfọdụ na-enwe ihe mgbu na-egbu mgbu nye ndị ọzọ na-enwe oke mgbu ma na-eme ka ihe mgbu kwụsị oge. (Jason M. Highsmith, MD)

Ahụ mgbu na ịdị nro n’ọkpụkpụ akwara na-esite n’aka ndị nociceptors ndị a chọtara n’ime diski intervertebral, nkwonkwo ihu, nkwonkwo sacrailiac, akwara ndị dị n’ọkpụkpụ akwara, na akụkụ myofascial dị n’ime ọkpụkpụ azụ. Dịka ekwuru na ngalaba ndị gara aga, mgbanwe mgbanwe mmegharị ahụ nwere ike ibute obere akụkụ nke azụ azụ a na-akpọ spinal stenosis, oke nke usoro azụ a na-akpọ osteophytes, ọbara mgbali nke usoro dị ala na nke kachasị elu, spondylolisthesis, mbibi nke ligamentum flavum na diski herniation . Mgbanwe ndị a na-ebute nchịkọta nke mgbaàmà ndị amaara dị ka ịkọ nkọ. Enwere ike inwe mgbaàmà dịka mgbu azụ na obere mgbu yana ya na ọnya ma ọ bụ ịmị ụkwụ, adịghị ike, na ọdịda. Ọnwụ nke eriri afọ ma ọ bụ nchịkwa eriri afọ nwere ike na-atụ aro mkpaghasị azụ azụ ma ọ dị mkpa nlekọta ahụike ozugbo iji gbochie nkwarụ na-adịgide adịgide. Mgbaàmà ndị a nwere ike ịdị iche na ogo ma ọ nwere ike ibute ndị nnabata dịgasị iche iche na ndị mmadụ iche iche.

Ihe mgbu ahụ nwekwara ike inye ike n’akụkụ ndị ọzọ nke ahụ n’ihi eziokwu ahụ na akwara azụ na-ewepụta ọtụtụ ngalaba na saịtị abụọ dị iche iche nke ahụ. Yabụ, mgbe diski diski na-aga n’ihu n’ọkpụkpụ akwara azụ, a ga-enwekwa ihe mgbu n’ụkwụ ebe akwara na-emecha banye. Ihe omume a, a na-akpọ radiculopathy, nwere ike isi n'ọtụtụ ebe pụta, n'ihi usoro nbibi. Disc bulging, ọ bụrụ na ọ na-agbago, ọ nwere ike imetụta ịgbadata cauda equina, ọ bụrụ na ọ na-eme mkpọtụ, ọ nwere ike imetụta mgbọrọgwụ akwara na-apụ na mpaghara ala na-esote oghere na akwara azụ ya na mpaghara azụ ya nwere ike inwe mmetụta mgbe diski ahụ na-ebugharị. n'akụkụ. N'otu aka ahụ osteophytes na-apụta n'akụkụ ala na ala akụkụ nke akụkụ ahụ nke akụkụ vertebral nwere ike ịbanye otu akwara ahụ na-akpata otu ihe mgbaàmà. Nnukwu ọbara usoro akwara hypertrophy nwekwara ike ịdakwasị mgbọrọgwụ akwara na-adabere na ntụle ha. Ihe irighiri akwara ndị ahụ nwere ike ịgụnye mgbọrọgwụ akwara tupu ebili na ọnụ ala intervertebral na-esote yana mgbọrọgwụ akwara n'ime nnukwu akwara irighiri akwara na dural. Udiri ihe ndi a, n'ihi nsogbu akwara, gosiputara site na ihe omumu nke cadaver. A na-eche na nkwenkwe Neural na-ewere ọnọdụ mgbe a na-agbagha dayameta nke akwara na-ebelata 70%. Ọzọkwa, enwere ike imebi ihe n’akpịrị isi mgbe a na-agbanye ihe ga-esote diski ahụ ihe na-erughị 4imita n’ịdị elu, ma ọ bụ mgbe a na-ebelata elu foraminal na-erughị milimita 15 na-eduga ná mgbali foraminal na nsogbu akwara. (Taher, Fadi, et al.)

Ọbịbịa Diagnostic

A na-enyocha ndị ọrịa site na iji akụkọ ziri ezi na nyocha anụ ahụ zuru oke na nyocha kwesịrị ekwesị na ule na-akpata iwe. Agbanyeghị, akụkọ ihe mere eme na-edokarị anya n'ihi mgbu na-adịghị ala ala nke a na-enweghị ike ịkọwa ya nke ọma na ihe isi ike ịchọpụta kpọmkwem ọnọdụ anụ ahụ n'oge ule na-akpata iwe n'ihi mmetụta nke akụkụ anatomical dị nso.

Site na akụkọ ihe mere eme nke onye ọrịa, a na-amata ihe kpatara mgbu azụ dị ala dị ka nke sitere na nociceptors na diski intervertebral. Ndị ọrịa nwekwara ike inye akụkọ ihe mere eme nke ọdịdị na-adịghị ala ala nke mgbaàmà na njedebe mpaghara gluteal jikọtara ya, tingling yana isi ike na ọkpụkpụ azụ nke na-emekarị ka ọ dịkwuo njọ na ọrụ. Enwere ike nweta nro site n'ịkụ aka n'ọkpụkpụ azụ. N'ihi ọdịdị nke ọrịa ahụ na-adịghị ala ala ma na-egbu mgbu, ọtụtụ ndị ọrịa nwere ike na-enwe mmetụta uche na nchekasị. A na-eche na ịda mbà n'obi na-enye aka na-adịghị mma na ibu ọrịa ahụ. Agbanyeghị, enweghị njikọ doro anya n'etiti oke ọrịa yana ọnọdụ ọnọdụ ma ọ bụ nsogbu nchekasị. Ọ dị mma ịmụrụ anya maka ọnọdụ ahụike uche ndị a kwa. Iji wepu ọrịa ọrịa ndị ọzọ siri ike, a ga-ajụrịrị ajụjụ gbasara ike ọgwụgwụ, oke ibu, ahụ ọkụ, na oyi, nke nwere ike igosi ụfọdụ ọrịa ndị ọzọ. (Jason M. Highsmith, MD)

Ekwesịrị ịwepụ etiology ọzọ maka mgbu azụ dị ala mgbe ị na-enyocha onye ọrịa maka ọrịa diski degenerative. A ga-ewepụ ọnya ọnya ọgbụgba, nke nwere ike ibute azụ mgbu dị ka aortic aneurysm, kaliluli akụrụ, na ọrịa pancreatic.

Ọrịa diski degenerative nwere ọtụtụ nchọpụta dị iche iche a ga-atụle mgbe onye ọrịa na-enye mgbu azụ. Ndị a gụnyere; obere mgbu idiopathic, mmebi nkwonkwo zygapophyseal, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, na lumbar radiculopathy. (�Ọrịa diski Degenerative � Physiopedia�)

nnyocha

Ejiri nyocha iji gosipụta nchoputa nke ọrịa diski degenerative. Enwere ike ekewa ndị a na ọmụmụ ụlọ nyocha, ọmụmụ ihe onyonyo, ule akwara, na usoro nchọpụta.

Nyocha nke Ima

A na-ejikarị ihe onyonyo na ọrịa diski degenerative na-akọwa mmekọrịta anatomical na njirimara morphological nke diski emetụtara, nke nwere uru ọgwụgwọ dị ukwuu na mkpebi n'ọdịnihu maka nhọrọ ọgwụgwọ. Usoro onyonyo ọ bụla, dị ka redio nkịtị, CT, ma ọ bụ MRI, nwere ike ịnye ozi bara uru. Otú ọ dị, ihe kpatara ya nwere ike ịchọta nanị na 15% nke ndị ọrịa n'ihi na ọ dịghị mgbanwe redio doro anya na-ahụ anya na ọrịa diski degenerative na-enweghị diski diski na ụkọ akwara. Ọzọkwa, ọ dịghị njikọ dị n'etiti mgbanwe mgbanwe anatomical a na-ahụ na eserese na ịdị njọ nke mgbaàmà ahụ, ọ bụ ezie na enwere njikọ n'etiti ọnụ ọgụgụ osteophytes na oke mgbu azụ. A pụkwara ịhụ mgbanwe na-emebi emebi na redio na ndị mmadụ asymptomatic na-eduga na ihe isi ike n'ikwekọ mkpa ụlọ ọgwụ na mgbe ịmalite ọgwụgwọ. (�Ọrịa diski Degenerative � Physiopedia�)

Ndepụta Foto

Igwe onyonyo a na-akọ ọnụ ma dịkwa ebe niile, nwere ike inye ozi dị mkpa maka nrụrụ, idozi, na mgbanwe nke agba ụkpụkpụ. Iji chọpụta ọnụnọ nke ogwe spinal na nguzozi nke sagittal, mgbanwe mgbanwe, ma ọ bụ ọmụmụ ndọtị ga-eme.

Igwe Nchekwa Magnetik (MRI)

MRI bụ usoro a na-ejikarị achọpụta mgbanwe mmebi na diski intervertebral n'ụzọ ziri ezi, ntụkwasị obi, na nke zuru oke. A na-eji ya na nyocha mbụ nke ndị ọrịa nwere mgbu olu mgbe redio dị larịị. Ọ nwere ike ịnye onyonyo na-adịghị emebi emebi n'ọtụtụ larịị ma na-enye ọmarịcha onyonyo diski. MRI nwere ike igosi hydration diski na morphology dabere na njupụta proton, gburugburu kemịkalụ, na ọdịnaya mmiri. A ghaghị ịtụle foto ahụike na akụkọ ihe mere eme nke onye ọrịa mgbe ị na-akọwa akụkọ MRI dị ka egosipụtara na ihe dị ka 25% nke ndị redio na-agbanwe akụkọ ha mgbe data ụlọ ọgwụ dị. Fonar mepụtara ihe nyocha MRI nke mbụ mepere emepe nwere ikike nke onye ọrịa ka enyocha ya n'ọnọdụ dị iche iche dịka iguzo, ọdụ, na ịgbagọ. N'ihi njirimara ndị a pụrụ iche, enwere ike iji nyocha MRI a na-emepe emepe maka nyochaa ndị ọrịa na-ebu ibu ma guzoro ọtọ iji chọpụta mgbanwe mgbanwe ndị na-akpata ọrịa nke a na-elegharakarị anya na nyocha MRI nke oge dịka ọrịa diski degenerative lumbar na herniation. Igwe a dịkwa mma maka ndị ọrịa claustrophobic, ka ha na-ekiri nnukwu ihuenyo telivishọn n'oge usoro nyocha. (�Ọrịa Diski Degenerative: ndabere, Anatomi, Pathophysiology.�)

A ga - amata Nucleus pulposus na annulus fibrosus nke diski ahụ na MRI, na - eduga n'ịchọpụta herniation diski dịka enwere ya na enweghị ya. Dịka MRI nwekwara ike igosipụta anya mmiri nke afọ na ogologo oge ogologo oge, enwere ike iji ya mee nhazi. Nke a nwere ike ịdị mfe mmegharị afọ ọ bụla ka ịkọwa mkpọsaisi n'efu. Ozi a nwere ike ịkọwapụta diski pathologic dị ka diski agbatị, diski zoro ezo, na diski mbupụ.

E nwere ọtụtụ grading sistemụ dabere na MRI nkwupụta ike, ịdị elu diski, ọdịiche dị n'etiti akwara na annulus, yana usoro diski. ,Zọ a, nke Pfirrmann et al, etinyerela n'ọtụtụ ebe wee nabata ọgwụgwọ. Dabere na usoro gbanwetụrụ, enwere akara asatọ maka ọrịa lumen disc degenerative. Ọkwa 8 na-anọchite anya diski intervertebral nkịtị yana klas nke asatọ kwekọrọ na ọkwa ngwụcha, na-egosi agamnihu nke ọrịa diski. Onwere onyoonye dakọtara n’enyemaka nchọpụta ahụ. Dika ha n’enye ha ezi ihe di iche na nkọwa ha banyere ihe ngosi diski, ana eji sagittal T1 onyoonyo maka ebumnuche. (Pfirrmann, Christian WA, et al.)

Modic akọwaala mgbanwe na-eme na akụkụ ahụ nke vertebral n'akụkụ nke diski degenerating dị ka mgbanwe 1 na anddị 2. Na ngbanwe Modic 1, enwela osiri ike nke ihe onyonyo T1 na onodu ike T2 ike. Echere na nke a ga - eme n'ihi na efere ndị ahụ abanyela sclerosis na ụmị ọkpụkpụ dị n'akụkụ na - egosi azịza mmekpa ahụ dịka ọnụọgụ ọnụọgụ na - abawanye. Ejiri kemịkal kemịkalụ nke esetịpụtara site na usoro iji mee ka ọghọm nke mgbasa na -agagọnụ ma na-egbochi mgbanwe. Mgbanwe ụdị Modic abụọ gụnyere mbibi ụmị ọkpụkpụ nke mpempe ihe dị n'akụkụ ibe ya n'ihi nzaghachi mkpaghasị na nnabata nke abụba na ụmị. Mgbanwe ndị a nwere ike ibute ụba nrịbama na onyunyo T2. (Modic, MT et al.)

Tomography gbakọrọ (CT)

Mgbe MRI na-anọghị, a na-ewere mkpokọta tomography dịka nyocha nke nwere ike ịchọpụta diski herni n'ihi na ọ nwere ọdịiche ka mma n'etiti oke akụkụ azụ nke ọnya ụsọ vertebrae, abụba perineal, na ihe diski herniated. N'agbanyeghị nke ahụ, mgbe ị na-achọpụta ọrịa herral n'akụkụ, MRI ka bụ onye a họọrọ.

Nyocha CT nwere ọtụtụ uru karịa MRI dịka ọ nwere gburugburu claustrophobic na-erughị ala, ọnụ ala dị ala, yana ịchọpụta mgbanwe dị mma nke aghụghọ na enwere ike na-efu na usoro ndị ọzọ. CT nwere ike ịchọpụta mgbanwe degeterative nke mbu na nkwonkwo facet na spondylosis nwere izi ezi. A na-ejikwa nyocha nke CT ka na-enyocha iguzosi ike n'ezi ihe.

A pụrụ ịchọpụta diski herniation na mkpịsị akwara na-emetụta ya site na iji njirisi ndị Gwẹ na Heithoff mepụtara. Ọ dị mkpa ka mkpịsị diski ahụ dina n'elu mgbọrọgwụ akwara na-agafe diski ahụ wee bụrụ ebe a na-eche ihu na asymmetrical. A ga-enwe ike igosipụta mkpịsị akwara na-enweghị ike ma ọ bụ ndaghachi. Nke ikpe azu, ihe akwara dị na ihe ọghọm (saịtị nke herniation) na-ebuwanye ibu na bulges site na edema, oke nke veidural epidural veranates, na mkpasu iwe na-ebute oke ngha.

Lumbar Dihe omuma

Usoro a bụ arụmụka na, ma ịmara ebe saịtị mgbu ahụ nwere uru ọ bụla gbasara ịwa ahụ ma ọ bụ na ọ kwadobeghị. Nkwupụta ụgha nwere ike ime n'ihi Central hyperalgesia na ndị ọrịa nwere mgbu na-adịghị ala ala (ịchọta neurophysiologic) yana n'ihi ihe mmekọrịta psychosocial. Ajuju ajuju ya mgbe ichoputara ihe di egwu di egwu. Ndị na-akwado nyocha a na-akwado njirisi siri ike maka ịhọrọ ndị ọrịa yana mgbe ha na-atụgharị nsonaazụ ma kwenye na nke a bụ naanị ule nwere ike ịchọpụta mgbu mgbu. Enwere ike iji akụkọ Lumbar n'ọtụtụ ọnọdụ, ọ bụ ezie na edozighi ntọala sayensị. Ndị a gụnyere; nyocha nke herniation n'akụkụ, nyocha diski symptomatic n'etiti ọtụtụ arụrụala, na-enyocha ihe arụ dị iche iche hụrụ na CT ma ọ bụ MRI, ntule nke spain mgbe aacasịrị ahụ, nhọrọ nke ọnọdụ ihu, yana njiri mara atụmatụ ịdị adị ụkwara ahụ.

Ihe nkiri ahụ na-enwekarị nchegbu banyere iwepụta ọrịa pathophysiology kama ịchọpụta usoro nke diski ahụ. Ya mere, ntule ihe nhụchaanya bụ ebumnuche nke nyocha. MRI nwere ike kpughere diski na-elekarị anya na-enweghị ihe mgbu, ebe enwere ike ịhụ ihe mgbu dị nro na nyocha ebe nchọpụta MRI dị ole na ole. N'oge ntụtụ saline nkịtị ma ọ bụ ihe dị iche, ihe ntụpọ nwere ike ime na diski na-ezighi ezi ịnakwere ọtụtụ iche. Ihe ozo di iche nwere ike banye n’ime ogwe ogwara n’agha site na anya mmiri na osisa ya n’ime an’obus fibrosus na diski ojoo. Nrụgide nke ihe dị iche a nwere ike ịkpasu mgbu n'ihi ihe dị n'ime ahụ site na akwara ozi meningeal nwa oge, akwara spinal, isi azụ rami, na isi awọ rami nke na-ewepụta annulus fibrosus nke mpụta. Enwere ike iwe ihe mgbu Radicular mgbe ihe dị iche ruru ebe nrụgide akwara sitere na diski na-ezighi ezi. Agbanyeghị, ule nyocha a nwere ọtụtụ nsogbu dị ka mmerụ ahụ akpata mgbọrọgwụ, kemịkalụ ma ọ bụ diski nje, ọdịiche nke nfụkasị, yana iwe ahụ mgbu. (Bartynski, Walter S., na A. Orlando Ortiz)

Onyonyo Njikọ Modality

Iji tulee mkpakọ akwara na stenosis nke ọma, njikọta usoro a ga-achọ.

Ihe ngosi CT

Mgbe emechara nyocha izizi, a na-achọpụta CT n’ime awa anọ. Enwere ike iji ya wee chọpụta ọnọdụ nke diski dịka herniated, protruded, exruded, nwere ma ọ bụ sequessed. A nwekwara ike iji ya na spain mee ka ọdịiche dị n'etiti oke nke ọnya anụ ahụ ma ọ bụ ihe diski mgbe a wasịrị ya aka.

CT Myelography

Echere ule a ka ọ bụrụ usoro kachasị mma maka ịtụle mkpakọ akwara. Mgbe emechara CT na ngwakọta ma ọ bụ mgbe myelography gasịrị, enwere ike nweta nkọwa banyere agba agba ana - emetụta ikuku dịtụ ala.

Usoro nyocha

Transforaminal Selective Nerve Rocks Blocks (SNRBs)

Mgbe a na-enyocha ọrịa diski multilevel degenerative na nyocha MRI, enwere ike iji nnwale a iji chọpụta otu mkpụrụ akwara esi emetụta ya. SNRB bụ ma nyocha na ọgwụgwọ ọgwụgwọ enwere ike iji ya maka lumbar spinal stenosis. Nnwale ahụ mepụtara mpaghara demotomal hypoesthesia site na ịgbanye anestetiiki na ihe dị iche n'okpuru nduzi fluoroscopic na ọkwa mmerụ ahụ nwere mmasị. Enwere mmekọrịta dị n'etiti akara ọrịa Clinical degenerative diski klaasị na nchoputa na MRI na nchoputa nke SNRB dịka Anderberg et al si kwuo. Enwere mmekọrịta 28% na nsonaazụ SNRB yana yana ụfụ ụkwara ụfụ na mpaghara nke adịghị ike neurologic. A na-achọpụta na ihe kachasị njọ gbasara mmebi na MRI na 60%. Ọ bụ ezie na ejighị ya mgbe niile, SNRB bụ nnwale bara uru na ịlele ndị ọrịa tupu ịwa ahụ na ọrịa diski multilevel degenerative diski karịsịa na spain yana njirimara na nyocha ya na MRI. (Narouze, Samer, na Amaresh Vydyanathan)

Ọmụmụ Electro Myographic

Nleba anya moto na mmetụta akwara ozi, nke a na-akpọ ọmụmụ electromyographic, nke a na-eme na nyocha agịga na-adịghị mma nwere ike ikpughe mgbaàmà mkpakọ akwara nke na-apụta na akụkọ ihe mere eme ụlọ ọgwụ. Enwere ike ịmegharị mgbọrọgwụ akwara iwe iwe site na iji injections iji mee ka irighiri akwara emetụta ma ọ bụ ndị na-anabata ihe mgbu na oghere diski, nkwonkwo sacroiliac, ma ọ bụ nkwonkwo facet site na discography. Akwụkwọ akụkọ Electromyography & Kinesiology kalenda (�)

Nnyocha nnyocha Laboratory

A na-emekarị ụlọ nyocha iji wepụta ọrịa ndị ọzọ dị iche.

Dika spondyloarthropathies seronegative, dị ka ankylosing spondylitis, bụ ihe na-akpatakarị mgbu azụ, a kwesịrị ịnwale HLA B27 immuno-histocompatibility. Emere atụmatụ na mmadụ 350,000 nọ na US na 600,000 na Europe emetụtawo ọrịa a na-akpata mgbu nke etiology na-amaghị. Mana HLA B27 adịkarịghị hụrụ na ndị America America. Spondyloarthropathies ndị ọzọ seronegative nke enwere ike ịnwale site na iji usoro a gụnyere ọrịa psoriatic ogbu na nkwonkwo, ọrịa mbufụt na-efe efe, yana ọrịa ogbu na nkwonkwo ma ọ bụ ọrịa Reiter. Enwere ike ịmụba ọbara immunoglobulin A (IgA) n'ụfọdụ ndị ọrịa.

Nnwale dị ka usoro erythrocyte sedimentation (ESR) na protein C- reactive (CRP) maka ndị na - emeghachi azụ na - ahụkarị ihe na - akpata mgbu azụ ala dịka osteoarthritis na malignancy. Achọrọ ka ọnụ ọgụgụ ọbara zuru ezu, gụnyere ọnụọgụ dị iche iche iji chọpụta ọrịa etiology. A na-enyo oria Autoimmune mgbe Rheumatoid factor (RF) na anti-nuklia antibody (ANA) enyocha. Enwere ike ịchọpụta urum acid na ntụpọ synovial maka kristal n'ọnọdụ ndị a na-adịghị ahụkebe iji wezuga mkpo gout na mmiri pyrophosphate.

Ọgwụgwọ

Enweghị usoro ọgwụgwọ doro anya nke ndị dọkịta niile kwenyere banyere ọgwụgwọ nke ọrịa diski degenerative n'ihi na ihe kpatara mgbu ahụ nwere ike ịdị iche na ndị dị iche iche na otú ahụ ka ogo ihe mgbu na ọdịiche dịgasị iche na ngosipụta ụlọ ọgwụ. Enwere ike ikwurịta nhọrọ ọgwụgwọ ahụ n'ọtụtụ; ọgwụgwọ nchekwa, ọgwụgwọ na ịwa ahụ.

Ọgwụ Conservative

Treatmentzọ ọgwụgwọ a gụnyere usoro mmega ahụ yana itinye aka na omume, ụdị anụ ahụ, inje, agụmakwụkwọ azụ, na ụzọ ụlọ akwụkwọ.

Usoro ọgwụgwọ sitere na mmega ahụ metụtara omume

Dabere na nchọpụta ọrịa ahụ, enwere ike ịkọwa ụdị mmega ahụ dị iche iche. A na-atụle ya otu n'ime ụzọ ndị isi na njikwa nchekwa iji gwọọ azụ mgbu na-adịghị ala ala. Enwere ike gbanwee mmega ahụ iji tinye ịgbatị mgbatị ahụ, mmega ahụ aerobic, yana mmega ume. Otu ihe ịma aka kachasị nke usoro ọgwụgwọ a gụnyere enweghị ike ya nyochapụta arụmọrụ dị n'etiti ndị ọrịa n'ihi ọdịiche dịgasị iche na usoro mmega ahụ, ugboro ole, na ike. Dika ihe omumu emere, a nwetara kachasi nma nke ihe mgbu azu di ala nke nwere otutu ihe mgbaàmà site na ime mmemme mmemme di omimi n'ime ebe omumu ihe omumu. Achọpụtara ọganihu dị ukwuu n'etiti ndị ọrịa na-arịa ọrịa mgbaàmà na-arịa ọrịa a na usoro metụtara nkwalite arụmọrụ yana mbelata ihe mgbu. Usoro ọgwụgwọ ndị mmadụ mere maka onye ọrịa ọ bụla n'okpuru nlekọta na nnabata nke onye ọrịa dịkwa ka ọ kacha arụ ọrụ na ndị na-arịa mgbu mgbu azụ. Enwere ike iji ụzọ ndị ọzọ na-edobe isi na ngwakọta iji melite usoro a. (Hayden, Jill A., et al.)

Mgbatị ahụ, ma ọ bụrụ na a na-eme ya mgbe niile, nwere ike imezi ntachi obi. Maka iwelata nsogbu ahụ ike, enwere ike iji usoro izu ike. A na-ahụkwa igwu mmiri ka ihe omumu azụ mgbu. Mgbatị ahụ nwere ike ịgụnye mmega mgbatị, aka iji aka, obere aka agbatị, ikpere aka abụọ gbatịa agbatị, na-ebuli oche, ịnọdụ ala, mgbatị afọ, na ugwu na sag.

Icalkpụrụ Ahụ

Usoro a gụnyere ojiji nke mkpali akwara ọkụ, izu ike, ngwugwu ice, biofeedback, paịlị kpo oku, phonophoresis, na iontophoresis.

Ọkpụkpụ akụrụngwa Ọdọ (TENS)

N'ime usoro a na - adịghị emerụ ahụ, a na - enye ihe mkpali eletrik na anụ ahụ iji mee ka akwara dị na mpaghara ahụ wee belata ihe mgbu ahụ ruo n'ókè ụfọdụ. Usoro a na - ewepu ihe mgbu ozugbo ịbịara ya ngwa ngwa mana ịrụ ọrụ ogologo oge anaghị enwe obi abụọ. Site na nyocha ụfọdụ, achọpụtara na enweghi ezigbo ọganihu na mgbu na ọnọdụ ọrụ ma e jiri ya tụnyere placebo. Ngwaọrụ ndị na - eme TENS ndị a nwere ike ịnweta ngwa ngwa site na ngalaba nnabata. Naanị otu mmetụta yiri ka ọ bụ mgbakasị ahụ dị nro na-enweta na otu ụzọ n'ụzọ atọ nke ndị ọrịa. (Johnson, Mark I)

Ulo akwukwo

Ewebata usoro a n'ebumnuche iji belata ihe mgbaàmà mgbu mgbu na ndaghachi ha. E bu ụzọ webata ya na Sweden ma buru n'uche ọnọdụ, ergonomics, mmega azụ kwesịrị ekwesị, yana mmewere nke mpaghara lumbar. A na-akuziri ndị ọrịa ọnọdụ kwesịrị ekwesị ka ha nọrọ ọdụ, guzoro ọtọ, bulie ibu, ụra, ịsacha ihu, na ịsacha ezé iji zere mgbu. Mgbe atụnyere usoro ọgwụgwọ ndị ọzọ, a chọpụtala na usoro ọgwụgwọ ụlọ akwụkwọ na-adị irè ma n'oge yana oge etiti iji melite azụ mgbu na ọnọdụ ọrụ.

Mmụta Ndidi

N'ime usoro a, onye na-eweta ọrụ na-agwa onye ọrịa banyere otu esi ejikwa akara mgbu mgbu azụ ha. A na - akuzi ọkpụkpụ azụ nkịtị na biomechanics metụtara usoro mmerụ ahụ na mbụ. Na-esote, n'iji ụdị ngwa ngwa, a na-akọwara onye ọrịa ọrịa ahụ ọrịa diski degenerative disc. Maka onye ọrịa ahụ, a na-ekpebi ọnọdụ ahụ ọfụma wee rịọzie ka ọ jigide ọnọdụ ahụ iji zere inweta mgbaàmà

Usoro Bio-Psychosocial na-abịakwute Multidisciplinary Back Therapy

Ihe mgbu azụ na-adịghị ala ala nwere ike ime ka onye ọrịa ahụ nwee nsogbu dị ukwuu, na-eduga ná mgbagwoju anya nke uche na ọnọdụ dị ala. Nke a nwere ike imetụta nsonaazụ ọgwụgwọ na-eme ka ọtụtụ usoro ọgwụgwọ bụrụ ihe efu. Ya mere, a ga-agụrịrị ndị ọrịa n'atụmatụ mmụta mmụta a na-akpọ �behavioral� na �bio-psychosocial� atụmatụ iji nweta ahụ efe site na mgbu. Na mgbakwunye na ịgwọ ihe ndị na-akpata ihe mgbu, ihe gbasara uche, na mmekọrịta mmadụ na ibe ya kwesịkwara ileba anya na usoro a. Iji belata nghọta onye ọrịa banyere mgbu na nkwarụ, a na-eji ụzọ dị ka atụmanya gbanwetụrụ, usoro ntụrụndụ, njikwa nzaghachi anụ ahụ site na omume mmụta, na nkwado.

Ọhịa Massage

Maka mgbu azụ na-adịghị ala ala, usoro ọgwụgwọ a yiri ka ọ bara uru. N'ime otu afọ, a chọpụtala na ịhịa aka n'ahụ na-arụ ọrụ ọfụma maka ụfọdụ ndị ọrịa ma e jiri ya tụnyere acupuncture na usoro izu ike ndị ọzọ. Agbanyeghị, ọ naghị arụ ọrụ karịa TENS na usoro mmega ahụ n'agbanyeghị na ndị ọrịa n'otu n'otu nwere ike ịhọrọ otu karịa nke ọzọ. (Furlan, Andrea D., et al.)

Ọkpụkpụ azụ

Usoro ọgwụgwọ a gụnyere mmachi nkwonkwo gabigara ókè ngagharị ya dị, mana ọ gafere oke usoro anụ ahụ nkịtị. Nke a bụ ọgwụgwọ akwụkwọ ntuziaka na-etinye mgbatị ogologo site na obere ọsọ ọsọ. Echere na ọ ga - eme ka ihe mgbu azụ dị ala site na usoro dị ka ntọhapụ nke akwara ndị amamịghe, mbibi nke akwara ndị na - adịkarị njọ, yana site na ijikwa akụkụ azụ nke nwegasịrị. O nwekwara ike belata nchapu nke diski ahụ, mee ka akwara hypertonic nwee ume, na-akpali akwara ndị nociceptive site na ịgbanwe ọrụ neurophysiological ma na-atụgharị menisci na mpaghara articular.

A na-eche na njikwa azụ azụ ka ọ dị mma na arụmọrụ ma e jiri ya tụnyere ọtụtụ ụzọ dịka TENS, usoro mmega ahụ, ọgwụ NSAID, yana ọgwụgwọ ụlọ akwụkwọ azụ. Ihe nyocha a dị ugbu a dị mma gbasara arụmọrụ ya ọ bụla na ogologo oge. Ọ dị mma nchekwa na ị na - enye ndị na - ahụ maka ọgwụgwọ ọzụzụ zụrụ azụ nke gbasara disni herniation na cauda equina na - erughị 1 n'ime nde mmadụ nde 3.7. (Bronfort, Gert, et al.)

Lumbar Na-akwado

Ndị ọrịa na-arịa mgbu azụ ala na-adịghị ala ala n'ihi usoro na-emebi emebi n'ọtụtụ otutu yana ọtụtụ ihe nwere ike irite uru na nkwado lumbar. Enwere ihe akaebe dị iche iche banyere arụmọrụ ya na ụfọdụ ọmụmụ na-ekwu na ndozi ngwangwa na enyemaka ozugbo na ogologo oge ebe ndị ọzọ na-atụghị enweghị mmelite dị otú ahụ ma e jiri ya tụnyere usoro ọgwụgwọ ndị ọzọ. Nkwado Lumbar nwere ike idozi, mebie nrụrụ, belata ike usoro, ma gbochie mmegharị nke spain. O nwekwara ike ịrụ ọrụ dị ka ebe anwụrụ ọkụ ma belata ihe mgbu ahụ site na ịhịa aka na mpaghara ndị emetụtara na itinye ọkụ.

Okporo umzọ Lumbar

Zọ a na-eji eriri akpọrọ azụ nke ọdụ iliac crest na obere ọgịrịga ma na-etinye ike dị ogologo n'akụkụ akwara axial iji belata mgbu azụ na-adịghị ala ala. A na-agbanwe ọkwa na oge ike ahụ dabere na onye ọrịa ahụ enwere ike ịtụ ya site na iji ngwaọrụ ma ka ị na-aga ma dina ala. Mgbapụta nke Lumbar na-arụ ọrụ site na imepe oghere oghere intervertebral na site na ibelata lumbar lordosis. A na-ebelata ihe mgbaàmà nke ọrịa diski degenerative site na usoro a n'ihi ntinye spain nwa oge na uru ya na ya nwere njikọ. Ọ na –eme ka mkpịsị akwara na nrụgide nke dị n'ahụ, na - egbochi ọgba aghara dị na akụkụ ahụ na annulus, yana kwa akara mgbu mgbu. Agbanyeghị, enweghị ezigbo akaebe banyere arụmọrụ ya n'ibelata mgbu azụ ma ọ bụ melite ọrụ kwa ụbọchị. Ọzọkwa, ihe ize ndụ ndị metụtara nsị lumbar ka na-eme nyocha yana enwere ụfọdụ akụkọ dị ebe ọ kpatara mmerụ akwara, nsogbu iku ume, na mgbanwe ọbara ọgbụgba n'ihi ike dị ukwuu na ntinye akwara adịghị mma. (Harte, A et al.)

Ọgwụ Ọgwụ

Usoro ọgwụgwọ ahụike gụnyere ọgwụgwọ ọgwụ na izu ike akwara, injection na steroid, NSAIDs, opioids, na nyocha ndị ọzọ. Achọrọ nke a, na mgbakwunye na ọgwụgwọ nchekwa, n'ọtụtụ ndị ọrịa nwere ọrịa diski degenerative. Mlọ ọgwụ na-ere ọgwụ bụ iji chịkwaa nkwarụ, belata ihe mgbu na ọzịza mgbe a na-eme ka ndụ gị ka mma. A na-ede ya dịka onye ọrịa si n'otu n'otu maka enweghị nkwekọrịta gbasara ọgwụgwọ ahụ.

Ndị na-agba ume

Ọrịa diski na-alụ ọgụ nwere ike ị rite uru na izu ike nke anụ ahụ site na ibelata spasm nke akwara ma si na ibelata ihe mgbu. Egosiwo ike nke izu ike akwara iji meziwanye ihe mgbu na ọnọdụ ọrụ site na ọtụtụ nyocha. Benzodiazepine bụ akụrụngwa izu ike na arụ ọrụ ugbu a.

Ngwá ọgwụ na-adịghị na steroidal Anti-Inflammatory Drugs (NSAIDs)

A na-ejikarị ọgwụ ndị a eme ihe dị ka nzọụkwụ mbụ na ọrịa degenerative disc na-enye analgesia, yana mmetụta mgbochi mkpali. Enwere akaebe siri ike na ọ na-ebelata mgbu azụ na-adịghị ala ala. Agbanyeghị, ojiji ya na-ejedebeghị site na mgbagha eriri afọ, dị ka ọrịa gastritis. Ndị na-ahọrọ COX2 inhibitors, dị ka celecoxib, nwere ike imeri nsogbu a site na naanị ịcheba ndị na-anabata COX2. Anabataghị ojiji ha maka ya n'ihi nsonaazụ ya ọ nwere na ịba ụba ọrịa obi na iji ogologo oge.

Ọgwụ Opioid

Nke a bụ nzọụkwụ dị elu na ọkwa mgbu WHO. Edebere ya maka ndị ọrịa nwere nnukwu mgbu na-anabataghị NSAID na ndị nwere nsogbu GI na-enweghị ike ịnagide ya na ọgwụgwọ NSAID. Agbanyeghị, ndenye ọgwụ ọgwụ maka ịgwọ mgbu azụ na-adịgasị iche n'etiti ndị dọkịta. Dị ka akwụkwọ akụkọ si kwuo, 3 ruo 66% nke ndị ọrịa nwere ike na-ewere ụfọdụ ụdị opioid iji belata mgbu azụ ha. Ọ bụ ezie na a na-akara mbelata obere oge nke mgbaàmà, enwere ihe ize ndụ nke iji ọgwụ ọjọọ eme ihe ogologo oge, ọnụ ọgụgụ dị elu nke ndidi, na nsogbu iku ume na ndị agadi. Ọgbụgbọ na ọgbụgbọ bụ ụfọdụ n'ime mmetụta ndị na-adịghị adịte aka enwetara. (�Nlebaanya sistemu: Ọgwụ Opioid Maka Mgbu Azụ Na-adịghị Anya: Ọganihu, Ịrụ Ọrụ, na Njikọ na Ahụhụ riri ahụ�)

Ndị Na-egbochi Nkụda mmụọ

Ndị na-egbochi ịda mba, na usoro dị ala, nwere uru nyocha ma nwee ike ịba uru na ndị ọrịa mgbu mgbu na-adịghị ala ala nke nwere ike ịpụta na mgbaàmà nkụda mmụọ metụtara. Mgbu na nhụjuanya nwere ike na-akpaghasị ụra onye ọrịa ma belata ọnụ ụzọ mgbu. Enwere ike idozi ihe ndị a site na iji ọgwụ mgbochi na obere doti n'agbanyeghị na enweghị akaebe ọ bụla na ọ na-eme ka ọrụ ahụ ka mma.

Usoro Ngwọta Ọgwụ

Injections Steroid

Injections ọgwụ steroid bụ ụdị ịgba ọgwụ kachasị eji eme ihe maka ọgwụgwọ nke ọrịa diski degenerative diski na radiculopathy metụtara. E nwere ọdịiche dị n'etiti ụdị steroid ejiri ya na ụdị ya. A na-atụle 8- 10 mil nke methylprednisolone na saline nkịtị dị ka ihe bara uru ma nwee nchebe. Enwere ike inye ndị gbara ya site n'ụzọ dị warara, caudal, ma ọ bụ ụzọ transramram trans. Enwere ike itinye agịga n'okpuru nduzi nke fluoroscopy. Ihe dị iche, mgbe ahụestị ọgwụ mpaghara na n’ikpeazụ, steroid ka etinyere n’ime oghere epidural na ọkwa emetụtara site na usoro a. A na - enweta ihe enyemaka mgbu site na njikọta nsonaazụ sitere na anesthesia mpaghara na steroid. Enwere ike ị nweta enyemaka mgbu ozugbo site na ọgwụ mgbochi mpaghara site na igbochi nnyefe ihe nrịba mgbu na mgbe ị na-ekwenyekwa nchọpụta ahụ. A na-ebelatakwa mmerụ ahụ n'ihi ihe ndị na - eme steroid iji gbochie cascade pro-inflammatory.

N'ime afọ iri na-adịbeghị anya, ojiji nke ogwu ogwu steroid abawanyela site na 121%. Agbanyeghị, enwere esemokwu gbasara ojiji ya n'ihi mgbanwe dị na ọkwa nzaghachi yana mmetụta ọjọọ nwere ike. Ọtụtụ mgbe, a na-ekwenye na injections ndị a na-ebute naanị obere mgbu nke mgbaàmà. Ụfọdụ ndị dọkịta nwere ike ịgbanye injections 2 ruo 3 n'ime otu izu, n'agbanyeghị na nsonaazụ ogologo oge bụ otu maka nke onye ọrịa nyere naanị otu ogwu. Maka otu afọ, ekwesighi inye ihe karịrị injections 4. Maka enyemaka mgbu dị irè karị, morphine na-enweghị nchekwa nwekwara ike ịgbakwunye na ntụtụ ahụ. Ọbụna ọgwụ anestetiiki mpaghara, dị ka lidocaine na bupivacaine, ka agbakwunyere maka ebumnuche a. Ihe akaebe maka enyemaka mgbu ogologo oge dị oke. (�Ọnwụnwa ejirila ebebo iji nyochaa ịdị irè nke enyemaka mgbu site na iji Ketamine na Steroid Epidural Maka Mgbu Na-adịghị Ala Ala)

Enwere ike inwe mmetụta dị iche iche n'ihi usoro ọgwụgwọ a, na mgbakwunye ọnụ ahịa dị elu na nrụpụta arụmọrụ ya. Enwere ike idozi agịga ma ọ bụrụ na ejighị fluoroscopy dị ka 25% nke ikpe, ọbụlagodi ọnụnọ nke ndị ọrụ nwere ahụmahụ. Enwere ike ịchọpụta oghere epidural site na pruritus pụrụ ịdabere. Mbido iku ume ma ọ bụ njide nwere oghere nwere ike ịdata ya mgbe a na-a morụ ọgwụ morphine yabụ onye ọrịa ahụ kwesịrị ka enyocha ya ka awa 24 gachara.

Ihu Ihu

A na-enye ọgwụ ndị a na nkwonkwo ihu, nke a na-akpọkwa zygapophysial, nke dị n'etiti vertebrae abụọ dị n'akụkụ. Enwere ike ịgbanye akụnwụ ahụ na oghere njikọ ma ọ bụ na etiti medụsọ nke azụ azụ, nke dị n'ime ya. Enwere ihe akaebe na usoro a na - eme ka ikike ịrụ ọrụ, arụmọrụ nke ndụ dị mma, na - ebelata ihe mgbu. Echere na ha ga-enye ma uru dị mkpirikpi ma ọ bụ ogologo oge, ọ bụ ezie na ọmụmụ egosila na injections akụkụ abụọ na epidural steroid bụ otu na arụmọrụ. (Wynne, Kelly A)

SI njikọ nwoke na nwanyị

Nke a bụ nkwonkwo ọgbụgba ahụ diarthrodial nwere nkwonkwo akwara si na myelinated na non-myelin nerve axons. Ọgwụ ahụ nwere ike ịgwọ ọrịa diski degenerative gụnyere sacroiliac nkwonkwo na-eduga na enyemaka ahụ ogologo oge na nke dị mkpirikpi site na mgbaàmà ndị dị ka mgbu azụ na obere mkpịwa ụkwụ, apata ụkwụ, na isi. Enwere ike imeghari agba agba ahụ kwa ọnwa 2 ruo 3 mana ekwesịrị ịme ya naanị ma ọ bụrụ na ọ dị mkpa ọgwụgwọ. (MAUGARS, Y. et al.)�

Rapgwọ Ọgwụ Ahụike Intradiscal maka Discogenic Pain

Dịka akọwara n'okpuru nyocha ndị ahụ, enwere ike iji nyocha mee ihe dịka usoro nyocha na usoro ọgwụgwọ. Mgbe amachara diski ọrịa, enwere ike ịnwale ọtụtụ ụzọ ndị na-adịghị emerụ ahụ obere oge tupu ịmalite ịwa ahụ. Enwere ike iji eletriki dị ugbu a na ikpo ọkụ ya na-eme ka mkpọtụ nke na-esote afọ sikwuo ike site na ịgbanye eriri ọkụ collagen, na-ekwupụta ma na-ebibi ndị mgbasa ozi na-enye ọnụnọ na ndị nociceptors, na ọnụ ọgụgụ akara. Uzo ndi eji eme ihe bu nke anakpo intradiscal electrothermal therapy (IDET) ma obu rediofrequency posterior annuloplasty (RPA), ebe ejife electrode na diski. IDET nwere akaebe na-agbanwe agbanwe na enyemaka nke mgbaàmà maka ndị ọrịa ọrịa degenerative, ebe RPA nwere nkwado pere mpe maka ịdị mkpụmkpụ obere ya na ogologo oge. Usoro abụọ a nwere ike ibute nsogbu dị ka mmerụ ahụ metụtara akwara, ọrịa catheter, ọrịa, yana herniation diski usoro.

Ọgwụgwọ Ọgwụgwọ

Edebere ọgwụgwọ ịwa ahụ maka ndị ọrịa nwere ọgwụgwọ nchekwa nchekwa dara ada na-eburu n'uche oke ọrịa ahụ, afọ, nsogbu ndị ọzọ, ọnọdụ mmekọrịta ọha na eze na ọnọdụ akụ na ụba na ọkwa a na-atụ anya ya. A na-eme atụmatụ na gburugburu 5% nke ndị ọrịa nwere ọrịa diski degenerative na-aga ịwa ahụ, ma ọ bụ maka ọrịa lumbar ha ma ọ bụ ọrịa cervical. (Rydevik, Bj�rn L.)

Usoro ntụgharị nke Lumbar

A na-egosi ịwa ahụ Lumbar na ndị ọrịa nwere oke mgbu, na oge nke 6 ruo 12 ọnwa nke ọgwụgwọ ọgwụ na-adịghị arụ ọrụ, bụ ndị nwere nnukwu ọkpụkpụ azụ azụ. Ịwa ahụ na-abụkarị usoro nhọrọ ma e wezụga n'ihe gbasara ọrịa cauda equina. Enwere ụdị usoro abụọ nke na-achọ itinye aka n'ọkpụkpụ azụ ma ọ bụ decompression ma ọ bụ ha abụọ. (�Ọrịa Diski Degenerative: ndabere, Anatomi, Pathophysiology.�)

Ọkpụkpụ spinal gụnyere ịkwụsị mmegharị n'akụkụ akụkụ mgbu iji belata ihe mgbu ahụ site na ịgwakọta ọtụtụ vertebrae ọnụ site na iji ọkpụkpụ aka. A na-elele ya anya dị ka ọ dị ogologo oge maka ndị ọrịa nwere ọrịa diski degenerative nwere ọrịa azụ ma ọ bụ mmegharị oke. Enwere ụzọ dị iche iche iji gwọọ ogwe ụfụ. (Gupta, Vijay Kumar, et al)

• Lumbar spinal posterolateral guttur njikọ

Usoro a gụnyere itinye okpukpu ọkpụkpụ n’ọkpụkpụ azụ. Enwere ike iwepu aka nke ọkpụkpụ site na posterior iliac crest. A na-ewepụ ọkpụkpụ dị ka ọ dị na oge ọ ga-enwe ọfụma ọ bụla. Ekwesịrị ime nkwado azụ n'oge ịwa ahụ ma ọ dị mkpa ka ndị ọrịa nọrọ n'ụlọ ọgwụ ihe dị ka ụbọchị 5 ruo 10. Ọ dị obere ngagharị na ịkwụsị ị smokingụ sịga dị mkpa maka ijikọ ọnụ. Agbanyeghị, ọtụtụ ihe egwu dị ka njikọ aka, ọrịa, ọbara ọgbụgba, yana njikọ siri ike na azụ mgbu nwere ike ime.

• Posterior lumbar inter fusion

N'ime usoro a, a ga-emerịrị decompression ma ọ bụ ụzọ diskectomy site n'otu ụzọ ahụ. A na-etinye usoro ọkpụkpụ aka na oghere diski a na-apụ apụ ligamentum flavum kpamkpam. Maka ọrịa diski degenerative, a na-agbasa oghere nke interminar ọzọ na-eme site na ịme akụkụ ele. Nkwado azụ bụ nhọrọ na usoro a. O nwere ọghọm dị iche iche ma e jiri ya tụnyere usoro ihu dị ka naanị obere okwute ka enwere ike itinye ya, mbelata nke mpaghara dị maka iwe, yana ihe isi ike mgbe ị na-arụ ịwa ahụ n’ọkpụkpụ azụ ndị ọrịa. Nnukwu ihe egwu dị na ya bụ esighi na njikọta.

• Ihe ngbasi ihu lumbar

Usoro a yiri nke a na - esote afọ ma ọ bụghị na a dọtara ya n’afọ kama n’azụ. O nwere uru ịghara igbaghasịsị azụ na akwara. Ọ contraindicated na ndị ọrịa na-arịa osteoporosis na nwere ihe ize ndụ nke ọbara ọgbụgba, retrograde ejaculation na ụmụ nwoke, na-adịghị n'otu, na ọrịa.

• Ihe ntụgharị transforaminal lumbar

Nke a bụ ụdị gbanwego nke usoro mgbe ochie nke na-ewu ewu. Ọ na - enye obere ihe ize ndụ na ezigbo mkparịta ụka ma gosipụtara na ọ nwere nsonaazụ mara mma na nsogbu ole na ole dịka CSF leak, nkwarụ akwara na-efe efe, yana ọnya ọnya.

Mkpokọta Disc Arthroplasty

Nke a bụ ihe ọzọ ga - agbanwe iji kpoo diski ma jiri ya mee ihe iji gwọ ọrịa ọrịa lumbar degenerative diski site na iji art artificial iji dochie diski emetụtara. Enwere ike iji mkpokọta prosthesis ma ọ bụ ọgwụ nuklia dabere n'ọnọdụ ọnọdụ.

Mgbagha gụnyere iwepu akụkụ nke diski ahụ akụkụ ahụ, nke na-emetụta akwara ịhapụ nke ahụ wee nye ohere maka mgbake ya site na usoro akpọrọ diskectomy na laminectomy. Arụ ọrụ nke usoro a bụ agbagha agbagha ọbụlagodi na ọ bụ ịwa ahụ a na-arụkarị. Nsogbu enwere pere mpe ma nwee ohere iweghachị ọrịa site na afọ ojuju dị elu na ndidi. (Gupta, Vijay Kumar, et al)

• Ọkpụkpụ Lumbar

A na-arụ ọrụ ịwa ahụ site na ụzọ etiti etiti azụ site n'ikewa flavum ligamentum. A na-achọpụta mgbọrọgwụ akwara nke na-emetụta ya na annulus na-agbapụta agbapụ ka ọ hapụ ya. Ekwesịrị ịme nyocha akwara ozi zuru oke ma emechaa, ndị ọrịa na-adịkwa mma ịla ụlọ 1 5 ụbọchị mgbe e mesịrị. Ekwesịrị ịmalite mmega ahụ dị ala n'azụ n'oge na-adịghị anya na-esochi ọrụ dị mfe wee rụọ ọrụ dị arọ na izu 2 na 12 n'otu n'otu.

• Laminectomy nke lumbar

Enwere ike ịrụ ọrụ a nke ọma n'otu ọkwa, yana site na ọtụtụ ọkwa. Laminectomy kwesịrị ịdị mkpụmkpụ dịka o kwere omume iji zere nsogbu spinal. Ndị ọrịa egosila enyemaka nke mgbaàmà na mbelata radiculopathy na-agbaso usoro ahụ. Ihe ize ndụ ndị ahụ nwere ike ịgụnye eriri afọ na eriri afọ, mwepu CSF, mmebi akwara, yana ọrịa.

Usoro Usoro Ọkpụkpụ

A na-egosi ọrịa diski degenerative cervical maka ịwa ahụ mgbe enwere mgbu na-enweghị ike ịnagide ya na moto na-aga n'ihu na ụkọ mmetụta. Ịwa ahụ nwere ihe dị mma karịa 90% mgbe enwere ihe ngosi redio nke mkpakọ mgbọrọgwụ akwara. Enwere ọtụtụ nhọrọ gụnyere anterior cervical diskectomy (ACD), ACD, na fusion (ACDF), ACDF nwere nhazi ime, yana foraminotomy azụ. (�Ọrịa Diski Degenerative: ndabere, Anatomi, Pathophysiology.�)

Usoro Ngwọta Ahụike nke Ahụ

Ationgha mkpụrụ ndụ ewepụtara dịka ọgwụgwọ ọhụrụ maka ọrịa diski degenerative yana nsonaazụ na-ekwe nkwa. Achọpụtala mmeghe nke chondrocytes iji belata ihe mgbu discogenic n'ime oge 2. Usoro ọgwụgwọ ndị a na-anwale ọnwụnwa nke mmadụ ugbu a. (Jeong, Je Hoon, et al.)

Ọgwụgwọ Ọgwụ

Ntughari Gene iji kwusi usoro nbibi nke diski na obubata mmeghari disc di ugbu a. Maka nke a, mkpụrụ ndụ ihe nketa bara uru ka aga-amata ebe ha na-ewedata ọrụ mmebi nke na-akwalite mkpụrụ ndụ ihe nketa. Nhọrọ ọgwụgwọ ọgwụgwọ ọhụụ a na-enye olileanya maka usoro ọgwụgwọ n'ọdịnihu ka a ga-eduzi ya na ịmaliteghachi diski intervertebral discs. (Nishida, Kotaro, et al.)

Ọrịa diski Degenerative disc bụ okwu metụtara ahụike nke azụ mgbu na-esite na diski intervertebral mebiri emebi, dị ka azụ azụ mgbu na azụ azụ ma ọ bụ olu olu na spain. Ọ bụ nbipu nke dishibido diski nke spain. Otutu mgbanwe ndu nwere ike ibia na diski ojoo. Ọdịdị arụ dị iche iche nwekwara ike ime na diski intervertebral. Obere mgbu na olu mgbu bụ nnukwu nsogbu ọrịa, nke echere na ọ na-emetụta ọrịa diski degenerative. Mgbu azụ bụ ihe nke abụọ na-akpata nleta ụlọ ọrụ dọkịta na United States. A na-eme atụmatụ na ihe dị ka 80% nke ndị okenye US na-arịa mgbu azụ ala ọ dịkarịa ala otu oge na ndụ ha. Yabụ, a chọrọ nghọta zuru oke maka ọrịa diski degenerative iji jikwaa ọnọdụ a na-ezukọ. - Dr. Alex Jimenez DC, CCST Insight

Akụkụ nke ozi anyị na-ejedebe na chiropractic, musculoskeletal, ọgwụ anụ ahụ, ahụike, na ahụike ahụike na / ma ọ bụ isiokwu ọgwụ ọrụ, isiokwu, na mkparịta ụka. Anyị na-eji usoro ọgwụgwọ na ahụike dị mma iji gwọọ ma kwado nlekọta maka mmerụ ahụ ma ọ bụ nsogbu nke usoro ahụ ike. Ozi anyị, isiokwu anyị, isiokwu anyị, na nghọta anyị metụtara okwu gbasara ahụike, okwu, na isiokwu ndị metụtara ma na-akwado ma ọ bụ na-enweghị usoro anyị na-arụ ọrụ. ọmụmụ na-akwado ọkwa anyị. Anyị na-ewepụtakwa akwụkwọ nke na-akwado ọmụmụ nyocha maka ndị otu na ndị ọha na eze ma anyị rịọ ha. Anyị ghọtara na anyị na-ekpuchi ihe ndị chọrọ nkọwa ọzọ gbasara otu ọ ga - esi nyere aka na atụmatụ nlekọta ma ọ bụ usoro ọgwụgwọ; ya mere, iji gụkwuo isiokwu a n'elu, biko nweere onwe gị ịjụ Dr. Alex Jimenez ma ọ bụ kpọtụrụ anyị na 915-850-0900. Ndị na-eweta (s) Akwụkwọ ikike na Texas * & New Mexico *

Nke Dr. Alex Jimenez DC, CCST dere ya

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