成惠林_好大夫在线

成惠林

主任医师 副教授

东南大学附属中大医院 神经外科

在线问诊 团队接诊 预约挂号 私人医生
微信扫码

微信扫码关注医生

有问题随时问

综合推荐热度 3.6

在线问诊量 1088

成惠林

成惠林

主任医师 副教授
在线问诊 团队接诊 预约挂号 私人医生

医学科普

椎间盘突出 -- 定义,发展,诊断

发表者:成惠林 4281人已读

定义:

椎间盘位于椎体之间,由外周类似车胎状的纤维环及中心凝胶状的髓核两部分组成。髓核经破裂的纤维环处突出压迫脊髓及神经谓之椎间盘突出。准确地讲,椎间盘突出应称为髓核突出。

Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber). 东南大学附属中大医院神经外科成惠林

椎间盘突出多发生于腰部的腰4-5椎体间和腰5骶1间隙,因为这部分脊柱受力最大。30-50岁的人易发生椎间盘突出,因为到这个年龄段时椎间盘的弹性和水份开始减少。

A herniated disc (sometimes written as herniated disk) occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body\"s weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.

 

The progression to an actual HNP varies from slow to sudden onset of symptoms. There are four stages: (1) disc protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations. Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.


Progression of Herniated Disc

The extremities affected are dependent upon the vertebral level at which the HNP occurred. Consider the following examples:

Cervical - Pain in the neck, shoulders, and arms
Thoracic - Pain radiates into the chest
Lumbar - Pain extends into the buttocks, thighs, legs

Cauda Equina Syndrome occurs from a central disc herniation and is serious requiring immediate surgical intervention. The symptoms include bilateral leg pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness of the anal sphincter. 

Diagnosis of a Herniated Disc
The spine is examined with the patient laying down and standing. Due to muscle spasm, a loss of normal spinal curvature may be noted. Radicular pain (inflammation of a spinal nerve) may increase when pressure is applied to the affected spinal level.

A Lasegue test, also known as Straight-leg Raising Test, is performed. The patient lies down, the knee is extended, and the hip is flexed. If pain is aggravated or produced, it is an indication the lower lumbosacral nerve roots are inflamed. 

Other neurological tests are performed to determine loss of sensation and/or motor function. Abnormal reflexes are noted as these changes may indicate the location of the herniation.

Radiographs are helpful, but Computed Axial Tomography (CAT) or Magnetic Resonance Imaging (MRI) provides more detail. The MRI is the best method enabling the physician to see the soft spinal tissues unseen in a conventional x-ray.

Radiographic Evidence of HNP

The findings from the examination and tests are compared to make a proper diagnosis. This includes determining the location of the herniation so treatment options can be reviewed with the patient.

本文是成惠林版权所有,未经授权请勿转载。

问医生

图文问诊开始

×
分享到微信
打开微信“扫一扫”,即可分享该文章

发表于:2009-10-10 22:44

成惠林大夫的信息

  • 感谢信: 0 感谢信 礼物: 0 礼物

网上咨询成惠林大夫

成惠林医生暂时不接受网络咨询

成惠林的咨询范围: 脊柱脊髓疾病, 神经外科疾病