pivd & spinal cord compressiondr. ashish gohiya assistant professor department of orthopaedics gandhi medical college, bhopal

embryology*notocord developed from endoderm. *around notocord develops somites *dorsomedial part of somite form skeletal muscles myotome. *ventrolateral part form vertebral body sclerotome. *sclerotome has loose and dense packed cells. *the space where sclerotome separates form intervertebral disc

anatomy*outer annulus fibrosus *inner nucleus pulposus

low back ache (lba)*more than 80% population experience some low back pain at some point in their life. *exact cause of symptoms is known in only 12 15% of patients.

origin of pain*disk in front *two facet joint post.

*functional spinal unit (fsu) *motion segment *three joint complex *motion segment involves*joint capsule *ligaments *muscles *nerves *vessels

disk as pain generator*posterior portion of annulus fibrosus is innervated by fibres of sinuvertebral nerve (branch of dorsal root ganglion) *irritation of the sinuvertebral nerve is responsible for axial back pain.

natural history*disk degeneration *circumferential tear *radial tear *internal disruption *herniation

types of herniation*central *paramedial *lateral

risk factor*occupation *improper postures *obesity *personality disorder *smoking *lifting heavy objects

presentation*low back pain *radiculopathy *neural symptoms

low back pain*site *duration *onset *progression *remissions & relapses *severity *character *aggravating factor *relieving factor *associated symptoms

radiculopathy*radiation of pain down in the leg. *not up to thigh *leg pain more than back pain *coughing, sneezing, valsalva.

sciatica

neural symptom*numbness *weakness *cauda equina syndrome

special tests*sciatic stretch test*slrt (straight leg raising test) *laesegue test *bowstring test

*femoral stretch test

invesitgationx - ray mri myelography

management*conservative*rest not more than 2 days *nsaids *physiotherapy *traction *epidural steroid *chemonucleolysis

*surgery discectomy - indication*cauda equina syndrome (with in 6 hr) *neurological deterioration under conservative treatment *no response to 3 wk conservative treatment fenestration microdiscectomy disc replacement surgery

rehabilitation *physical, mental, vocational .