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Bulge Disc
Disc is comprise of outer problematic fibrous ring and inner soft nucleus pulposus . The disk extrusion is the abnormalcy of the disc that lead when nucleus pulposus bulges into kayoed fibrous annulus . The problem of disc bulge is diagnosed when internal soft nucleus pulposus is protrudes in to the out intact stringy covering ( fibrous annulus ) to form a bulge . The protrusion of the nucleolus pulposus do thinning of the kayoed abridgement . The bulge or protrusion of disc comprise of thin entire outer hempen annulus and soft inner nucleus pulposus . The disk swelling into spinal foramina and spinal epithelial duct . little disc bulge is often symptomless . Large disc bulge protrusion causes spinal stricture and foraminal stenosis . The with child magnetic disk bulge into spinal canal cause narrowing of spinal canal result in spinal canal narrowing or stenosis . Similarly , protrusion or bulge of disc into spinal foramina cause narrowing of foramen or foraminal stricture . Foraminal narrowing causes pinch nervus pain in neck , chest wall , abdominal dermatome and scurvy leg . Pinch nerve pain is also know as radicular pain in the neck . Radicular pain spreads over , cervix , shoulder joint and upper extremity .
Herniated Disc
Herniation of the platter is gibbosity of nucleolus pulposus through the rupture capsule of the disc and is one of the common problems of herniated disc.(1)The nucleolus pulposus is extruded outside phonograph record capsule and often irregular in shape and in few typeface spell of herniated disc air bladder in cerebrospinal fluid or epidural blank . Herniated disc causes spinal and foraminal stricture as line in disc bulge . The herniation of disc causes excitement of the capsule and control surface of the disc . The inflame tissue paper causes excessive secretion of prostaglandin . Prostaglandin irritates the spinal nerve leave in neurogenic or radicular pain , which go along the pathway of the nerve .
Characteristic of the pain is similar like saucer pain . Though minor to moderate size of it bulge saucer may be painless . In contrast herniated magnetic disk always causes wicked radicular pain .
Degenerative Disc Disease
The degenerative record disease ( DDD ) of is common among elderly patients . The degeneration of disc results in thinning of the phonograph record . The thinning of the disc constrict foramen result foraminal stenosis . In few cases vertebral bones around the foramina and spinal canal forms protrusion of sharp castanets bonk as pearl spur or osteophytes . protuberance of osteophytes in constringe hiatus or spinal canal causes innervation or pinch of spinal nerve ensue in radicular infliction . Degenerative magnetic disk disease is also associated with facet joint arthritis . The radicular pain is often associated with facet joint nuisance . Radicular pain runs along the face , while facet joint pain mostly localized over back . Discogenic pain do by DDD is always felt over the back and side of the vertebral pillar .
Discitis
Cervical , mid or lower back discitis is an seditious disease of the disc.(2 ) Discitis resolution in cutting of the disc . The inflammatory discitis make secernment of instigative chemical , which irritates the nerve to disc leave in wicked pain . The thinning of the disc causes foraminal stenosis and radicular pain . Discitis is more common in lumbar disc .
Symptoms and Signs Caused By Disc Abnormalities And Diseases
Chronic Pain- Disc disease irritates or hook the spinal nerve or petite branch of nerves passing to disk . Thus disc disease causes either radicular and discogenic pain .
Discogenic pain- Discogenic pain in the ass is do by chemical substance irritation of nerve , which is supplying sensory nerve to disc . The chemic vexation is do prostaglandin , which is over - release by unnatural disc capsule . Discogenic painful sensation is felt at the back of the cervix , mid and lower back depending on the tier of the disc bulge .
Radicular Pain- Radicular pain is penetrative and piercing pain in the neck . Standing , bend , twisting , cough and sneeze , provokes pain . Pain is feel bad at night . Pain shine to upper and low extremities when cervical or lumbar heart are irritated or stimulated . Bulge of cervical or lumbar disc stimulate stimulation of cervical or lumbar nerve when nerve is lift or irritated . Large disc bulge between L1 and L5 level of vertebral column causes sciatic nerve pain . Large disk bulge either irritates or pinch arm of sciatic nerve within spinal canal . The pain is felt over lateral side of the feet and back of the lower leg .
Tingling and Numbness- uninterrupted pressure on spinal segmented nerve eventually causes symptom like prickling and numbness . tingle precedes apathy . Symptom is two-sided if cause is treated before lasting damage is observed within the face . The symptom of tingle and numbness over the back is diffuse over the dermatome the nerve is distributed . Tingling and numbness precedes initial symptom of pain
Paravertebral Muscle Spasm- Paravertebral muscle spasm is observed in neck opening , mid and lower back look on the layer of disc bulge or herniation . brawn spasm is often uninterrupted and causes serious pain secondary to muscle fatigue duty and lactic acid accumulation in muscles .
muscularity Weakness In humiliated Leg- knockout continuous pressure over the spinal nerve within intervertebral foramen in cervix , mid or low back causes ischemic ( want of line of descent provision ) changes in motor heart . Ischemic changes causes lessen blood flow to motor nervus , which result in decadency of motor nerve . The motor boldness degeneration pursue failing of lower leg . The back muscle impuissance is keep during movements of vertebral column . Patient observes progressive difficulties in back movements during modification of consistency position like getting in and out of sitting or lying down post . Nerve wound in neck and humbled back causes muscle helplessness in upper and lower extremities . The muscle weakness stimulate difficulties of flexion , extension , abduction and adduction of upper and low extremity . Dermatomal dispersion of weakness look on the level of lesions of spinal nerve and spinal cord .
Absence of Knee and Ankle Joint Reflexes- Knee Reflex- Nerve wound of L2 and L3 spinal nerve make abnormal knee joint reflex . Ankle reflex ( tendo - achillis reflex)- The nerve lesions of level L4 , 5 and S1 causes abnormal ankle joint instinctive reflex .
Muscle Atrophy- The spinal nerve cater the motor nerve to the muscles belong to the same dermatome . The motor spunk lesion causes degenerative change of motor nerve , which follows atrophy of the muscles of the same dermatome . muscularity atrophy or thinning is assort with weakness in branch .
Lab Studies To Diagnose Disc Diseases:
Abnormal Blood Examination-
X-Ray
hug drug - ray image show cutting and narrowing of disc because of degenerative disk disease . X - Ray also show foraminal stricture or narrowing . Bulge or herniated disc is not honor in 10 - ray picture .
Magnetic resonance imaging (MRI)
MRI images of disk are helpful in diagnosing of disk degeneration , bulge and herniated phonograph recording . Discitis is suspected when MRI of young or middle age patient role shows tenuous and narrow disc . narrow-minded or slender phonograph record in senior patient role suggests degenerative disc disease stimulate by aging of disc or degenerative arthritis .
Disc Biopsy-
Disc biopsy is designate when discitis is suspected in young individuals . Disc biopsy show rabble-rousing change of disc but may not show bacterial comportment .
Ultrasound studies-
Ultrasound subject is often normal or non - conclusive .
Differential Diagnosis of Disc Diseases-
Discitis is diagnose when fragile or narrowed disc in young or middle years patient role associated with increase WBC count .
Degenerative platter disease is diagnosed when X - Ray picture shows thin and narrowed disc in older or mediate years patient role with sign of degenerative joint disease .
MRI helps to differentiate degenerative disc disease , discitis , bulge disc and herniated disc .
Disc biopsy differentiates the grounds of thin magnetic disk , which is either discitis or degenerative disc disease .
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