Chii chinonzi Degenerative Disc Chirwere (DDD) ?: Muenzaniso

by Dr Alex Jimenez | Kudzorera Pain, Chiropractic, Dzose Kudzorera Painini, chisingaperi Pain, utano, Herniated Disc, Pasi Pasi Pain, Neck Pain, Sciatica, Sciatica Nerve Pain, Scoliosis, Pamuviri Utano, Spine Care, Mishonga, Wellness

Degenerative Disc Denda iri izwi rakajairika rechimiro mune iyo inokanganisa intervertebral disc inokonzeresa kurwadziwa kusingaperi, uko kunogona kunge kuri kurwadziwa kwepashure mumusana we lumbar musana kana kurwadziwa kwemutsipa mumutsipa wechibereko. Haisi iyo "chirwere" chese, asi kuputsika kweiyo intervertebral disc yemuzongoza. Iyo intervertebral disc chivakwa chine yakawanda yekutarisisa iri kutariswa pane ichangoburwa, nekuda kweyekuchipatara kwayo. Iko kushanduka kwehutachiona kunogona kuitika mukushomeka kwediski kunosanganisira fibrosis, kudzikira, uye disc desiccation. Zvikanganiso zvakasiyana zveatomical zvinogona zvakare kuitika muiyo intervertebral disc senge sclerosis yezvipenga, fissuring uye mucinous degeneration yeanodzora, uye kuumbwa kwemasteophytes.

Kurwadziwa kwakadzika kumashure uye kurwadziwa kwemutsipa matambudziko makuru ehurombo, ayo anofungidzirwa kuve ane chekuita nekuchinja kunochinja mudisiki. Kurwadziwa kwemusana ndicho chechipiri chinotungamira chikonzero chekushanya kwechiremba muUSA. Zvinofungidzirwa kuti vangangoita makumi masere muzana evakuru veUS vanotambura nemarwadzo ekumusana kamwechete panguva yehupenyu hwavo. (Modic, Michael T., naJeffrey S. Ross) Naizvozvo, kunyatsonzwisisika kwechirwere chine disc chirwere chinodiwa mukugadzirisa mamiriro akajairika.

Anatomy YezveKwakabatana Maumbirwo

Anatomy of the Spine

Musana ndiwo musimboti mukuru, unochengetedza chimiro uye unopa matambudziko akasiyana siyana nemaitiro ezvirwere. Iyo musana inoumbwa nemanomwe e cervical vertebrae, gumi nemaviri thoracic vertebrae, mashanu lumbar vertebrae, uye akaisanisa sacral uye coccygeal vertebrae. Iko kugadzikana kwemuzongoza kunochengetedzwa nemakoramu matatu.

Iyo yekumberi ikholamu inoumbwa neyekunze longitudinal ligament uye yepamberi chikamu cheiyo vertebral muviri. Iyo yepakati mbiru inoumbwa neashure chikamu cheiyo vertebral muviri uye yekumashure longitudinal ligament. Iyo posterior ikholamu ine yepashure muviri arch ine inopindirana maitiro, laminae, maficha, uye spinous maitiro. ( Degenerative Disk Chirwere: kumashure, Anatomy, Pathophysiology)

Anatomy yeIntervertebral Disc

Intervertebral disc iri pakati pemiviri yakateerana vertebral miviri mune vertebral ikholamu. Inenge chikamu chimwe muzvina chehurefu hwehurefu hwehuremu inoumbwa ne intervertebral discs. Iyi disc inogadzira fibrocartilaginous joini, iyo inonzi zvakare symphysis yakabatana. Iyo inobvumira kufamba zvishoma mune vertebrae uye inobata vertebrae pamwechete. Intervertebral disc inozivikanwa neiyo kukonana kuramba uye kumanikidza kuramba hunhu. Iyo intervertebral disc inoumbwa neakanyanya zvikamu zvitatu; yomukati yegatinatinous nucleus pulposus, yekunze annulus fibrosus, uye cartilage endplates iyo inowanikwa zvakanyanya uye isingasviki pakuteedzana kwemitezo ye vertebral miviri.

Nucleus pulposus ndiyo chikamu chemukati chiri gelatinous. Iyo ine proteinoglycan uye getsi yemvura yakasungirirwa pamwe chete nerudzi II Collagen uye elastin fibers yakarongedzwa zvakasununguka uye zvisingaite. Aggrecan ndiyo yakakura proteinoglycan inowanikwa mu nucleus pulposus. Iyo inosanganisira anenge 70% yeiyo nucleus pulposus uye inoda kusvika makumi maviri neshanu muzana we annulus fibrosus. Iyo inogona kuchengetedza mvura uye inopa iyo osmotic zvivakwa, izvo zvinodiwa kuti urambe kumanikidzwa uye kuita sechinhu chinotyisa chinotora. Iyi yakakwira yakawanda yevaregeda mune yakajairika disc inobvumira matani kuti atsigire compression pasina kudonha uye mitoro yacho yakagoverwa zvakaenzana kune annulus fibrosus uye vertebral muviri panguva yekufamba kwemuzongoza. (Wheater, Paul R, et al.)

Icho chikamu chekunze chinodaidzwa kuti annulus fibrosus, ine yakawanda mhando I collagen fibers yakarongedzwa seyakatenderera denderedzwa. Iyo collagen fibers inomhanya nenzira inodakadza pakati pe lamellae yeiyo annulus mune mamwe magiravhisi inopa iyo inokwanisa kukwanisa kuramba simba rinonetesa. Circumferential ligaments inosimbisa iyo annulus fibrosus paripherally. Pane chinhu chekunze, iyo yakakura ligament inosimbisa annulus fibrosus uye yakaonda ligament inosimbisa iyo posterior side. (Choi, Yong-Soo)

Kazhinji, pane dhisiki rimwe chete pakati peviri pega pevhuru kunze kwekunge pakati peatlasi neaxis, inova yekutanga neyechipiri kervical vertebrae mumuviri. Aya ma disc anogona kufamba anenge matanhatu? mune ese masanhu ekufamba uye kutenderera kwakatenderedza imwe neimwe axis. Asi rusununguko urwu rwekufamba runosiyana pakati pezvikamu zvakasiyana zve vertebral column. Iyo vertebrae yemuromo wechibereko ine yakakura kwazvo nzira yekufamba nekuti iyo intervertebral discs yakakura uye kune yakafara concave yakadzika uye yakavezwa yepamusoro vertebral muviri nzvimbo. Ivo zvakare vane akachinjika akaenzana mativi majoini. Thoracic vertebrae ine hushoma huwandu hwekufamba mukubhururuka, kuwedzeredza, uye kutenderera, asi iine yemahara yekumashure kuruka sezvavanosungirirwa pambabvu cage. Iyo lumbar vertebrae ine yakanaka kubhururuka uye kuwedzera, zvakare, nekuti avo intervertebral discs akakura uye anotenderera maitiro ari kumashure kumashure aripo. Nekudaro, iyo yekupedzisira lumbar kutenderera ishoma nekuti iwo maficha majoini anowanikwa sagittally. ( Degenerative Disk Chirwere: kumashure, Anatomy, Pathophysiology)

Ropa

Iyo intervertebral disc ndeimwe yeakakura masisitimu eavascular mumuviri ane capillaries anogumisa pazvipenga. Iwo matishu anowana zvinovaka muviri kubva mumidziyo iri mune subchondral bone iyo iri padhuze neiyo hyaline shwashwa pane yekupedzisira. Izvi zvinovaka muviri zvakaita seoksijeni uye glucose zvinoendeswa kune iyo intervertebral disc kuburikidza nekupararira kuri nyore. (ErIntervertebral Disc Spine Orthobullets.Com )

Ness Supply

Sensory innervation ye intervertebral discs yakaoma uye inosiyana zvichienderana nenzvimbo iri mumuzongoza. Kutapurika kwekufungidzira kunofungidzirwa kuve kunopindirana nezvinhu P, calcitonin, VIP, uye CPON. Sinu vertebral nerve, iyo inomuka kubva kune yakadzika midzi ganglion, inochengetedza iyo yakasarudzika tambo dzeanobvisa. Tsinga dzemagetsi hadziwedzeri kupfuura tambo dzepamusoro.

Lumbar intervertebral discs inowedzerwawo inopiwa pane iyo posterolateral element nemapazi kubva kune ventral yepakati rami uye kubva kune grey rami communicantes padyo nejoini yavo neiyo ventral primary rami. Izvo zvinotevera zvema disc zvinopihwa nemapazi kubva kune rami communicantes. Mamwe emami ricommicantes anogona kuyambuka intervertebral disc uye kuiswa mukati meanonamira tishu, iyo yakadzika kusvika pakatangira psoas. (Palmgren, Tove, et al.)

Iyo cervical intervertebral discs inowedzerwazve inopiwa pane inozotevera makala nematavi eiyo vertebral nerve. Iyo cervical sinu vertebral nerves yakawanikwawo kuva neakakwira nzira mu vertebral canal ichipa diski panguva yavo yekupinda uye iyo iri pamusoro. (BOGDUK, NIKOLAI, et al.)

Pathophysiology yeDhigenerative Disc Chirwere

Anenge 25% yevanhu vasati vasvitsa makore makumi mana ekuratidza kuchinja kwechiitiko kune imwe nhanho. Anopfuura makore makumi mana emakore, uchapupu hweMRI hunoratidza shanduko muinopfuura makumi matanhatu muzana yevanhu. (Suthar, Pokhraj) Naizvozvo, zvakakosha kuti udzidze maitiro ekusagadzika emisangano ye intervertebral disc sezvo yakawanikwa ichipera nekukurumidza kupfuura chero humwe humwe hutano mumuviri, ichitungamira shure nekurwadziwa kwemutsipa. Iko shanduko mumatatu matatu e-discvertebral disc inoenderana nekuchinja mune vertebral muviri uye majoini anoratidza kuenderera mberi uye kwesimba maitiro.

Iyo yekudzora maitiro eiyo intervertebral discs yakakamurwa kuita nhanho nhatu, sekureva kwaKirkaldy-Willis naBernard, inonzi degenerative cascade . Aya matanho anogona kusangana uye anogona kuitika mukati memakumi emakore. Nekudaro, kuzivisa aya matanho mukiriniki hakugoneke nekuda kwekupindirana kwezviratidzo nezviratidzo.

Stage 1 (Kugadziriswa Danho)

Iyi nhanho inoratidzwa nekunetseka. Kune shanduko dzakaitika munhoroondo, idzo dzinoratidza misodzi yekusangana uye fissures mune iyo annulus fibrosus. Iyi misodzi yakatenderedza ingashanduka kuva misodzi yakajeka uye nekuti annulus pulposus yakanyatso nyorwa, misodzi iyi inogona kukonzera kurwadziwa shure kana kurwadziwa kwemutsipa, uko kunoitwa munzvimbo uye nekufamba kunorwadza. Nekuda kwekudzokorora kwekushungurudzika kwema discs, endplates anogona kuparadzanisa achitungamira mukuvhiringidzwa kweropa kugoverwa kune disc uye nekudaro, ichinyima iyo yekupa kwayo zvinovaka muviri uye kubvisa marara. Iyo annulus inogona kunge iine-micro-fractures mune collagen fibrils, iyo inogona kuonekwa pane elektroni microscopy uye MRI scan inogona kuratidza desiccation, bulging ye disc, uye yakakwirira-nzvimbo yakadzika mune iyo annulus. Nhengo dzejoinha dzinogona kuratidza kuitika kwekuita uye inogona kukonzera kurwadziwa kwakanyanya neiyo inosangana neiyo synovitis uye kutadza kufambisa iyo yakabatanidzwa mune iyo bilegapophyseal joints. Shanduko idzi dzinogona kusazoitika mumunhu wese. (Gupta, Vijay Kumar, et al.)

Iyo nucleus pulposus inobatanidzwawo muchiitiko ichi sezvo yayo mvura imbibing simba ichideredzwa nekuda kwekuunganidzwa kwemakemikari akachinja proteinoglycans. Shanduko idzi dzinounzwa zvakanyanya nemaemymymes maviri anonzi matrix metalloproteinase-3 (MMP-3) uye minyewa inhibitor yeMetalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, naMaynak Gupta) Kusakwana kwavo kunotungamira mukuparadzwa kweproteoglycans. Iko kuderedzwa kwekugona kutora mvura kunotungamira pakuderedzwa kwe hydrostatic kudzvinyirira mu nucleus pulposus uye inokonzeresa iyo annular lamellae kubhuroka. Izvi zvinogona kuwedzera kufamba kwechikamu ichocho zvichikonzera kusaura shear kumadziro eainular. Shanduko idzi dzese dzinogona kutungamira kuchirongwa chinonzi annular delamination uye kupera simba mune annulus fibrosus. Aya maviri maitiro akaparadzaniswa e-pathological maitiro uye maviri anogona kutungamira pakurwadziwa, kunyorova kwenzvimbo, hypkidility, tsandanyama dzakabvumidzwa, zvinorwadza kufamba pamwe chete. Nekudaro, kuongororwa kwemitsipa panguva ino kunowanzoitika.

Nhanho yechipiri (Chikamu cheKusimba)

Iyi nhanho yekusashanda inoteverwa nedanho rekusagadzikana, izvo zvinogona kubva kubva mukuwonda kuri kuita kwekupfuurira kwemuchina wekudyidzana kwakaoma. Panogona kunge paine shanduko dzinoverengeka dzakasangana panguva ino, kusanganisira kuvhiringidzwa uye kutenderera, izvo zvinogona kutungamira pakurasikirwa kwe disc nzvimbo urefu. Multiple annular misodzi inogona kuitikawo panguva ino nekuchinja kwakafanana muzvimiro zvegopophyseal. Zvinogona kusanganisira kuora kweiyo cartilage uye facet capsular laxity inotungamira kune subluxation. Aya mabhanduko ekuchinja anoguma nekusagadzikana kwechikamu chakakanganiswa.

Zviratidzo zvinoonekwa muchikamu chino zvakafanana nezvinoonekwa muchikamu chekusagadzikana senge "nzira yekupa" yekumusana, kurwadziwa kana wakamira kwenguva yakareba, uye "kubata" kumashure nekufamba. Izvo zvinofambidzana nezviratidzo senge kufamba zvisina kujairika mumajoini panguva yekurohwa uye kucherechedza kuti musana unodzedzereka kana kusuduruka kune rimwe divi mushure mekumira wakamira kwenguva yakati mushure mekufamba. (Gupta, Vijay Kumar et al.)

Nhanho 3 (Re-Kusimudzira Chikamu)

Mune ino yetatu uye yekupedzisira nhanho, kuenderera mberi kunogadzirisa kunotungamira kune disc nzvimbo yakatetepa ne fibrosis uye osteophyte kuumbwa uye transdiscal bridging. Marwadzo ari kubva mukuchinja uku akanyanya kuenzaniswa nematanho maviri apfuura, asi izvi zvinogona kusiyana pakati pevanhu. Iyi disc nzvimbo yakatetepa inogona kuve nehuwandu hunoreva kumusana. Izvi zvinogona kukonzera iyo nzira yekudyidzana yakamanikana munzira yakatetepa-yakaderera nekuwedzerwa kwetechero padyo. Longitudinal ligaments, inotsigira vertebral ikholamu, inogona zvakare kushomeka mune dzimwe nzvimbo inotungamira mukusagadzikana uye kusagadzikana kwemuzongoza. Kufamba kwemuzongoza kunogona kukonzera ligamentum flavum kune bulge uye inogona kukonzera yepamusoro aricular process subluxation. Izvi pakupedzisira zvinotungamira pakuderedzwa kwe diameter mune anteroposterior kutungamira kwenzvimbo intervertebral nzvimbo uye stenosis yemukati nerve midzi canges.

Kuumbwa kwe osteophytes uye hypertrophy yezviso zvinogona kuitika nekuda kwekushandurwa mu axial mutoro kumuzongoza uye vertebral miviri. Izvi zvinogona kuumba pane zvakakwirira uye zvisina kusimba zvinyoronyoro maitiro uye osteophytes anogona kubuda kune inoenderana interaltebral canal asi iwo hypertrophied sefa inogona kupindirana neyepakati canal. Osteophytes inofungidzirwa kuve yakagadzirwa kubva mukuwedzera kweiyo inonziularular cartilage iyo periosteum mushure meizvozvo ivo vanopfuura endochondral calcation uye ossization. Iwo osteophytes zvakare anoumbwa nekuda kwekushanduka kwekunetseka kweokisijeni uye nekuda kwekuchinja kwekumanikidza kwemvura kuwedzera mutoro wekugovera zvikanganiso. Iyo osteophytes uye periarticular fibrosis inogona kukonzera kuomesana majoini. Maitiro e -ularular anogona zvakare kutenderedza munzira yekumusoro inokonzeresa kudzoka kwehupfumi hwemberi kunogadzirisa kushomeka kweiyo intervertebral canal, nerve midzi canal, uye spinal canal. (KIRKALDY-WILLIS, WH et al.)

Shanduko idzi dzese dzinotungamira pakurwadziwa kwakadzika kumashure, uko kunoderera nekuomarara. Zvimwe zviratidzo sekufamba kwakaderedzwa, mhasuru nyoro, kuomarara, uye scoliosis inogona kuitika. Iwo masero anorevheterana uye macrophages anobatanidzwa muchiitiko ichi nekuburitsa kukura kwezvinhu uye nekuwedzera maserox matrix, ayo anoita sevarevereri. Kuburitswa kwema cytokines kwakawanikwa kuve kwakabatana neese nhanho uye kunogona kunge kuchirapa.

Etiology yeiyo Njodzi Factors yeDhigenerative Disc Chirwere

Kuchembera uye Kufa

Izvo zvakaoma kusiyanisa kuchembera kubva pakuchinja kwechiitiko. Pearce et al vakurudzira kuti kukwegura uye kuora kunomiririra matanho anoteedzana mukati meimwe maitiro anoitika muvanhu vese asi pamatanho akasiyana. Kuora kwe Disc, zvisinei, kunoitika kazhinji kazhinji nekukurumidza kupfuura kukwegura. Naizvozvo, inosangana kunyange mune varwere vezera rekushanda.

Iko kunoratidzika kune hukama pakati pekukwegura uye kuora, asi hapana chikonzero chakasiyana chakamiswa. Zvidzidzo zvakawanda zvakaitiswa maererano nezveutano, kufa kwemaseru, uye kuunganidzwa kwezvinhu zvakasvibiswa zvematrix uye kutadza kwenhengo. Izvo zvemukati yemvura yeiyo intervertebral disc inoderera nezera rekuwedzera. Nucleus pulposus inogona kuwana fissures iyo inogona kupfuurira mukati meanulus fibrosus. Kutanga kweichi chiitiko chinonzi chondrosis inter vertebralis, chinogona kuratidza kutanga kwekuparadza kwakadzika kweiyo intervertebral disc, endplates, uye vertebral miviri. Maitiro aya anokonzera shanduko yakaoma mukuumbwa kwemoleti ye disc uye ine biomeological uye yekiriniki sequelae iyo inogona kupedzisira yakonzeresa kusagadzikana kwakanyanya mumunhu akanganisa.

Iko kusunganidzwa kwesero mukudzima kunodzikira nezera rinowedzera. Izvi zvinonyanya nekuti masero ari mu disc akaiswa pasi peesescence uye vanorasikirwa nekwanisi yekuwedzera. Zvimwe zvinokonzeresa zvekukonzeresa kwezera -kushomeka kweiyo intervertebral discs inosanganisira kurasikirwa kwesero, kuderedzwa kwehutano, kushandurwa kwepashure-kushandurwa kwematrix mapuroteni, kuunganidzwa kwezvigadzirwa zvemamorekuru akashatiswa, uye kuneta kutadza kwematrix. Kuderedza chikafu kune iyo yepakati disc, iyo inobvumidza kuunganidzwa kwemasero marara zvigadzirwa uye zvakashatiswa matrix mamorekuru zvinoita senge inonyanya kukosha shanduko pane ese shanduko idzi. Izvi zvinokanganisa kudya kunovaka muviri uye zvinokonzeresa kuwira kwepH level, izvo zvinogona kuwedzera kukanganisa mashandiro esero uye zvinogona kutungamira kune kufa kwesero Yakawedzera catabolism uye yakadzora anabolism yemaseru enescent anogona kukurudzira kuora. (Buckwalter, Joseph A.) Maererano neimwe ongororo, paive nemaseru enecescence akawanda mukati meiyo nucleus pulposus achienzaniswa ne annulus fibrosus uye madhisiki eherniated aive nemukana wakakura wesero senescence. (Roberts, S. et al.)

Kana kukwegura kuenderera mberi kwenguva yakati, kuiswa kwe chondroitin 4 sulfate uye chondroitin 5 sulfate, iyo ine simba hydrophilic, inoderera apo keratin sulfate kune chondroitin sulfate ratio inowedzera. Keratan sulfate ine zvinyoro nyoro hydrophilic uye zvakare ine maitiro madiki ekuumba yakagadzikana yakaunganidzwa ne hyaluronic acid. Sezvo aggrecan yakapatsanurwa, uye huremu hwayo uye huwandu hunoderedzwa, iyo viscosity uye hydrophilicity yeiyo nucleus pulposus inoderera. Shanduko yekuchinja kune inoenderana pakati peiyo discs inokurumidza nekuderedzwa kwe hydrostatic kumanikidza kweiyo nucleus pulposus uye nekuderera kwekugoverwa kwezvakawanda nekufungidzirwa. Kana mvura yemukati yeiyo extracellular matrix yakadzikira, intervertebral disc kukwirira kuchaderedzwa. Iyo yekudzivisa kwe disc kune axial mutoro zvakare ichaderedzwa. Nekuti axial mutoro unobva waendeswa zvakananga kune annulus fibrosus, mafuturu eanulus anogona kubvaruka nyore.

Iyi nzira dzose dzinotungamira kune shanduko yezvimiro inoonekwa mu degenerative disc chirwere. Nekuda kweiyo mvura yakadzikira inowanikwa mune annulus fibrosus uye inosanganisirwa kurasikirwa kwekutevera, axial mutoro unokwanisa kuiswa zvakare kune chikamu chekumashure kwechimiro pachinzvimbo cheyakajairika anterior nepakati chikamu chezviso. Izvi zvinogona kukonzera facet arthritis, hypertrophy yeanogara ari vertebral miviri, uye bony spurs kana bony overgrowths, inozivikanwa se osteophytes, semhedzisiro yekusagadzikana discs. (Choi, Yong-Soo)

Genetics uye Kuumbwa

Icho chinonzi genetic chikamu chakawanikwa sechinhu chinonyanya kukonzera chirwere chinopera simba. Twin zvidzidzo, uye zvidzidzo zvinosanganisira mbeva, zvakaratidza kuti majini anoita basa mukudzikira kwe disc. (Boyd, Lawrence M., et al.) Majini kodhi iyi ye collagen I, IX, uye XI, interleukin 1, aggrecan, vhitamini D receptor, matrix metalloproteinase 3 (MMP-3), uye mamwe mapuroteni ari mamwe emajeni ari yakakurudzirwa kuti ibatanidzwe mune degenerative disc chirwere. Polymorphisms mu5 A uye 6 A alleles inoitika munzvimbo yekusimudzira yemageneti inodzora kugadzirwa kweMMP 3 inoonekwa iri chinhu chikuru chekuwedzera kwe lumbar disc degeneration muvanhu vakura. Kukurukurirana pakati peaya majini akasiyana siyana kunobatsira zvakanyanya kune intervertebral disc degeneration chirwere chakazara.

Nutrition uye Kuumbwa

Kuora kwe disc kunofungidzirwazve kuitika nekuda kwekutadza kwehutano hwekupa kune intervertebral disc masero. Kunze kwechiitiko chekare chekuchembera, kushomeka kwehutano hwemasokisi e disc kunokanganiswa zvakanyanya nekuguma kwekupera, kuputa, uye huwandu hwehutano. Kushaikwa kwemutano kunogona kutungamira mukuumbwa kwe lactic acid pamwe chete neinobatana wakaderera oxygen. Iyo yakakonzera yakaderera pH inogona kukanganisa kugona kwe disc masero kugadzira uye kuchengetedza iyo extracellular matrix ye discs uye inokonzeresa intervertebral disc degeneration. Iwo akaora ma disc anoshaya kugona kupindura zvakajairika kune vekunze simba uye zvinogona kutungamira mukuvhiringidzwa kunyangwe kubva kudiki kushoma kunetseka. (Taher, Fadi, et al.)

Kukura zvinhu zvinomutsa chondrocyte uye fibroblasts kuti iwedzere huwandu hwe extracellular matrix. Iyo zvakare inhibits iyo synthesis yematrix metalloproteinases. Semuenzaniso yezvinhu izvi zvekukura zvinosanganisira shanduko yekukura, insulin-senge yekukura chinhu, uye yekutanga fibroblast kukura chinhu. Iyo matrix yakasvibiswa inogadziriswa nehuwandu hwakawedzera hwekushandura kukura chinhu uye yakakosha fibroblast kukura chinhu.

Nzvimbo uye Kugadzika

Kunyangwe hazvo ma disc ese ari ezera rimwe chete, ma disc akawanikwa muzvikamu zvezasi zve lumbar ari panjodzi yekuchinja kunochinja pane ma disc akawanikwa muchikamu chepamusoro. Izvi zvinoratidza kuti kwete kuchembera chete, asi zvakare kurodha muchina, chinhu chinokonzeresa. Kushamwaridzana pakati pe degenerative disc chirwere uye zvinhu zvakatipoteredza zvakatsanangurwa nenzira yakazara naWilliam naSambrook muna 2011. (Williams, FMK, uye PN Sambrook) Kuremerwa kwepanyama kunosanganisirwa nebasa rako chinhu chengozi icho chine mupiro kudisiki chirwere chinodzora. Iko kune zvakare mukana wemakemikari anokonzeresa kushomeka kwedisiki, senge kuputa, zvinoenderana nezvimwe zvidzidzo. (Batti , Michele C.) Nicotine yakaverengerwa mumapatya kudzidza kukonzera kutadza kweropa kuyerera kune iyo intervertebral disc, zvichitungamira mukushomeka kwe disc. (BATTI , MICHELE C., et al.) Zvakare, mubatanidzwa wakawanikwa pakati pezvironda zveatherosclerotic muaorta uye nekurwadziwa kwepashure kunongedzera chinongedzo pakati peatherosclerosis uye degenerative disc chirwere. (Kauppila, LI) Iyo disc degeneration kuomarara yaisanganisira mukurema, kufutisa, metabolic syndrome, uye kuwedzerwa kwemuviri mashoma index mune zvimwe zvidzidzo. ( Chidzidzo cheVanhu-Yakavakirwa YeVana Vechidiki Disc Degeneration Uye Yayo Mubatanidzwa NeKunyanyisa Kufutisa Uye Kufutisa, Kudzokera Kumarwadzo, Uye Kuderera Kwekushanda Mamiriro. Am 2011; 93 (7): 662-70 )

Kurwadziwa muDisc Degeneration (Discogenic Pain)

Discogenic pain, iri rudzi rwekurwadziwa kwekusaziva, inomuka kubva kune ma nociceptors mu annulus fibrosus apo hunyanzvi hwehurongwa hunokanganiswa nechirwere chemagengenative disc. Annulus fibrosus ine immune reactive nerve fibers muchikamu chekunze cheiyo disc nemamwe makemikari senge vasoactive intestinal polypeptide, calcitonin peptide inoenderana negene, uye chinhu P. (KONTTINEN, YRJ T., et al.) Kana degenerative shanduko iyo intervertebral discs inoitika, yakajairika dhizaini uye mechina mutoro inoshandurwa ichitungamira kune zvisina kujairika kufamba. Aya ma disc nociceptors anogona kukwidziridzwa zvisina kujairika kune zvemagetsi zvinokurudzira. Iwo marwadzo anogona zvakare kutsamwiswa neyepasi pH nharaunda inokonzereswa nekuvapo kweiyo lactic acid, zvichikonzera kuwedzera kugadzirwa kwevanorwadziwa vapikisi.

Kurwadziwa kubva kuhuremu hwechirwere che disc chirwere chinogona kubuda kubva kwakawanda mavambo. Izvo zvinogona kuitika nekuda kwekukuvara kwechimiro, kudzvanywa, uye kutsamwiswa pamitsipa iri mumuzongoza. Iyo diski pachayo inongova nechero tutsitsi tushoma, asi chero kukuvara kunogona kubata idzi nzwa, kana dziya dziri mumashure makarefu ligament, kurwadzisa. Kufamba kwema Micro mu vertebrae kunogona kuitika, izvo zvinogona kukonzera zvinorwadza Reflex mhasas spasms nekuti iyo disc inokanganiswa uye inopera pasi nekurasikirwa kwekunetseka uye kukwirira. Iko kufamba kunorwadza kunomuka nekuti iyo nerves inopa iyo nzvimbo inomanikidzwa kana kutsamwiswa neiyo facet joints uye ligaments mune foramen inotungamira kumakumbo uye kumashure kurwadziwa. Kurwadziwa uku kunogona kuwedzera nekuburitswa kwemapuroteni anozvimba anoita pane mutsinga mu foramen kana kutsika nerves mumutsipa wepelinha.

Pathological fungidziro yeiyo degenerative discs, kana ichicherechedzwa pasi peiyo microscope, inoburitsa kuti kune vascularized granulation tishu uye yakadzama inowanikwa mukati me fissure yeyekunze yeyero ye annulus fibrosus inosvika mukati meiyo nucleus pulposus. Iyo granulation tishu nharaunda inopunzirwa neakawanda mamina masero uye ivo vanogara vachipa maitiro ezve pathological anozopedzisira atungamira kune discogenic kurwadziwa. Izvi zvinosanganisira neovascularisation, intervertebral disc degeneration, disc tembiricha kuzvimba, uye kugadzirwa kwe fibrosis. Mast cell anoburitsawo zvinhu, senge tumor necrosis factor uye ma interleukins, izvo zvinogona kuratidza kuanzwikwa kwemimwe nzira idzo dzinoita basa mukukonzera kurwadziwa kumashure. Zvimwe zvinhu zvinogona kukonzeresa nzira idzi zvinosanganisira phospholipase A2, iyo inogadzirwa kubva kuArachidonic acid Cascade. Inowanikwa mukuwedzera kwakadzika mune chetatu chekunze kwegore retuerative disc uye inofungidzirwa kukurudzira nociceptors iripo kuti isunungure zvinhu zvinoputika kuti zvikonzere kurwadziwa. Izvi zvinhu zvinounza axonal kukuvara, intraneural edema, uye demyelination. (Brisby, Helena)

Iko kurwadziwa kwemusana kunofungidzirwa kuti kunobva kune iyo intervertebral disc pachayo. Saka nei marwadzo achiderera zvishoma nezvishoma nekufamba kwenguva kana degenerating disc inomira ichikonzera kurwadziwa. Nekudaro, marwadzo acho anomuka kubva kudiski pachezvayo chete mu11% yevarwere zvinoenderana nedzidzo dzendoscopy. Chikonzero chaicho chemarwadzo ekumashure chinoratidzika kunge chiri nekuda kwekusimudzira kwemuganhu wepakati wenzara uye kurwadziwa kunotaurwa pamwe chete neruoko kana gumbo zvinoita kunge kunomuka nekuda kwekusimudzira kweiyo musimboti wetsinga. Mushonga we disc disceneration unofanirwa kunyanya kutarisa pakurwadziwa kwekudzora kutambura kwemurwere nekuti ndicho chiratidzo chinoremadza chinokanganisa hupenyu hwemurwere. Naizvozvo, zvakakosha kumisikidza marongero ehurombo nekuti hazviitike chete nekuda kweshanduko yemuma discs e intervertebral asiwo nekuda kwezvimwe zvinhu zvakaita sekuburitswa kwemakemikari uye kunzwisisa nzira idzi kunogona kutungamira mukuzorora kunorwadza. (Choi, Yong-Soo)

Clinical Mharidzo yeDegenerative Disc Chirwere

Varwere vane degenerative disc chirwere vanosangana nemakumi ezviratidzo zvechiratidzo zvichienderana nenzvimbo yechirwere. Vaya vane lumbar disc kuora vanowana yakaderera kumashure kurwadziwa, radicular zviratidzo, uye kushaya simba. Avo vane cervical disc degeneration vane kurwadziwa kwemutsipa uye kurwadziwa kwepafudzi.

Kutambudzika kwekudzokera shure kunogona kuwedzera nekufamba uye chinzvimbo. Kazhinji, zviratidzo zvinowedzerwa nekufamba, nepo kuwedzera kwacho kuchiwanzo kuvasunungura. Kukuvara kwakamonyoroka kudiki, kunyangwe kubva mukuzungunusa gorofu, kunogona kukonzera zviratidzo. Iko kurwadziwa kunowanzoonekwa kuve kushoma kana uchifamba kana kumhanya, kana uchichinja chinzvimbo kazhinji uye kana uchinge warara. Zvisinei, kurwadziwa kunowanzozviisa pasi uye kazhinji kacho, zvinosiyana zvakanyanya kubva kumunhu kuenda kumunhu uye vanhu vazhinji vanozotambura kubva padanho repasi rekurwadziwa kusingaperi kwenzvimbo yekumashure kumashure zvichiramba zvichitambura nekugomera, hudyu, uye gumbo kurwadziwa. Iko kusimba kwekurwadziwa kuchawedzera nguva nenguva uye kunogara kwemazuva mashoma uye wozodzikira zvishoma nezvishoma. Iyi laflare-up inoitika episode uye inoda kurapwa neanotyisa analgesics. Kurwadziwa kwakanyanya kunoitika munzvimbo yakagara uye kunowedzerwa nekukotama, kusimudza, uye kumonyanisa kufamba kazhinji. Kukura kwekutambudzika kunogona kusiyanisa zvakanyanya nevamwe vaine kurwadziwa kwekushungurudza kune vamwe vane kurwadziwa kwakanyanya uye kunoremadza nguva nenguva. (Jason M. Highsmith, MD)

Iko kurwadziwa kwepamhepo uye nyoro mu axial spine inowanzo simuka kubva kune nociceptors inowanikwa mukati meiyo intervertebral discs, facet joints, sacroiliac joints, dura mater yemidzi nerve, uye zvimiro zve myofascial zvinowanikwa mukati me axial spine. Sezvakataurwa muzvikamu zvakapfuura, kushanduka kwekuita kwekuchinja kwemukati kunogona kukonzera kudzikiswa kwegwinya remuzongoza rinodaidzwa kuti spinal stenosis, kuwanda kwemabatirwo ezviito zvehunyorwa anonzi osteophytes, hypertrophy yeakadzika uye yepamusoro expressionular maitiro, spondylolisthesis, bulging ye ligamentum flavum uye disc herniation . Shanduko idzi dzinoguma nekuunganidzwa kwezviratidzo zvinozivikanwa seyurogenic claudication. Panogona kunge paine zviratidzo zvakadai sekudzoka kumashure kurwadziwa uye gumbo kurwadziwa pamwe chete nehuremu kana kutetepa pamakumbo, kushaya simba kwemhasuru, uye tsoka kudonha. Kushaikwa kwematumbo kana kudzora bumbu kunogona kuratidza kuputika kwembambo uye kukurumidza kurapwa kunodikanwa kudzivirira kusaremara zvachose. Zviratidzo izvi zvinogona kusiana mukuoma uye zvinogona kuvepo mukusiyana kwakawedzera muvanhu vakasiyana.

Marwadzo acho anokwanisa kupenyerera kune dzimwe nhengo dzemuviri nekuda kwekuti tambo yemuzongoza inopa matavi akati wandei kunzvimbo mbiri dzemuviri. Naizvozvo, kana iyo iyo degenerated disc ichimanikidza pane spinal nerve midzi, kurwadziwa kunogona zvakare kunowanikwa mugumbo kune iyo nerve pakupedzisira inogara mukati. Ichi chiitiko, chinodaidzwa kuti radiculopathy, chinogona kuitika kubva kune zvakawanda zvinowanikwa, nekuda kwechimiro chekushanduka. Iyo bulging disc, kana ichibuda pakati nepakati, inogona kukanganisa kutsika midzi ye cauda equina, kana ikaburitsa posterolaterally, inogona kukanganisa mitsipa yekubuda panguva inotevera yepasi peverrebral canal uye neye spinal nerve mukati meiyo ventral ramus inogona kukanganisika kana disc ichibuda. gare gare. Saizvozvo, osteophytes inoyerera padivi pekumusoro nekudzika kwemashure emuviri yemitezo ye vertebral inogona kukanganisa mutsipa mumwechete wehutachiona ichikonzera zviratidzo zvakafanana. Superior articular process hypertrophy inogona zvakare kukanganisa pamidzi yenzara zvichienderana nekufungidzira kwavo. Iyo nerves inogona kusanganisira nerve midzi isati yabuda kubva inotevera yepasi pevertebral canal uye nerve midzi mukati memusoro nerve midzi canal uye dural sac. Zviratidzo izvi, nekuda kwekukanganisa kwetsinga, zvakave zvaratidzwa ne cadaver zvidzidzo. Neural kukanganisika kunofungidzirwa kuitika apo iyo neuro foraminal diameter yakaiswa zvinotsoropodzwa pamwe ne 70% kuderedzwa. Uyezve, neural kukanganisa kunogona kugadzirwa kana iyo posterior disc ichimanikidzwa isingasviki mamirimita pakukwirira, kana iyo foraminal urefu ichideredzwa kusvika pasi pegumi nemamirimita anotungamira kune foraminal stenosis uye nerve impingement. (Taher, Fadi, et al.)

Kuongorora Nzira

Varwere vanotanga vanoongororwa vane nhoroondo yechokwadi uye kunyatsoongorora muviri uye kuongororwa kwakakodzera uye kwakamutsa. Nekudaro, nhoroondo inowanzo kusanzwisisika nekuda kwekurwara kusingaperi uko kusinga tsanangurikwe zvakanaka uye kunetseka pakusarudza chaiyo nzvimbo yematomiki panguva yekutsamwisa kuyedzwa nekuda kwesimba rezvakavakirwa anatomical zvivakwa.

Kuburikidza nenhoroondo yemurwere, chinokonzera kurwadziwa kwakadzika kumashure kunogona kuzivikanwa sekumuka kubva kune ma nociceptors mune intervertebral discs. Varwere vanogona zvakare kupa nhoroondo yeiyo isingagumi hunhu hwezviratidzo uye inosanganisirwa gluteal dunhu chiveve, kurira pamwe nekuomarara mumuzongoza izvo zvinowanzo nyanyisa nebasa. Unyoro hunogona kukosheswa nekupuruzira pamusoro pemusana. Nekuda kwechimiro chechirwere ichi chisingaperi uye chinorwadza, varwere vazhinji vanogona kunge vari kutambura nemanzwiro uye kusagadzikana kwekushushikana. Kushungurudzika kunofungidzirwa kuti kuri kupa zvakashata kune iro chirwere chirwere. Nekudaro, hapana hukama hwakajeka pakati pechirwere chakasimba uye nemanzwiro kana kusagadzikana kwekushushikana. Izvo zvakanaka kuve wakangwarira nezve aya mamiriro ehutano hwepfungwa futi. Kuti ubvise mamwe maronda akakomba, mibvunzo inofanirwa kubvunzwa maererano nekuneta, kushaya huremu, kupisa muviri, uye kutonhora, izvo zvinogona kuratidza zvimwe zvirwere. (Jason M. Highsmith, MD)

Imwezve etiology yekurwadziwa kwepashure kwemusana inofanirwa kubviswa kana uchinge waongorora murwere nekuda kwehuremu rechirwere che disc. Abdominal pathologies, iyo inogona kupa marwadzo ekumashure senge aortic aneurysm, renal calculi, uye chirwere chepancreatic, inofanira kusiirwa kunze.

Degenerative disc chirwere ine akatiwandei kusiyanisa kuongororwa kunofungidzirwa kana murwere achiratidza nemarwadzo ekumusana. Izvi zvinosanganisira; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, uye lumbar radiculopathy. (EDegenerative Disc Denda Physiopedia )

kuferefeta

Kuongorora kunoshandiswa kusimbisa kuongororwa kwechirwere chedhigenerative disc. Izvi zvinogona kukamurwa kuva marabhoritari zvidzidzo, kufungidzira zvidzidzo, nerve conduction bvunzo, uye maitiro ekuongorora.

Imaging Studies

Iyo yekufungidzira mune inodzikama disc chirwere inonyanya kushandiswa kutsanangura anatomical hukama uye morphological maficha eakakanganiswa discs, iyo ine yakakosha yekurapa kukosha mune ramangwana kuita sarudzo kwekurapa sarudzo. Chero nzira yekufungidzira, senge yakajeka radiography, CT, kana MRI, inogona kupa ruzivo rwakakosha. Zvisinei, chinokonzera chikonzero chinogona kuwanikwa chete mu15% yevarwere sezvo pasina yakajeka radiological shanduko inoonekwa mune degenerative disc chirwere mukushaikwa kwe disc herniation uye kushomeka kweitsinga. Uyezve, hapana kuwirirana pakati peatomical shanduko dzinoonekwa pakufungidzira uye kuomarara kwezviratidzo, kunyangwe paine kuwirirana pakati penhamba yemaosteophytes uye kuomarara kwekurwadziwa kumashure. Degenerative shanduko mune radiography inogona zvakare kuonekwa mune asymptomatic vanhu zvinotungamira mukuomerwa mukuenderana nekiriniki kukosha uye nguva yekutanga kurapwa. (EDegenerative Disc Denda Physiopedia )

Padi Radiography

Iyi isingadhuri uye inowanikwa zvakanyanya pachena cervical radiography inogona kupa ruzivo rwakakosha pamusoro pekuremara, kubatana, uye kushanduka kwekuita bony. Kuti uone kuvepo kwekugadzikana kwemuzongoza uye sagittal chiyero, kusimba kwesimba, kana zvidzidzo zvekuwedzera zvinofanirwa kuitwa.

Magnetic Resonance kuri (MRI)

MRI ndiyo nzira inowanzo shandiswa yekuongorora shanduko inoshanduka muiyo intervertebral disc nenzira kwayo, yakavimbika, uye yakanyatsonzwisisika. Inoshandiswa mukutanga kuongororwa kwevarwere vane marwadzo emutsipa mushure mekujeka radiography. Inogona kupa isina-invasive mifananidzo mumapani akawanda uye inopa yakanakisa mhando mifananidzo yedhisiki. MRI inogona kuratidza disc hydration uye morphology-yakavakirwa pane iyo proton density, kemikari nharaunda, uye zvemukati zvemvura. Clinical pikicha uye nhoroondo yemurwere inofanirwa kutariswa kana uchidudzira zvirevo zveMRI sezvakaratidzwa kuti ingangoita makumi maviri neshanu ezviuru zvevarapi venhau vanoshandura mushumo kana dhata rekiriniki riripo. Fonar akaburitsa yekutanga yakavhurika MRI scanner nekwaniso yemurwere kuti ionekwe munzvimbo dzakasiyana sekumira, kugara, uye kukotama. Nekuda kweizvi zvakasarudzika maficha, ino yakavhurika MRI scanner inogona kushandiswa pakuvheneka varwere mune huremu-huremu hunomira uye kusimuka mamiriro kuti aone iko kuri kuita kwehutachiona shanduko iyo inowanzo kufuratirwa mune yakajairwa MRI scan yakadai se lumbar degenerative disc chirwere ne herniation. Muchina uyu zvakare wakanakira varwere ve claustrophobic, sezvavanosvika pakuona huru terevhizheni panguva yekuwongorora. ( Degenerative Disk Chirwere: kumashure, Anatomy, Pathophysiology.ology)

Nucleus pulposus uye annulus fibrosus ye disc inogona kuwanzo kuongororwa paMRI, zvichitungamira pakuonekwa kwe disc herniation sezvakange zviripo uye zvisipo. Sezvo MRI inokwanisawo kuratidzira misodzi yeakaipisisa uye iyo yekumusoro yenguva refuitudinal ligament, inogona kushandiswa kuenzanisa herniation. Izvi zvinogona kuve nyore annular bulging kusunungura chidimbu disc herniations. Ruzivo urwu runogona kurondedzera iyo pathologic discs dzakadai se extruded disc, protruded discs, uye dzakatamiswa disc.

Kune akati wandei grading masisitimu akavakirwa paMRI chiratidzo kukadzika, disc urefu, musiyano uri pakati peiyo nucleus uye annulus, uye iyo disc dhizaini. Iyo nzira, nePfirrmann et al, yakave yakashandiswa zvakanyanya uye inogamuchirwa nekiriniki. Maererano neyakagadziridzwa system, pane mamakisi masere ezvirwere zve lumbar disc degenerative chirwere. Giredhi 8 inomiririra yakajairika intervertebral disc uye giredhi 1 inoenderana nedanho rekupedzisira rekushomeka, zvichiratidza kufambira mberi kwechirwere che disc. Pane mifananidzo inoenderana kubatsira kubatsira kuongororwa. Sezvo ivo vachipa musana wakanaka kusiyanisa uye zvakakwana tsananguro ye disc dhizaini, sagittal T8 huremu mifananidzo inoshandisirwa basa rezvikamu. (Pfirrmann, Christian WA, et al.)

Modic akarondedzera shanduko dzinoitika mu vertebral miviri iri padivi neakasvibisa ma discs se Type 1 ne Type Type 2 shanduko. MuModic 1 shanduko, iko kuderera kweiyo T1 uremu mifananidzo uye kuwedzera yakawedzera T2 yakayerwa mifananidzo. Izvi zvinofungidzirwa kuitika nekuti mahwendefa ekupedzisira afamba sclerosis uye iri padyo pemapfupa ari kuratidza kupererwa kupindirana nekuwedzera kwekuita. Kuwedzera uku kwekunyepedzera kubatana uye iko kwekupedzisira kuramba kupesana kunounzwa nemakemikari zvinhu anoburitswa kuburikidza ne autoimmune mechanism. Modic mhando 2 shanduko dzinosanganisira kuparadzwa kwemwongo wemapfupa wepedyo vertebral endplates nekuda kwemhinduro yekuputika uye kupinda mukati memafuta mumongo. Idzi shanduko dzinogona kutungamira kuwedzera density density paT1 uremu mifananidzo. (Modic, MT et al.)

Yakagadziriswa Tomography (CT)

Kana MRI isingawanikwe, yeComputer tomography inoonekwa seyedzo yekuongorora inogona kuona disc herniation nekuti ine musiyano uri nani pakati peanotevera margins eanopindirana bony vertebrae, mafuta eparine, uye herniated disc zvinhu. Kunyangwe zvakadaro, kana uchitsvaga lateral herniations, MRI inoramba iri yekufungidzira modality yesarudzo.

CT scan ine zvakati wandei zvakanakira pamusoro peMRI seyakadaro ine zvishoma claustrophobic nharaunda, mutengo wakaderera, uye zvirinani kuona bonny shanduko idzo dzisinganzwisisike uye dzinogona kupotsa pane mamwe modalities. CT inogona kuona kusanduka kwekuchinja kwezvekudyarwa kwemajoini uye spondylosis nekunyatso kurongeka. Kuvimbika kweBony mushure mekusanganisa zvakare kwakanyanya kuongororwa neCB.

Disc herniation uye yakabatana nerve impingement inogona kuongororwa nekushandisa maitiro akagadziridzwa naGundry naHithoff. Izvo zvakakosha kuti disc protrusion inhema zvakananga pamusoro pemidzi yemitsipa inofamba nenzira ye disc uye kuve yakataridzika uye asymmetrical ine dorsolateral chinzvimbo. Panofanira kuve neanoratidzira nerve midzi kumanikidza kana kutamiswa. Chekupedzisira, iyo nerve distal kune kusakanganiswa (saiti ye herniation) inowanzokura uye mabheji ine anokonzeresa edema, mukurumbira wemapoka epascinic epineins, uye kuputika kwepashure kunoguma kwaita kukuvara kwemugumo.

Lumbar Discography

Maitiro aya ane gakava uye, kunyangwe kuziva nzvimbo yemarwadzo kune chero kukosha maererano nekuvhiyiwa kana kwete, haina kuratidzwa. Manyepo positives anogona kuitika nekuda kwepakati hyperalgesia mune varwere vane kurwadziwa kusingaperi (neurophysiologic kutsvaga) uye nekuda kwepfungwa psychosocial. Izvo zvine mubvunzo kumisikidza chaizvo kana discogenic kurwadziwa ikava yakakosha kliniki. Avo vanotsigira kuongororwa uku vanotsigira nzira dzakasimba dzekusarudzwa kwevarwere uye kana vachidudzira mhedzisiro uye vanotenda iyi ndiyo yega muedzo unogona kuona kurwadziwa kwe discogenic. Lumbar discography inogona kushandiswa mumamiriro akati wandei, kunyangwe isina kusimbiswa musainzi. Izvi zvinosanganisira; kuongororwa kweiyo inoteedzera herniation, kuongorora chiratidzo chechisimba pakati pekunetseka kwakawanda, kuongorora humwe humwe hutachiona hunoonekwa paCT kana MRI, kuongororwa kwemuzongoza mushure mekuvhiyiwa, kusarudzwa kweiyo fusion level, uye zvinoratidzira maitiro e discogenic kurwadziwa kuripo.

Iyo discography inonyanya kunetseka nekutsigira pathophysiology pane kusarudza iyo anatomy ye disc. Naizvozvo, discogenic kurwadziwa kuongororwa ndicho chinangwa che discography. MRI inogona kuratidza disc isingatarisiki isina kana kurwadziwa, nepo kurwadziwa kwakanyanya kuchionekwa pane discography uko kuwanikwa kweMRI kuri mashoma. Munguva yekukuvara kweanowanzoita munyu kana chimwe chakapesana, mugumo unoguma unogona kuitika nokusanzwisisika kugamuchira misiyano yakawanda. Iyo misiyano yezvakasiyana inogona kutambanukira mukati meiyo nucleus pulposus kuburikidza nemisodzi uye fissures mune annulus fibrosus mune zvisina kujairika discs. Iko kudzvanywa kwechinhu ichi chakasiyana kunogona kutsamwisa kurwadziwa nekuda kwemukati nekupamhidzira meningeal nerve, musana wakasangana musana, anterior yepakati rami, uye grey rami commicantes inopa iyo yekunze annulus fibrosus. Radicular pain inogona kutsamwiswa kana zvinhu zvakasarudzika zvasvika kunzvimbo yekunetseka neruzi midzi nekusvibiswa disc. Nekudaro, iyi bvunzo ye discography ine zvinoverengeka matambudziko akadai nerve midzi kukuvara, makemikari kana bhakitiriya disititis, musiyano allergy, uye kuwedzera kwokurwadziwa. (Bartynski, Walter S., uye A. Orlando Ortiz)

Kutevedzera Modality Kusanganisa

Kuti uedze iyo nerve midzi kudzvinyirira uye cervical stenosis zvakakwana, musanganiswa we nzira dzekufungidzira ungangodiwa.

CT Discography

Mushure mekuita discography yekutanga, CT discography inoitwa mukati memaawa mana. Inogona kushandiswa mukutarisa chimiro cheiyo disc senge herniated, protruded, extruded, inowanikwa kana yakagadziridzwa. Inogona zvakare kushandiswa mumuzongoza kusiyanisa masikuru emhedzisiro yemarara kana disc zvinhu mushure mekuvhiyiwa kwemuzongoza.

CT Myelography

Iyi bvunzo inoonekwa senzira yakanakisa yekuongorora nerve midzi kudzvinyirira. Kana CT yaitwa musanganiswa kana mushure meelography, nhoroondo nezve bony anatomy ndege dzakasiyana dzinogona kuwanikwa nyore.

Maitiro Ekuongorora

Transforaminal Selection Nerve Root Blocks (SNRBs)

Kana multilevel degenerative disc chirwere ichifungidzirwa pane MRI scan, iyi bvunzo inogona kushandiswa kuona iyo chaiyo nerve midzi yakakanganisika. SNRB zvese zviri zviviri kuongororwa uye kurapwa kwechiedza kunogona kushandiswa lumbar spinal stenosis. Muedzo unogadzira nzvimbo yedhivhomiti yenzvimbo ye hypoesthesia nekubaya anesthetic uye yakasiyaniswa zvinhu pasi pefuruor fluopic kutungamirirwa kune inofarira nerve midzi. Iko kune kuwirirana pakati pe multilevel cervical degenerative disc chirwere makiriniki zviratidzo uye zvavakawana paMRI uye zvakawanikwa zveSNRB maererano naAnderberg et al. Iko kune 28% kuwiriraniswa pamwe neSNRB mhedzisiro uye nemadermatomal radicular pain uye nzvimbo dzekushomeka kwemutsipa. Mhosva dzakakomba dzekushomeka paMRI inowanikwa yakawiriraniswa ne60%. Kunyangwe isiri kushandiswa nguva zhinji, SNRB ndeye muedzo unobatsira pakuongorora varwere vasati vavhiya mune multilevel degenerative disc chirwere kunyanya kumuzongoza pamwe chete nezvakiriniki zvinhu uye zvavakawana paMRI. (Narouze, Samer, uye Amaresh Vydyanathan)

Electro Myographic Zvidzidzo

Mota yakasarudzika uye yekunzwa tsinga conduction bvunzo, inonzi electromyographic zvidzidzo, izvo zvakajairika neisina kujairika tsono bvunzo inogona kuburitsa tsinga yekumanikidza zviratidzo izvo zvinokosheswa mukiriniki nhoroondo. Mitsipa inotsamwiswa midzi inogona kuiswa munzvimbo nekushandisa majekiseni kuti utindise maronda akakuvara kana ekugashira marwadzo munzvimbo yedhisiki, mubatanidzwa wesacroiliac, kana majoini echikamu ne discography. ( Journal Of Electromyography & Kinesiology Karenda )

Laboratory Studies

Laboratory bvunzo kunoitwa kazhinji kusabvisa zvimwe mutsauko diagnostic.

Sezvo seronegative spondyloarthropathies, senge ankylosing spondylitis, zvakajairika zvikonzero zvekurwadziwa kumashure, HLA B27 immuno-histocompatibility inofanira kuedzwa. Inofungidzirwa vanhu mazana matatu ezviuru mazana mana emuUS uye mazana matanhatu ezviuru muEurope vakanganiswa nechirwere ichi chinoputika chekusazivikanwa etiology. Asi HLA B350,000 haina kujairika kuwanikwa muAfrica America. Mamwe seronegative spondyloarthropathies iyo inogona kuedzwa uchishandisa iyi gene inosanganisira psoriatic arthritis, chirwere chechipfuva chechipfuva, uye regency arthritis kana Reiter syndrome. Serum immunoglobulin A (IgA) inogona kuwedzerwa mune vamwe varwere.

Miedzo yakaita se erythrocyte sedimentation rate (ESR) uye C- reactive protein (CRP) muyedzo wekuyedza weakachemiti chikamu chinogadziriswa chinoonekwa muzvikonzero zvinokonzeresa kurwadziwa kwepashure senge osteoarthritis uye kusarongeka. Kuverengeka kwakazara kweropa kunodikanwa zvakare, kusanganisira masiyano akasarudzika kuti uwane chokwadi etiology. Zvirwere zve Autoimmune zvinofungidzirwa apo Rheumatoid factor (RF) uye anti-nyukiliya antibody (ANA) bvunzo dzinova dzakanaka. Serum uric acid uye kuongororwa kwerudzi rwemakristasi kune makristasi kunogona kudikanwa mune zvisingawanzoitika kusabvisa gout uye pyrophosphate dihydrate deposition.

mabatiro

Iko hakuna nzira chaiyo yekurapa yakabvumwa nanachiremba vese nezvekurapa kwechirwere che disc disc nekuti chikonzero chekurwadziwa chinogona kusiyana mune vamwe vanhu uye nekunetseka kwemarwadzo uye kusiyana kwakasiyana mukuratidzwa kwechiremba. Nzira dzekurapa dzinogona kukurukurwa zvakadzama pasi; kurapwa kwekuchengetedza, kurapwa kurapwa, uye kurapwa kwekuvhiya.

Kurapa kwekuchengetedza

Iyi nzira yekurapa inosanganisira kurapa kwekurovedza muviri pamwe nekupindira kwekuita, maitiro emuviri, jekiseni, dzidzo yekumashure, uye nzira dzechikoro dzekuseri.

Exercise-Yakavakirwa Therapy neKukanganiswa Kwekupindira

Zvichienderana nekuongororwa kwemurwere, mhando dzakasiyana dzekudzidzira dzinogona kuve dzakarairwa. Iyo inoonekwa seimwe yenzira huru dzekuchengetedza manejimendi kubata kusingaperi kurwadza kumashure. Maekisesaizi acho anogona kuchinjirwa kuti abatanidze kurovedza muviri, kurovedzera muviri, uye kurovedzera muviri. Imwe yematambudziko makuru ekurapa uku inosanganisira kutadza kwayo kuongorora kushanda kwevarwere nekuda kwekusiyana kwakasiyana pakudzidzira muviri, kuwanda uye kusimba. Maererano nezvidzidzo, kunyanya kushanda kwe sub-acute low back pain nekusiyana-siyana kwenguva yezviratidzo kwakawanikwa nekuita graded Exercises mukati meyekugadziriswa kwekugara kwemurwere. Kuvandudza kwakakosha kwakacherechedzwa pakati pevarwere vari kurwara nezviratidzo zvisingaperi pamwe neiyi kurapwa nezve basa rekuvandudza pamwe nekudzora kurwadziwa. Kurapa kwemunhu oga kwakagadzirirwa murwere wega wega achitariswa uye kutevedzera murwere kunoitawo sekunge kwakanyanya kunobatsira pakurwara kwemusana vanorwara. Dzimwe nzira dzekuchengetedza dzinogona kushandiswa mukubatanidza kugadzirisa iyi nzira. (Hayden, Jill A., et al.)

Aerobic Exercises, kana ichiitwa nguva nenguva, inogona kuvandudza kutsungirira. Kwekuderedza kushushikana kwemhasuru, nzira dzekuzorora dzinogona kushandiswa. Kushambira kunoonekwawo semuedzo wekurwadziwa kumashure. Kudzikisira pasi kunogona kusanganisira kuwedzera kurovedza muviri, kucheka nyowani, kudzika kumashure, kutwasanudza bvi kusvika kune chinhambwe, zvigaro zvinosimudza, zvigadziriso zvakagadziridzwa, mudumbu kutsemuka, uye gomo uye sag kurovedza.

Maitiro Emuviri

Iyi nzira inosanganisira kushandiswa kwemagetsi nerve kukurudzira, zororo, ice packs, biofeedback, kupisa pads, phonophoresis, uye iontophoresis.

Transcutaneous Electrical Nerve Stimulation (Tens)

Nenzira iyi isinga gadzi, kusimudzira kwemagetsi kunoiswa kuganda kuitira kuti kusimudzira tsinga dzakapora munzvimbo iyi kudzoreredza kurwadziwa kusvika padanho. Iyi nzira inosunungura kurwadziwa nekutevera mashandiro asi kuita kwayo kwenguva refu kuri kusahadzika. Nezvimwe zvidzidzo, zvakawanikwa kuti hapana kukosha kwakanyanya kwekurwadziwa uye chimiro chinoshanda kana uchienzaniswa ne placebo. Midziyo iri kuita aya maTR inogona kuwanikwa nyore nyore kubva kubazi rezvekubuda kunze. Iyo chete mhedzisiro mhedzisiro inoratidzika kunge yakapusa ganda kutsamwiswa inoitika mune yechitatu yevarwere. (Johnson, Mako I)

Kudzoka Chikoro

Iyi nzira yakaunzwa nechinangwa chekudzikisa zviratidzo zvekurwadziwa uye kudzokorora kwavo. Yakatanga kuunzwa muSweden uye inofunga nezvemaitiro, ergonomics, akakodzera kurovedza muviri, uye iyo anatomy yedunhu lumbar. Varwere vanodzidziswa chimiro chakasarudzika chekugara, kumira, kusimudza huremu, kugona, kushambidza kumeso, uye mazino mazino kudzivirira kurwadziwa. Kana ichienzaniswa nemamwe maitiro ekurapa, kumashure chikoro chekurapa chakaratidza kuve chinoshanda mune zvese nekukurumidza uye kwepakati nguva dzekuvandudza kurwadziwa shure uye chimiro chinoshanda.

Patient Education

Nenzira iyi, mupi anopa murwere maitiro ekugadzirisa kwavo zviratidzo zvekurwadziwa. Zvakajairika spinal anatomy uye biomechanics inosanganisira michina yekukuvara inodzidziswa pakutanga. Tevere, uchishandisa mhando dzemasana, iyo degenerative disc chirwere kuongororwa inotsanangurwa kumurwere. Kumurwere wega, chinzvimbo chakaringana chakatemwa uyezve ndokumbirwa kuchengetedza chinzvimbo icho kuti udzivise kuwana zviratidzo.

Bio-Psychosocial Nzira yekuita kuMultidisciplinary Back Therapy

Kurwadziwa kusingaperi kwemashure kunogona kukonzera kushushikana kwakawanda kumurwere, zvichitungamira mukukanganisa kwepfungwa uye nemweya wakaderera. Izvi zvinogona kukanganisa migumisiro yekurapa ichipa nzira zhinji dzekurapa pasina. Naizvozvo, varwere vanofanirwa kudzidziswa pamatanho ekudzidza ekuziva anonzi kuzvibata uye bio-psychosocial nzira dzekuwana zororo kubva pakurwadziwa. Pamusoro pekurapa zvinokonzeresa zvekurwadziwa, zvepfungwa, uye zvemagariro zvikonzero zvinofanirwa kugadziriswa nenzira iyi. Kuti uderedze maonero evarwere ekurwadziwa uye kuremara, nzira senge dzakachinjwa tarisiro, maitiro ekuzorora, kudzora kweyepanyama mhinduro nehunhu hunodzidziswa, uye kusimbiswa kunoshandiswa.

Massage Therapy

Kune kurwadziwa kusingaperi kwemashure, iyi kurapa inoita senge inobatsira. Kwerinopfuura gore 1 nguva, kurapwa kwemassage kwakawanikwa kuve kwakashanda kune vamwe varwere kana ichienzaniswa neacupuncture uye dzimwe nzira dzekuzorora. Nekudaro, hazvishande pane Tens uye kurapa kwekurovedza muviri kunyangwe vamwe varwere vanogona kuda imwe kupfuura iyo. (Furlan, Andrea D., et al.)

Kugadziriswa kwepamuviri

Uku kurapa kunobatanidza nekushomeka kwemubatanidzwa kupfuura iwo wenguva zhinji mafambiro, asi usinga pfuure neiwo wakajairika anatomical renji. Ichi chiitiko chekurapa chinosanganisira kureba kwenguva refu nekuchenesa velocity. Iyo inofungidzirwa kuvandudza yakaderera kurwadziwa shure kuburikidza nemaitiro akati wandei sekuburitswa kwemaitiro akasungwa, kuparara kweanodzvinyirira uye peri-articular adhesions, uye kuburikidza nekuparadzira zvikamu zvemuzongoza izvo zvakange zvadzingwa. Izvo zvinogonawo kuderedza kuwanda kwe disc, zorodze mhasuru dze hypertonic, kusimudzira iyo noncicpent fibers kuburikidza nekushandura basa rehururopathy uye kudzoreredza menisci pane yakavanzika kumeso.

Spinal manipulation inofungidzirwa kuve yakakwirira mukubudirira kana ichienzaniswa nenzira zhinji dzakadai seTENS, kurapa kwemaitiro, NSAID zvinodhaka, uye chikoro chekurapa chekurapa. Iyo iripo tsvakurudzo iripo yakajeka maererano nekushanda kwayo mune dzakareba uye pfupi. Izvo zvakare zvakachengeteka kwazvo kutungamira pasi-kwakadzidziswa varapi vane zviitiko zve disc herniation uye cauda equina iri kutaurwa chete mune yakaderera kupfuura 1 muvanhu 3.7 miriyoni. (Bronfort, Gert, et al.)

Lumbar Supports

Varwere vari kurwara nemucheto wakaderera kumashure kurwadziwa nekuda kwemanyawi maitiro pamatanho akawanda ane zvikonzero zvakati zvinogona kubatsirwa nerubar. Pane humbowo hunopesana maererano nekubudirira kwayo nezvimwe zvidzidzo zvinoti kuvandudza kwakaringana mukubatsirwa uye kwenguva refu kwenguva refu vamwe vachikurudzira hakuna kugadziriswa kwakadaro kana uchienzaniswa nedzimwe nzira dzekurapa. Tsigiro dzeLumbar dzinogona kudzikamisa, kururamisa urema, kuderedza mashini emagetsi, uye kudzikamisa kufamba kwemuzongoza. Izvo zvinogona zvakare kuita sengebho uye kuderedza kurwadziwa nekugadzirisa nzvimbo dzakakanganisika uye kuisa kupisa.

Lumbar Kudhonza

Iyi nzira inoshandisa harness inosungirirwa kuneacac cosst uye yakadzika mbabvu kaseji uye inoshandisa yehurefu simba muchiuno axial spine kudzoreredza kurasikirwa kwakadzika kumashure kumashure. Chikamu uye urefu hwesimba zvinogadziriswa zvinoenderana nemurwere uye zvinogona kuyerwa nekushandisa zvishandiso zvese uchifamba uye uchirara pasi. Lumbar traction inoita nekuvhura iyo intervertebral disc nzvimbo uye nekuderedza lumbar masterosis. Zviratidzo zvechirwere chedhiresi disc chinoderedzwa kuburikidza nenzira iyi nekuda kwekugadzikana kwemuzongoza kwechinguvana uye zvawakabatsira. Iyo inogadzirisa kushinyira kweropa uye kusagadzikana kwechimakanika, inokanganisa kushambadzira mune chikamu uye annulus, uye zvakare nonciceptive pain signals. Nekudaro, hapana humbowo hwakawanda maererano nekushanda kwayo mukudzora kurwadziwa shure kana kugadzirisa basa remazuva ese. Zvakare, njodzi dzinosanganiswa ne lumbar traction dzichiri pasi pekutsvagurudza uye dzimwe nyaya dzemishumo dziripo apo zvakakonzera kukanganisa kwetsinga, kushomeka, uye kushandurwa kweropa nekuda kwesimba rakakura uye kusarongeka kweiyo harness. (Harte, A et al.)

Kurapa Kwekurapa

Kurapa kwekurapa kunosanganisira kurapa zvinodhaka nevanozorora mhasuru, jekiseni reidididha, NSAIDs, opioids, uye mamwe analgesics. Izvi zvinodikanwa, mukuwedzera pakurapa kwekuchengetedza, muvarwere vazhinji vane degenerative disc chirwere. Pharmacotherapy inoitirwa kudzora kuremara, kuderedza marwadzo uye kuzvimba pachiri kugadzirisa hupenyu hwehupenyu. Ino catered zvinoenderana nemurwere wega sezvo pasina kuwirirana pamusoro pekurapwa.

Muscle Relaxants

Degenerative disc chirwere chinogona kubatsirwa nevasuru vanozorora nekudzora kuputika kwemasuru uye nekudaro vachideredza marwadzo. Iko kushanda kweavo vanozorora mhasuru mukuvandudza marwadzo uye chimiro chinoshanda chakasimbiswa kuburikidza nemhando dzinoverengeka dzekutsvaga. Benzodiazepine ndiyo yakajairika yekuzorodza mhasuru pari zvino mukushandisa.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Iyi mishonga inowanzo shandiswa sedanho rekutanga re disc degenerative chirwere inopa analgesia, pamwe neanopokana nekurwisa simba. Pane ufakazi hwakasimba hwekuti hunodzora kurwadza kwakadzikira kumashure. Nekudaro, kushandiswa kwayo kunogumira nekuvhiringidzika kwegumbo, senge acute gastritis. Sarudzo COX2 inhibitors, senge celecoxib, inogona kukunda dambudziko iri nekungotarisa COX2 receptors. Kushandiswa kwavo hakugamuchirwi zvakanyanya nekuda kwezvinokonzeresa mhedzisiro yekuwedzera chirwere chemoyo nemweya nekushandisa kwenguva refu.

Mishonga yeOpioid

Iri idanho rakakwira kumusoro mumatanho ekurwadziwa eWHO. Iyo yakachengeterwa varwere vane kurwadziwa kwakanyanya kusapindura maNSAID uye avo vane zvisingatsungiririki GI kusagadzikana neNSAID kurapa. Nekudaro, iko kunyoreswa kwema narcotic ekurapa kurwadziwa shure kunosiyana zvakanyanya pakati pevanachiremba. Zvinoenderana nezvinyorwa, 3 kusvika ku66% yevarwere vanogona kunge vari kutora imwe nzira yeopioid kudzora marwadzo ekumusana. Kunyangwe hazvo kudzikiswa kwenguva pfupi kwezviratidzo kuchiratidzwa, kune mukana wekushungurudzwa kwenguva yakareba, zvinodhaka, mwero mukuru wekushivirira, nekushushikana kwekufema muvanhu vakura. Nausea uye kurutsa ndeimwe yenguva pfupi mhedzisiro mhedzisiro yakasangana ( Systematic Ongororo: Opioid Kurapa Kwekusingaperi Kudzokera Kurwadziwa: Kuwandisa, Kubudirira, Uye Kusangana Nekupindwa Muropa )

Anti-Kushungurudzika

Anti-kushungurudzika, mune yakaderera madosi, ane analgesic kukosha uye inogona kubatsira mune isingaperi yepashure kurwadziwa varwere vanogona kuve vanoratidzana vane kushungurudzika zviratidzo. Kurwadziwa uye kutambudzika zvinogona kunge zvichikanganisa kurara kwemurwere uye kuderedza chikamu chekurwadziwa. Izvi zvinogona kugadziriswa nekushandisa anti-depressants mune yakaderera madhidhi kunyangwe pasina humbowo hwekuti inovandudza basa racho.

Jekiseni Therapy

Epidural Steroid Injection

Epidural steroid majekiseni ndiwo anonyanya kushandiswa jekiseni rudzi rwekurapa chirwere chisingaperi chekushungurudzika disc chirwere uye chinosangana ne radiculopathy. Pane musiyano uripo pakati porudzi rweasrogenid yakashandiswa nedhidhi yayo. 8- 10 mL yemusanganiswa we methylprednisolone uye yakajairika saline inoonekwa sedanho rinoshanda uye rakachengeteka. Iyo majekiseni anogona kupihwa kuburikidza nemahara, caudal, kana trans foramina nzira. Tsono inogona kuiswa pasi pekutungamirirwa kwe fluoroscopy. Kutanga kusiyanisa, tevere anesthesia yemunharaunda uye pekupedzisira, iyo steroid inoiswa munzvimbo yehuchipatino pane yakakanganiswa nzira nenzira iyi. Iko kurwadzisa kwekurwadziwa kunowanikwa nekuda kwekubatanidzwa kwemhedzisiro kubva kuanesthesia yemunharaunda uye iyo steroid. Pari zvino kurwiswa kwemarwadzo kunogona kuitika kuburikidza neanesthetic yemuno nekuvharira chiratidzo chekurwadziwa nekutapudza kuchiratidziro Kuzvimba kunodzikiswazve nekuda kwezviitwa zvemaSoftware mukuvharidzira pro-immune Cascade.

Mumakore gumi apfuura, kushandiswa kwepidural steroid jekiseni kwakawedzera ne121%. Nekudaro, pane gakava maererano nekushandisa kwayo nekuda kwekusiyana kwematanho ekupindura uye nemhedzisiro inogona kuve yakaipa. Kazhinji, aya majekiseni anotendwa anokonzeresa kwenguva pfupi kurerutsa zviratidzo. Vamwe vanachiremba vanogona jekiseni majekiseni maviri kusvika matatu mukati mevhiki imwe chete, kunyangwe mhedzisiro yenguva yakareba yakafanana neiya yemurwere akapihwa jekiseni rimwe chete. Kwegore rimwe chete, majekiseni anodarika mana haafanire kupihwa. Kune mamwe marwadzo ekukurumidza uye anoshanda, morphine yekuchengetedza-isina inogona kuwedzerwa mujekiseni. Kunyangwe maanesthetics emuno, senge lidocaine uye bupivacaine, akawedzerwa nekuda kwechinangwa ichi. Uchapupu hwekuregererwa kwekurwadziwa kwenguva refu hushoma. ( APlaboebo-Inodzorwa Trial Kuongorora Kugona KweMarwadzo Ruregerero Uchishandisa Ketamine Ine Epidural Steroids Yechirwere Chisingaperi Chisingararame )

Iko kunogona kuve nemhedzisiro mhedzisiro nekuda kwekurapa uku, kuwedzera kune mutengo wayo wepamusoro uye zvinobata zvinetso. Tsono dzinogona kubviswa zvisirizvo kana fluoroscopy isinga shandiswe mune yakanyanya 25% yemakesi, kunyangwe kuvepo kwevashandi vane ruzivo. Iko kuiswa kwepascinoma kunogona kuzivikanwa ne pruritus zvakavimbika. Kudzvinyirira kushungurudzika kana kurongedza urini kunogona kuitika zvichitevera jekiseni ne morphine nekudaro murwere anofanirwa kutariswa kwemaawa makumi maviri nemana zvichitevera jekiseni.

Facet Majekiseni

Aya majekiseni anopiwa kune ma facet joints, anonziwo maZezgapophysial joints, ayo ari pakati pezviviri zvakapindirana vertebrae. Anesthesia inogona kuturika zvakananga kunzvimbo yakabatana kana kune yakabatana medial bazi remadors rami, iyo inogara mukati. Pane humbowo hwekuti iyi nzira inovandudza kugona kushanda, kunaka kwehupenyu, uye kudzoreredza kurwadziwa. Ivo vanofungidzirwa kupa zvese zvipfupi uye zvenguva refu bhenefiti, kunyangwe ongororo dzakaratidza zvese zviri zviviri facet majekiseni uye eprinthal steroid majekiseni akafanana mukuita. (Wynne, Kelly A)

SI Join Injection

Iyi diarthrodial synovial yakabatana nerve neruzivo kubva kune zvese myelinated uye isiri-myelin nerve axons. Jekiseni rinogona kunyatsobata degenerative disc chirwere chinosanganisira sacroiliac chinjo inotungamira kune dzakareba nekufupika kusunungurwa kubva kuzviratidzo zvakadai sekuderera kurwadziwa kumashure uye kutumidza kurwadziwa kumakumbo, chidya, uye mabhureki. Majekiseni anogona kudzokororwa pese pamwedzi miviri kusvika pamatatu asi anofanirwa kuitwa chete kana zvichikosha. (MAUGARS, Y. et al.)

Intradiscal Isiri-Inoshanda Kurapa kweDiscogenic Pain

Sezvinotsanangurwa pasi pekuferefetwa, discography inogona kushandiswa ese senzira yekuongorora uye yekurapa. Mushure mekunge chirwere chechirwere chawonekwa, nzira dzisingapindiki dzinogona kuedzwa usati watanga kuvhiya. Magetsi parizvino uye kupisa kwaro kunogona kushandiswa kunzvera iyo yekupedzisira annulus nekudaro ichisimbisa collagen fibers, ichidzvinyirira nekuparadza vanopwanya simba vanomiririra uye nociceptors, uye zvisimbiso manhamba. Nzira dzinoshandiswa mune izvi dzinonzi intradiscal electrothermalapy (IDET) kana radiofrequency posterior annuloplasty (RPA), mune iyo electrode inopfuudzwa kune disc. IDET ine umboo hwakapusa mukuzorodza kwezviratidzo zvevarwere vane hushoma hwechirwere, apo RPA ine rutsigiro rwakaringana maererano neiyo pfupi uye kushanda kwenguva refu. Maitiro ese ari maviri anogona kutungamira kumatambudziko akadai nerve midzi kukuvara, catheter kusashanda, utachiona, uye post-maitiro disc herniation.

Kurapa Kwokuvhiya

Kurapa kwekuvhiya kunochengeterwa varwere vane chakundikana kurapwa kwakachengetedza kurangarira kuomarara kwechirwere, zera, zvimwe zvinokanganisa, mamiriro ezvehupfumi nehupfumi, uye nhanho yemhedzisiro inotarisirwa. Inofungidzirwa kuti vangangoita 5% yevarwere vane degenerative disc chirwere vanovhiyiwa, kungave kune avo lumbar chirwere kana chirwere chechibereko. (Rydevik, Bj rn L.)

Lumbar Spine Maitiro

Kuvhiya kweLumbar kunoratidzwa kune varwere vane kurwadziwa kwakanyanya, nekureba kwemwedzi mitanhatu kusvika gumi nemiviri yekusashanda kwemishonga yekurapa, vane chirwere chakakomba chemuzongoza stenosis. Kuvhiya kunowanzo kuve nzira yekusarudzika kunze kwekunge iri cauda equina syndrome. Kune maviri maitiro maitiro anovavarira kusanganisa musana fusion kana kudzvinyirira kana zvese zviri zviviri. ( Degenerative Disk Chirwere: Kwakashure, Anatomy, Pathophysiology. )

Spinal fusion inosanganisira kumisa kufamba padanho rinorwadza vertebral kuitira kuti udzikise kurwadziwa nekuzadza vertebrae yakati wandei uchishandisa bhurawu. Iyo inoonekwa seinoshanda munguva refu kune varwere vane degenerative disc chirwere vane musana malalignment kana kunyanyisa kufamba. Kune nzira dzinoverengeka dzekufungidzira kwefusion. (Gupta, Vijay Kumar, et al)

• Lumbar spinal posterolateral guttur fusion

Iyi nzira inosanganisira kuisa kumisikidzwa kwepfupa munzvimbo yepashure yemusana. A graft pfupa inogona kukohwewa kubva kuseri yeyac crest. Mapfupa akabvisirwa periosteum yake kuti ibudirire kunyatso. A back brace inodiwa munguva yepashure yekushanda uye varwere vangangoda kugara muchipatara kwemazuva mashanu kusvika gumi. Kufambisa diki uye kurega kusvuta kunodiwa kuti ubatanidze zvakanaka. Nekudaro, njodzi dzinoverengeka dzakadai sekusabatana, kutapukira, kubuda ropa, uye kubatana kwakasimba nemarwadzo kumashure kunogona kuitika.

• Posterior lumbar interbody fusion

Nenzira iyi, decompression kana diskectomy nzira dzinogona zvakare kuitwa nenzira imwecheteyo. Iyo mabhonzo emapuranga anoiswa zvakananga kune disc nzvimbo uye ligamentum flavum inosimbiswa zvizere. Kune iyo inoshanduka disc chirwere, nzvimbo yepamhepo yakawedzerwa nekuwedzera nekuita chidimbu medial facetectomy. Kumashure mabhureki ndeakasarudzika neiyi nzira. Iyo ine zvinoverengeka zvakashata kana ichienzaniswa neanterior nzira yakadai seiyo chete madiki mashizha anogona kuiswa, iyo yakaderedzwa nzvimbo nzvimbo inowanikwa yefusion, uye kuoma kana uchinge uchinge uchinge uchinge uchirapa pane varwere vemuzongoza. Njodzi huru inobatanidzwa ndeyekusabatana.

• Anterior lumbar interbody fusion

Maitiro aya akafanana neyekumashure kweimwe kunze kwekuti inosvikirwa kuburikidza nemudumbu panzvimbo yemusana. Iyo ine mukana wekusavhiringidza tsandanyama dzemashure uye nerve kupa. Iyo inopesana nevarwere vane osteoporosis uye ine njodzi yekubuda ropa, kudzosera ejaculation mune varume, isiri mubatanidzwa, uye hutachiona.

• Transforaminal lumbar interbody fusion

Iyi ndiyo shanduro yakagadziridzwa yemberi yekumashure nzira iri kuve yakakurumbira. Iyo inopa panjodzi yakaderera nekuratidzwa kwakanaka uye inoratidzwa kuva nemhedzisiro yakanaka ine mashoma matambudziko akadai seCSF inodonha, inononoka kurwara kwemitsipa, uye hutachiona hwekukuvara.

Yese Disc Disc Arthroplasty

Iyi ndiyo imwe nzira yekurasa disc uye yakashandiswa kurapa lumbar degenerative disc chirwere uchishandisa iyo yekuisira disc kutsiva yakakanganisika disc. Yakazara prosthesis kana yenyukireya prosthesis inogona kushandiswa zvichienderana nemamiriro echipatara.

Kudzvinyirira inosanganisira kubvisa chikamu che disc che vertebral body, izvo zviri kureva kuti nerve kusunungura izvo uye inopa nzvimbo yekudzokorora kwayo kuburikidza nemaitiro anonzi diskectomy uye laminectomy. Kubudirira kwemaitiro acho kunetsekana kunyangwe kuri kuitwa kwechiremba kunowanzoitwa. Matambudziko ari mashoma ane mukana wakaderera wekudzokoroka kwezviratidzo nekugutsikana kwemurwere. (Gupta, Vijay Kumar, et al)

• Lumbar discectomy

Kuvhiya kunoitwa kuburikidza neyekumashure midline nzira nekukamura iyo ligamentum flavum. Midzi yetsinga inobatwa inoonekwa uye bulging annulus inotemwa kuti isunungure. Kuongorora kwakazara kwetsinga kunofanirwa kuitwa mushure uye varwere vanowanzo gadzirira kuenda kumba 1 - 5 mazuva gare gare. Kudzidzira kudzikira kumashure kunofanirwa kutanga nekukurumidza kuchiteverwa nebasa rakareruka uyezve rinorema basa pa2 uye 12 mavhiki zvichiteerana.

• Lumbar laminectomy

Maitiro aya anogona kuitwa zvakakwana rimwe zera, uyezve kuburikidza nemazinga akawanda. Laminectomy inofanira kupfupika sezvinobvira kudzivirira kusagadzikana kwemuzongoza. Varwere vakaisa zororo rezviratidzo uye kuderedzwa kwe radiculopathy ichitevera maitiro. Njodzi dzinogona kusanganisira matumbo uye bhebhi kuparara, CSF kuvuza, nerve midzi kukuvara, uye hutachiona.

Cervical Spine Maitiro

Cervical degenerative disc chirwere inoratidzirwa pakuvhiyiwa kana paine kurwadziwa kusingatsungiririki kwakabatana neinofambira mberi mota uye kushomeka kwekunzwa. Kuvhiya kune inopfuura makumi mapfumbamwe muzana% mhedzisiro yakanaka kana paine humbowo hwehutachiona hwemitsipa midzi yekumanikidza. Pane zvakawanda zvingasarudzwa zvinosanganisira anterior cervical diskectomy (ACD), ACD, uye fusion (ACDF), ACDF nekugadziriswa kwemukati, uye posterior foraminotomy. ( Degenerative Disk Chirwere: Kwakashure, Anatomy, Pathophysiology. )

Cell-based Therapy

Stem cell transplantation yabuda senge sosi yekurapa yechirwere che disc chirwere chine anovimbisa mhedzisiro. Kuiswa kweiyo autologous chondrocyte yakawanikwa yekuderedza discogenic kurwadziwa kupfuura 2 makore. Aya marapiro aripo ari kuyedzwa nevanhu. (Jeong, Je Hoon, et al.)

Gene Therapy

Kutapurirana kweGene kuitira kuti kumise iyo dhijisheni yekuita uye kunyange kukonzeresa disc kumisikidza pari zvino kuri kuongorora. Kune izvi, majini anobatsira anofanirwa kuve achizivikanwa panguva yekudzvinyirira basa rekusimudzira kukurudzira majini. Idzi sarudzo dzemaitiro ekurapa dzinopa tariro yekurapa mune ramangwana kuti ritungamirirwe pakugadzirisa zvekare ma discvertebral discs. (Nishida, Kotaro, et al.)

Degenerative disc chirwere inyaya yehutano inoratidzwa nehurefu hwekurwadziwa nekuda kweakakanganisika intervertebral disc, sekurwadziwa kwakadzika kumashure mu lumbar musana kana mutsipa kurwadziwa mumuromo wechibereko. Iko kuputsa kweiyo inopindirana disc yemuzongoza. Dzinoverengeka pathological shanduko dzinogona kuitika mu disc degeneration. Yakasiyana anatomical kukanganisa inogona kuitikawo mune yeververtebral disc. Kurwadziwa kwakadzika kumashure uye kurwadziwa kwemutsipa matambudziko makuru eepakati, ayo anofungidzirwa kuve ane chekuita nehuremu hwechirwere chechirwere. Kurwadziwa kumashure ndiyo yechipiri inotungamira chikonzero chekushanya kwehofisi kwachiremba muUnited States. Zvinofungidzirwa kuti vangangoita makumi masere muzana evakuru veUS vanotambura nemarwadzo ekumusana kamwechete panguva yehupenyu hwavo. Nekudaro, kunyatsonzwisisika kweiyo degenerative disc chirwere kunodiwa pakugadzirisa iyi yakajairika mamiriro. - Dr. Alex Jimenez DC, CCST Insight

Chiyero cheruzivo rwedu chinogumira kuchiropractic, musculoskeletal, mishonga yemuviri, hutano, uye zvine hutano nyaya dzehutano uye / kana anoshanda mushonga zvinyorwa, misoro, uye hurukuro. Isu tinoshandisa zvinoshanda zvehutano & hutano zvirongwa kuti tibate uye titsigire kuchengetedza kwekukuvara kana kusagadzikana kweiyo musculoskeletal system. Zvatinotumira, misoro, misoro, zvidzidzo, uye ruzivo rwunovhara nyaya dzemakiriniki, nyaya, uye misoro inoenderana nekutsigira zvakanangana kana zvisina kunangana nzvimbo yedu yekuchipatara yekuita. zvidzidzo zvinotsigira zvinyorwa zvedu. Isu tinoitawo makopi ekutsigira ekutsvagisa zvidzidzo zviwanikwe kubhodhi uye kana kuruzhinji pakukumbira. Isu tinonzwisisa kuti tinofukidza zvinhu zvinoda imwe tsananguro yekuti ingabatsire sei mune imwe chirongwa chekutarisira kana yekurapa protocol; Naizvozvo, kuti uenderere mberi nekukurukura nyaya iri pamusoro, ndapota inzwa wakasununguka kubvunza Dr.Alex Jimenez kana kuti tibate pa 915-850-0900. Iye anopa (s) Anobvumidzwa muTexas * & New Mexico *

Yakanyorwa naDr. Alex Jimenez DC, CCST

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