pivd & spinal cord compression

dr. 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
*functional spinal unit (fsu)
*motion segment
*three joint complex
*disk in front
*two facet joint post.
*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 sciatica
*radiation of pain down in the leg.
*not up to thigh
*leg pain more than back pain
*coughing, sneezing, valsalva.
neural symptom
*numbness
*weakness
*cauda equina syndrome
special tests
*sciatic stretch test
*slrt (straight leg raising test)
*laesegue test
*bowstring test
*femoral stretch test
invesitgation
x - 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 .