Rodrigo Rivera Sepúlveda Orthopedics and Traumatology Hospital Felix Bulnes University Andrés Bello Introduction • • • • • • Pain Anatomy Embryology Epidemiology Classification Pathophysiology Pain Set by International Association for the Study of Pain: "an unpleasant experienc e, sensory and emotional, associated with potential or actual damage, or describ ed in terms of such damage." IASP Pain • Help v / s Damage - Serves as a sign of care useful in certain situations, avoiding further damage , or help identify a disease - it loses its usefulness when it is severe, dispro portionate, without regard to the cause or the result is deleterious to the pati ent Pain Tissue Trauma Increased concentration of nociceptive substances (eg prostaglandi ns, histamine, serotonin, substance P. ..) Activation of CNS pain Pain: The 5th Vital Sign 1. 2. 3. 4. 5. Blood Pressure Temperature Pulse Respiration Assessment of Pain ( recommended by the American Pain Society) American Pain Society. 1998 Analog scale pain Analog scale pain Back pain. Biomechanical elements • functional spinal unit: 2. Lig.Lon. Later. 3. Lig. Lon. above. 4. Vertebral bo dy. 5. Intervertebral disc. 6. Hole conjugation and nerve root. 9. Intervertebra l joint. 13. Vertebral canal. Anatomy Innervation of spinal structures Primary Industry Previous: transverse processes and muscles paravert ant. Poster ior primary ramus: branch medial post Musculat paravert deep neural arch periost eum, joints zigoapofisiarias, ligamnto inter-and supraspinous and intertransvers e, lig yellow skin. Lateral branch, musculature and skin deep axial paravert. Innervation of spinal structures Sinuvertebral recurrent nerve: Periosteum of posterior wall spinal cord and epid ural venous plexus, epidural adipose tissue, fibrous anulus later LCVP, anterior aspect of the dura. Sympathetic trunk and branch communicating gray: lateral an d anterior aspect of the anulus fibrosus, LCVA, anterior and lateral periosteum of the vertebral body. Innervation of spinal structures Cord and dorsal root ganglia: Your irritation and / or compression causes metame ric commitment, with pain in a specific dermatome.

Back pain. Functional considerations. • basic biomechanical functions: 2. Weight transfer static and dynamic axial and appendicular skeleton. 3. Allow the support of physiological movements. 4. Prot ect the structures of the spinal cord and nerve roots. Physiology Pressurized core axial load stabilizing the anulus tight spinal unit allows full range of motion Pathophysiology of DIV Pathophysiology • disc disease: normal disc degenerative process. • It affects their three eleme nts: - Drying the kernel - the anulus fissure - sclerosis and osteophytes Pathophysiology Desiccation of the nucleus (Decreased proteoglycan) Low voltage drive anulus Una ble to stabilize spinal segmental hypermobility and abnormal traction osteophyte s fascetaria Pathophysiology of DIV Pathophysiology • Events abnormal degenerative process: - Rupture of anulus fibrosus: acute or p rogressive nuclear prolapse. - Symptomatic instability: For commitment to artic. fascetarias - secondary Estenorraquis: osteophytes, bulging ring and soft tissu e hypertrophy. Slipped disc • Rupture disc material bulging anulus. According severity can be: - Bulging dis c - disc extrusion (HNP) Slipped disc • Mechanical Compression: Deficit compromised root HNP L3-L4: 10% HNP L4-L5 and L5-S1: 90% Slipped disc • CK: autocrine and paracrine mechanisms: - Estimation. Nerve endings - Sensitiz ation of nociceptors - Promotes loss of proteoglycans (alters balance EZS / inhi bitors) - Neovascularization Back pain. Kinematic Bases • RISK FACTORS: 2. Age (20-60 years). 3. Static spinal posture. 4. Occupation and dynamic postur e. 5. Body vibration exposure prolonged. 6. Fitness and sports. 7. Psychological aspects. • • • Mobility KINEMATICS functional unit. Mobility of the spine. REPRESENTATIVE VALUES OF THE MOVEMENT KINEMATICS OF THE SPINE Pathophysiology • 2. 3. 4. 5. Vertebral body: intervertebral disc. Vertebral ligaments. Spinal a nd abdominal muscles. Core and root structures.

Cinematic Bases Key Concepts • Clinical diagnosis and imaging • The vast majority is due to mechanical causes postural-tension of less significance. • The physician must recognize the warni ng symptom patterns: pain at rest and / or night pain.€Fever weight loss and mor ning stiffness polyarthralgia acute pain, persistent, refractory to symptomatic treatment. Diagnostic sequence Syndromatic pure back pain sciatic pain 2.-3.-Root Esclerotógeno neural claudication pain lumbar pain lumbar 4.-Atypical International Association LUMBAR PAIN OF PAIN FOR ESTUDY I. Agree to the compromised system and its etiology. System: Musculoskeletal. Ne urologic. Visceral or vascular disease. Psychological. Idiopathic 2. • • • • • 2. Etiology: • Degenerative. • Inflammatory. • Metabolic. • Neoplasm. • Trauma. • Congenita. • Infectious. THANK YOU