Valley University Faculty of Health Sciences HISTOLOGY II Pathology and Scientific Novelty Group H Student: Oliver Mérida Zapata

Teacher: Dr. Norma Paz Méndez 2006 Pathology of the Herniated Disc Definition .- The hernia is a defect or injury c aused by intervertebral disc degeneration. It consists of a nucleus pulposus sur rounded by a fibrous ring. When it breaks the ring facilitating the exit outside the nucleus, we have a herniated disk. Fissure. The fissure disc is tearing the fibrous disc. The most typical is the r adial crack, in which the tear is perpendicular to the direction of the fibers. The disc protrusion is the deformation of the fibrous material by the impact of gelatinous nucleus pulposus against it. Herniated disc. If the shell does break and part of the nucleus gets out of the enclosure, is diagnosed with a herniated disk. Side view of the hernia The pathologies of the spine are becoming more common in humans due to lack of i nformation possessed by them, because of inadequate movements they made and the charges made on the spine of these factors being responsible for a hernia disk, which may occur more frequently mind cervical and lumbar. The herniated nucleus pulposus or slipped disk is a condition in which part or all of the central port ion of a soft gelatinous intervertebral disc (nucleus pulposus) is forced throug h a weakened part of the disk, eg pain Produce neck and arm (cervical herniation ) due to nerve root irritation. Discs are between every two vertebrae and serve to cushion the load on the spine . When discs degenerate with age or repeated efforts, they can get out of its no rmal location, which is known as a herniated disc. The exit can compress neural structures. Although the disks are the entire spine, disc herniations are locate d mainly in the neck (cervical) and lower back. Causes The main causes of a hern iated disc are as follows: For joint degeneration or aging, with vertebral osteo phyte formation. It is not yet known but the mechanisms have reported the existe nce of several genes. Microtrauma. By a mechanism repetitive flexion - extension of trunk loading too much weight ( professions which requires great effort). A continuous pressure on the disc caus es it to be deteriorating. Rotational motion on a continuing basis (professions where it is prolonged sitting, carrying continuous changes of direction and mean ing through swivel chairs, driven most often by foot - shear effect). Excess bod y weight and volume, accentuating the risk with a large abdomen. There is then e xcessive pressure on the back due to vertebral curve accentuating lumbar lordosi s (swayback). Atrophy back lumbar paravertebral muscles. Some factors related to lifestyle, such as smoking, lack of regular exercise and inadequate nutrition c ontribute substantially to poor health of the disc. As the body ages, natural bi ochemical changes cause discs gradually dry out, affecting the strength and elas ticity. Poor posture combined with the habitual use of incorrect body mechanics can exert additional stress on the cervical spine. If you combine these factors with the effects of everyday wear and tear, injury, a wrong way to lifting or tw isting movements, it is easy to understand what causes a herniated disc. A disc herniation may develop suddenly or gradually, over weeks or months.

Gradual steps towards Herniation Disc Degeneration: chemical changes associated with aging weaken the discs, but not because of hernia. Prolapse: the form or po sition of the disc changes and a slight invasion into the spinal canal. Also cal led bulging. Extrusion: the gel-like nucleus pulposus through the wall like a ri m (annulus fibrosus) but remains within the disc. Kidnapped Kidnapping or Disc: the nucleus pulposus through the annulus fibrosus and lies outside the disc into the spinal canal (herniated nucleus pulposus or HNP, for its acronym in English ). PATHOLOGIES SECONDARY TO CERVICAL DISK HERNIA root compression of peripheral ner ves. The compression of the spinal nerve root causes pain in the area of distrib ution of root€but remember that the pain may spread more widely than imagined, feeling pain at the root of the scapular region C4 and C7 root pain in the anter ior chest. Typically, acute spasms of pain in addition to a dull base. The pain may cause muscle spasms with reduced movement in the spine or total loss of moti on associated with torticollis. The commitment of the motor root results in musc le weakness and decreased or absent reflexes in her arms. Listed below are the m uscles innervated by the roots most commonly involved: Deltoid ... ... ... ... . .. ... ... ... ... ... ......................... ............................... ...... C5-C6. Biceps ... ... ... ... ... ... ... ... ... ... ... ............... ....................... ......................... C5-C6. Triceps ............... .................................. ............................................. ..... ....... C6-C7-C8. Extensors and wrist flexors and finger ................. .......................... ....... C7-C8. Abductors and extensors of the thumb . .. ... ... ... ... ... ... ... ... ... .... ... ..... C7-C8. Intrinsic muscles o f the hands ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... .. C8-D 1. The commitment of the sensory root can produce paresthesia and therefore chan ges all the modalities of sensation in the affected dermatome. In the early stag es, the motor root irritation can cause increased sensitivity and unpleasant (hy peresthesia). Compression of the cervical spinal cord. Compression of the cervic al spinal cord is a very serious condition that occurs most commonly at C5-C6. A lthough there are a variety of presentations involving more usual findings by upper motor neuron lesion in one or both legs with findings by lower motor neuron lesion in the upper limbs. It can also be a variety of sensory abn ormalities in her arms and legs. Vertebral artery compression. The compression o f the vertebral artery can lead, particularly in the patient, brain stem ischemi a and the production of vertigo, tinnitus, visual disturbances, difficulty speak ing and swallowing, ataxia and other signs of brain dysfunction. Pathophysiology fissure, protrusion or herniated disc occurs when pressure inside the disc is g reater than the resistance of the fibrous. As the fibrous thickening is third in the anterior wall in the back, most of the cracks, protrusions and herniations occur in the latter. The typical mechanism consists of the following sequential movement: Flexion of the spine forward: In doing so the wheel is more load on th e front. As a gelatinous consistency, the nucleus pulposus is compressed against the back wall of the fibrous. Weight Carrying important: Doing so tends to comp ress a vertebra against the other, increasing the pressure within the disc. Exte nsion of the spine with the weight loaded: In doing so, the increase in disc pre ssure leading to weight bearing is "squeezing" the nucleus pulposus back harder. If the pressure against the back wall of the fibrous enough, the envelope tears (fissures disk), balloons (prorusión disk) or part (herniated disk). A similar effect can be achieved by repeated flexion and extension movements with a small er load or no load. Each time, generate small impacts against the rear wall of t he fibrous. These mechanisms occur more readily when the back muscles are very powerful. If they are sufficiently developed, these muscles protect the disc by several mecha nisms. Since the posterior longitudinal ligament is strongest in the midline, th e portion of the annulus fibrous posterolateral has to bear a disproportionate s

hare of the load. For that reason, the majority of lumbar disc herniations occur in the back, slightly lateralized, and compress the nerve root for, which gener ates the characteristic intense radicular pain. There have been several distinct ions between the bulge, kidnapping or free disk fragment, often based on operati ve findings or pathological. From a clinical standpoint, these distinctions are generally minor, with the possible exception of "contained herniation, which may cause the patient becomes a candidate for intradiscal procedures. Clinical char acteristic data provides the history are: Symptoms may begin with a low back tha t after days or weeks to us, gradually or sometimes suddenly, evolucjo to radicu lar pain,€frequently Lumbala attenuation. Rarely identify triggers. Relieves pa in of knee and thigh. In general, patients avoid making excessive movements but stay in one position (either sitting, standing or lying down) for a long time ma y worsen the pain, which is necessary to change their position at intervals rang ing from a few minutes 10-20 minutes. This attitude of change of position is not the same as writhe in pain, as, for example, in cases of ureteral obstruction. The pain is aggravated by coughing, sneezing or straining: the "piston effect" w as found positive in 87% of the cases studied in a publication. Bladder symptoms: the incidence of voiding dysfunction is between 1% and 18% and are, in most cases, problems emptying, urinary retention or stress. The first s ign may be the bladder hypoesthesia; symptoms is not unusual to find "irritating ," including urinary urgency, urinary frequency (including nocturia) and an incr eased postvoid residual. Enuresis is less common. It has been reported incontine nce drip cases of radiculopathy (note: the true urinary retention can be seen in cauda equina syndrome. Occasionally a lumbar disc herniation can occur only wit h bladder symptoms, which can improve after surgery, although it is impossible t o ensure that such improvement will occur. Low back pain itself is generally a m inor component (only 1% of patients have reported low back pain have sciatica) a nd, when the only symptom, it is necessary to look for other causes. Sciatica ha s such a high sensitivity to indicate the presence of a herniated disk that the probability of finding a herniated disc without sciatica is clinically important = 1 in 1000. Among the exceptions include the central disc herniation, which ma y raquiestenosis cause symptoms of lumbar (neurogenic claudication), or cauda eq uina syndrome. radicular compression caused a series of signs and symptoms that may be present in varying degrees. syndromes characteristic of the nerve roots m ost commonly affected are: L3-L4 (disc between the 3rd and 4th lumbar vertebra) lower in front of the knee, inside of the ankle or leg and internal malleolus. L4-L5 (disc between the 4th and 5th lumbar vertebrae) on outside lower leg, dorsum of the foot, sole, inner edge of the foot and big toe. L5-S1 (disc between the 5th lumbar and 1st sacral vertebra) on the posterior lower leg, outside edge of the foot, ankle or externa l malleolus and the little finger or pinky. Functional disability that causes lu mbar disc herniation can be measured by scales such as the Oswestry .... The low er extremity pain by VAS (Visual Analogic Scale). SYMPTOMS cervical herniated cervical disc pain, especially in the back or side p ain near or over deep blades on the affected side pain radiating to the shoulder , upper arm, forearm, and sometimes the hand, fingers or chest Worsening pain wh en coughing, straining or laughing Increased pain when bending the neck or turni ng head to one side of the neck muscles spasm Weak arm muscles Exploration Diagn osis: Disorders of the vertebral static Loss of lumbar lordosis physiological co nditioning the rigid backbone. Scoliosis right or left (called by the side of co nvexity, present in 60%). Ramond Signs: muscle contracture paralumbar unilateral or bilateral defense is the phenomenon, present in more than 60%. It consists o f a scoliosis, low ribs, scapula and elevation of the iliac crest. Alterations r oot trunk flexion causes leg pain is a sign of conflict root disk pressure of th e paraspinal muscle mass may trigger pain in the leg (ring sign). Motor disorder s will be walking on tiptoe (S1) and heels (L5). Oppose flexion of the foot (L5) and the extension movement of the foot (S1). It will check the strength of the

quadriceps (L3 and L4). Were tested for the presence of muscle atrophy and fasci culations. It will explore the patella or patellar reflex (L3 and L4) and for the root aqui llano L5 and S1. Sensory disturbances are explored the sensitivity of the anteri or thigh (roots, L1, L2 and L3). It explores the inside of the leg (L4 root). Th e outer side of the leg, the inner half of the dorsum of the foot including the great toe (L5 root). The outer half of the back of the feet including the lower finger (root S1). Also€will explore the sensitivity of the perianal region and posterior thigh, leg and plantar region for roots S1, S2. Sphincter disorders is explored the presence of bladder balloon. The symptoms and examination of sensitivity, mobility and motor reflexes will of fer a perfect map of the possible affected root. Confirm the process by NMR (Nuc lear Magnetic Resonance) or a CT (Computed Tomography). Sometimes We performed a nerve conduction study by researching Electromyographic Scientific Novelty New discovery may improve treatment of neurodegenerative diseases and type II di abetes New Discovery Universitat Autònoma de Barcelona UAB scientists identify therapeutic targets against illnesses caused by protein aggregates. The discovery opens the door to designing new drugs to cure Parkinso n's, type II diabetes, Alzheimer's and the human variant of mad mad cow disease. The formation of protein aggregates is the cause of several neurodegenerative di seases such as Parkinson's, Alzheimer's and evil the human variant of mad cow di sease, as well as dysfunction of the pancreas that causes type II diabetes. A team of scientists from the UAB has developed a method to identify specific ar eas of the proteins associated with these diseases that facilitate the formation of aggregates. The research opens the door to designing new drugs aimed at bloc king these areas and to stabilize the molecules do not form aggregates. Proteins are long molecular chains that travel from one place to another cell, carrying information vital to the body's activity. The function of each protein depends l argely on the form it takes in space. In some cases, without however, the proteins lose this form to conflict with other, get together, form a twist and added without any functions are growing calls to form amyloid fibers . This causes neurodegenerative diseases like Parkinson's and Alzheimer's, is th e origin of transmissible spongiform encephalopathies, as the evil mad cow disea se and its variant in humans (Creutzfeldt Jacob disease), and also triggers the pancreatic malfunctions that result in type II diabetes. A team of scientists fr om the Universitat Autònoma de Barcelona, led by the researcher Salvador Ventur a, has developed a method to identify those parts of the proteins that initiate the formation of aggregates. This method can identify the precise zones of each protein that, when in contact with other molecules, forcing the withdrawal and t he formation of aggregates and amyloid fibers. Scientists have tested the method with different proteins involved in conformational diseases, identifying segmen ts that were known for their role in protein aggregation in these diseases. Acco rding to Salvador Ventura, does our method identifies potential therapeutic targ ets against illnesses caused by protein aggregation, such as Alzheimer's, Parkin son's and diabetes type II. Allows identification of the targets with better acc uracy to attack them, theoretically more effectively?. The method developed by the UAB researchers identifies the areas that cause prot ein aggregation both in globular proteins, thread-shaped folded, as in those wit h extended wire form, and may be useful for designing new drugs diseases related to protein aggregation. In the case of proteins with extended wire form, you ca

n design drugs that work by coating and blocking the areas identified by the new method, so that they can not contact other proteins and aggregate. If the prote ins are globular, the aggregation areas are usually protected on the inside, and are not dangerous unless they are accidentally exposed to the outside. In this case, the drugs must be aimed at stabilizing the structure of the protein, preve nting areas from becoming exposed. The research, published recently in earchers Natalia Sánchez de Groot, osep Vendrell and Salvador Ventura, logy and Institute of Biotechnology ònoma de Barcelona. BMC Structural Biology, was conducted by res Irantzu Pallares, Francesc Xavier Avilés, J Department of Biochemistry and Molecular Bio and Biomedicine (IBB) of the Universitat Aut

BIBLIOGRAPHY www.neurocirugia.com/diagnostico/ hernialumbar / www.enbuenasmanos. com / articles / sample.asp www.diariomedico.com/traumatologia/n240400.html www. escuela.med.puc.cl / publications / Manual to / DolorOseo.html DOWNIE A Patricia . Kinesiology in orthopedics and rheumatology. Buenos Aires Argentina. Editorial Médica Panamericana. 1987. Haro H: [The basic research of herniated lumbar dis c.]. Clin Calcium 15:365-370, 2005.