Dr. MUZAHIM.M.TAHA Dr mohammed Hameed Faedh Tikrit University.

Iraq

National Development University INDONESIA

a disc herniation is the term given to any uneven out pouching or bulging of the intervertebral disc as seen on MRI, and irritate these neural structures, which in turn may cause severe back and leg pain

And since mixter and barr

published intervertebral disc

PROTRUTIO N

EXTRUSION

surgery, various technique have been developed, include laminectomy

SEQUESTRATION

segmental
Neural

Low back pain Buttock and leg pain Weakness

Neural L5-S1 : cause buttocks pain, posterior high, posterior lower leg and down to the heel If you want to know anything else..please ask me Notes : cauda equina syndrome is an emergency cindition that usually requires immediate surgical treatment (the symptom are loses bowel and bladder control, pain, weakness, numbness and paralysis of the legs

Conservative

Physical therapy

Nerve block

Epidural block
Notes : indication for surgery :

excercise

Cauda equina syndrome

Progressive neurology deficit Profound neurologi deficit and Severe pain to four to six weeks of conservative treatments

Retrospective study 50 sample who were based diagnosed on the basis clinical signs & symptom of back pain & radiculopaty and confirmed by MRI and then operated after a period of consevative treatment of 2-3 month
32 M & 18 F

Scoring by ODI

27 (L4-L5), 21 (L5-S1),2 (L3-L4)

Follow upn 1-2 years Have 2-3 month treatment

4-5th decades of life

Pain intensity (0-5 poin) Personal care (0-5 poin) Lifting (0-5 poin) Walking (0-5 poin) Sitting (0-5 poin)
Point total/50 X 100 : %disability 0-20% minimal disability 21-40% moderate disability 41-60 severe disability 61-80 crippled

Standing (0-5 poin) Sleeping (0-5 poin) Sex life (0-5 poin) Social life (0-5 poin) Traveling (0-5 poin)
81-100 : exaggerating their symptoms 38 (41-60% ODI) & 12 (61-80%)

After the operations the operative results to the patiens were devided into 4 groups regarding the operative outcome :
Excellent
Good Fair Poor

Neurological deficit &org sphincter incontinence in patient with LDP mandate early

surgical interference, because delayed surgery give poor outcome

The higher incidence in male, however there is no significant effect for the gender of the patient on the functional recovery & surgical outcome

LDP is disease of the 3rd, 4th , 5th decades

Laminectomy and diskectomy give better results whene done early on ypunger patients with LDP

Older patient maybe change to the degenrative disease, may show bad results of
surgery and long term follow up

Most of the lumbar flexion extension and of total movements

occurs at the lumbosacral junction at the L4/L5 level

Earl operation with extruded or sequestrated who presented early give encourgable results

Degeneratif change of lumbosacral spine is an important unfavorable factor affecting the surgical outcome & functional

recovery

Absence of degenerative change pre post operatively

Younger age group Sequestrated or extruded discs operated early

Older age group The presence of degeneratif change Physcososial stres

Early surgery with extruded or sequestrated disc Early surgery for patients with neurological deficit Longterm conservative therapy for older patient Delayed surgical intervention after failure of lonterm conservative treatment to the relief the radicular

symptoms of older patient