![]() ![]() Disc herniations are classified based on the circumference of disc involvement when less than 25% of the circumference of the disc is involved, it is termed a protrusion, and when it involves greater than 25% of the circumference, it is called a bulge. Posterior disc herniations contribute to nerve impingements. The disc herniations are an extension of the disc material beyond the confines of the disc space. In 2014, Lumbar Disc Nomenclature: version 2.0 was released, updating the original version from 2001. The standardized spine nomenclature is based on the recommendations from the American Society for Spine Radiology, American Society for Neuroradiology, and North American Spine Society. The disc spaces are composed of the nucleus pulposus and annulus fibrosis. The group of nerve roots caudal to this forms the cauda equina, which consists of free-floating nerve roots in the central canal as they exit at the corresponding levels in the lumbosacral spine. The spinal cord ends approximately at the level of L1-L2. However, there are many anatomical variants however, identifying a transitional vertebra at the lumbosacral junction as lumbarization of S1 or sacralization of L5 clinically helps during surgical management. The attachment of the iliolumbar ligament and the size of the vertebral body helps in identifying the L5 vertebral body the ligament extends from the L5 transverse process to the iliac crest. The lumbar spine consists of 5 lumbar vertebral bodies. It is also the modality of choice for assessing cord compression. MRI is also highly sensitive for evaluating tumors and metastasis. ![]() In patients who are possible candidates for augmentation procedures, MRI is the modality of choice. CT is the imaging modality of choice in patients with suspected fractures. ACR appropriateness criteria help in choosing the right modality in a variety of circumstances. As a broad rule, whenever there is a concern for infection, or there is a suspicion for malignancy, contrast-enhanced studies are the recommended approach. While plain radiographs are usually the first imaging modality, depending on the acuity, medical condition, and general contraindications to imaging modalities, the appropriate modality merits consideration. ![]() Patients presenting with fever and low back pain or patients with a history of drug misuse or immunosuppression should lead to the suspicion of an infection. Symptoms of cauda equina syndrome would include saddle anesthesia, bowel or bladder incontinence. However, patients with cauda equina syndrome, malignancy, suspected infection, or fracture require further imaging. Patients with uncomplicated back pain do not require imaging unless it persists for more than six weeks. The American College of Radiology enlists appropriateness criteria for evaluating back pain. Ultrasound (US) and nuclear medicine imaging are occasionally choices. The most common modalities include radiographs, computed tomography (CT), magnetic resonance imaging (MRI). Imaging provides varied details based on modality. The causes for low back pain range from muscle spasms and disc protrusions to more severe entities such as discitis, osteomyelitis, and malignancy. The lifetime prevalence of back pain is approximately 70% to 85%. It accounted for 4.4% of emergency department visits from 2000 to 2016. It is the second most common complaint to visit a provider in the United States. In order to locate the specific segment of disc degeneration, diagnostic imaging tests may be used.Low back pain is a ubiquitous symptom. Other cases may require insight from a spine specialist and/or additional testing. The above diagnostic methods are typically enough to diagnose pain from a spinal disc, and most cases can be diagnosed by visiting a primary care physician. See Preparing to See A Doctor for Back and Neck Pain Additionally, movement tests that determine which motions or positions alleviate or worsen pain can help indicate where pain is produced in the spine. A physical exam may include feeling by hand (called palpation) along the lower spine to locate areas of tenderness, inflammation, or physical abnormalities. A physical exam tests the spine’s range-of-motion and strength.A medical history also gathers information on regular physical activity, sleep habits, and past injuries. A medical history is collected that details current symptoms, including when the pain began, if pain is accompanied by other symptoms such as numbness or tingling, and if pain started after an injury.The first steps for a lumbar DDD diagnosis include the following: ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |