Functional Recovery for Patients With Lumbar-sacral Disc Prolapse

7/29/2019 Functional Recovery for Patients With Lumbar-sacral Disc Prolapse

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Dr. MUZAHIM.M.TAHADr mohammed Hameed Faedh

Tikrit University. Iraq


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National Development University

INDONESIA


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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

EXTRUSION

SEQUESTRATION

PROTRUTIO

N

And since mixter and barr

published intervertebral disc

surgery, various technique have

been developed, include

laminectomy


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Low back pain

Buttock and leg painsegmental

WeaknessNeural

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


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ConservativePhysical

therapyNerve block

Epidural

blockexcercise

Notes : indication for surgery :

Cauda equina syndrome

Progressive neurology deficit

Profound neurologi deficit and

Severe pain to four to six weeks of conservative treatments


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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

27 (L4-L5),

21 (L5-S1),2

(L3-L4)

4-5th

decades

of life

Have 2-3

month

treatment

Follow

upn 1-2

years

Scoring by

ODI


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Pain intensity (0-5 poin) Standing (0-5 poin)Personal care (0-5 poin) Sleeping (0-5 poin)

Lifting (0-5 poin) Sex life (0-5 poin)

Walking (0-5 poin) Social life (0-5 poin)

Sitting (0-5 poin) Traveling (0-5 poin)

Point total/50 X 100 : %disability

0-20% minimal disability

21-40% moderate disability

41-60 severe disability

61-80 crippled

81-100 : exaggerating their symptoms

38 (41-60% ODI) & 12 (61-80%)


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After the operations the operative results to the

patiens were devided into 4 groups regarding the

operative outcome :

Excellent

Good

Fair

Poor


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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


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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


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Absence of degenerative change pre post

operatively

Younger age group

Sequestrated or extruded discs operated early


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Older age group

The presence of degeneratif change

Physcososial stres


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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


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Functional Recovery for Patients With Lumbar-sacral Disc Prolapse

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