Herniated lumbar intervertebral disk
Article Abstract:
Intervertebral disks are the fibrous disks between the vertebrae of the spine. Although low back pain is common, herniation of an intervertebral disk is responsible for relatively few cases of back pain. Herniation means that the intervertebral disk protrudes from its normal position and may impinge on a nerve root. Sciatica, or inflammation of the sciatic nerve, causes acute pain, which radiates through the buttock and down the back of the leg. Sciatica is usually the first symptom of a herniated disk, but other disorders may cause similar symptoms. Greater than 95 percent of lumbar (the region of the small curve of the lower back) disk herniations occur at the levels of the vertebrae known as L4-5 and L5-S1 (L meaning lumbar; S meaning sacral; the numbers denote the vertebrae). When intervertebral disk herniation is suspected, physical examination should concentrate on abnormalities of the L5 and S1 nerve roots. Disk herniation cannot be diagnosed with ordinary X-ray; more sophisticated imaging techniques, such as myelography, computed tomography (CT) or magnetic resonance imaging (MRI), are required. However, these techniques are not recommended until a patient is being considered for surgery. Most of the symptoms of disk herniation, such as pain, lost or diminished reflexes, and muscle weakness, can be resolved with conservative therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), bed rest, and an early return to standing and walking are often helpful. Muscle relaxants and narcotic pain killers have a limited role and should be used for restricted periods of time. Conventional traction and corsets do not appear to be effective in treating herniated disks. Surgery is recommended when intervertebral disk herniation is confirmed by imaging, the patient has sciatic pain, neurologic abnormalities, and fails to respond to six weeks of conservative therapy. Only 5 to 10 percent of patients with a herniated disk require surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1990
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Diagnostic imaging procedures for the lumbar spine
Article Abstract:
Low back pain, originating in the lumbar region of the spine, is a common health complaint. The condition may require some medical intervention or may resolve on its own. Many different procedures can be used to visualize the lower back. Although most practitioners were taught to X-ray all patients with low back pain, imaging is now recommended for selected patients only. Studies have shown that plain radiography is a source of radiation to the gonads (reproductive organs), can be costly and misleading, and has diagnostic limitations, such as not revealing unexpected problems. Radiography should be reserved for patients suspected of having cancer, infection, swelling of the spinal column, neurological deficits or possible fractures. Simpler tests suggestive of underlying disease (such as blood tests) can be used to identify patients who require further imaging techniques. The angles at which X-ray films are taken should be limited to back, front and side; oblique views should be obtained in selected cases. The diagnosis of a herniated disk, displacement of the disk between the vertebrae causing pressure on nerves or narrowing of the spinal space, should be confirmed by myelography, computed tomography (CT) or magnetic resonance imaging (MRI). It is suggested that these imaging procedures be used only when surgery is being considered. Lumbar discography, in which a contrast material is injected into the disk to produce a diagnostic image, may cause back symptoms and is controversial. Thermography detects temperature differences in skin surfaces and may be used to diagnose sciatica, or irritation of the sciatic nerve, which is thought to cause these temperature changes. More research is needed to evaluate the efficacy of lumbar discography and thermography. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1989
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New diagnostic tests: breakthrough approaches or expensive add-ons?
Article Abstract:
Doctors should evaluate new diagnostic tests in a real-life setting to see if they are cost-effective before deciding whether to integrate the test into their practice. A good example is PET scanning to see if lung cancer has spread to other parts of the body. A 2003 study found that PET scanning might be more effective than CAT scans in certain patients. But PET scans are expensive and it is not clear whether the scan will lead to better treatments and better patient outcomes.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 2003
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