Guide Disc Herniation - Between Herniated Disc & Surgery (3. API - aging pain inflammation)

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Depending on the cause of the compression, symptoms may develop suddenly or gradually, and they may require anything from supportive care to emergency surgery. One of the most common causes of spinal cord compression is the gradual wear and tear on the bones of the spine, known as osteoarthritis. People who develop spinal cord compression from this are usually older than Other conditions that may cause spinal cord compression can develop more quickly, even very suddenly, and can occur at any age:.

Symptoms of spinal cord compression can develop quickly or slowly, depending on the cause. Injuries may cause immediate symptoms. Tumors or infections may cause symptoms that develop over days or weeks. Wear and tear of the spine may take years to cause symptoms. Pressure on nerves in the lumbar region lower back can also cause more serious symptoms known as cauda equina syndrome. If you have any of these symptoms, you need to get medical attention right away, typically in the emergency room:.

Severe pain and weakness that spreads into one or both legs, making it hard to walk or get out of a chair. Army veteran Richard Shetter sought a second opinion from the Johns Hopkins orthopaedic spine division. To diagnose spinal cord compression, your healthcare provider will ask you questions about your symptoms and do a complete physical exam. During the exam, he or she will look for signs of spinal compression, such as loss of sensation, weakness, and abnormal reflexes. Tests that help with your diagnosis may include:.


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X-rays of your spine. X-rays may also show an abnormal alignment of your spine. Special imaging tests of your spine. A CT or MRI scan will give a more detailed look at the spinal cord and the structures surrounding it. The medical team involved in treating your spinal cord compression may include arthritis specialists, bone surgeons, nerve specialists, and physical therapists. Treatment depends on the cause and your symptoms and may involve medication, physical therapy, injections, and surgery. Except in cases of emergency, such as cauda equina syndrome or a broken back, surgery is usually the last resort.

Medicines may include nonsteroidal anti-inflammatory drugs NSAIDs that relieve pain and swelling, and steroid injections that reduce swelling. Physical therapy may include exercises to strengthen your back, abdominal, and leg muscles. You may learn how to do activities more safely.

Lumbar Disk Disease (Herniated Disk) | Neurology

Braces to support your back or a cervical collar may also be helpful. Participants were recruited from a hospital-based outpatient spine center between January and March All patients received a standardized history and physical examination. Exclusion criteria were known pregnancy; severe active medical or psychiatric comorbidities that would limit study participation; the presence of significant central canal or neuroforaminal stenosis from reasons other than LDH as the likely cause of radicular pain; infectious, inflammatory, or neoplastic cause of radiculopathy; significant degenerative or isthmic spondylolisthesis suspected of contributing to symptoms; and prior lumbar spine surgery at the affected level.

Some patients met clinical criteria for study participation, but had not yet undergone MR imaging to confirm whether LDH was present at the baseline evaluation. These patients were offered informed consent at the baseline evaluation for practical reasons, but did not formally enter the study unless their subsequent MRI imaging met study criteria. Subjects who went on to receive surgical treatment during the 6-month follow up period were excluded from analysis. The SACQ is widely used in orthopedic research, and has previously demonstrated reliability and validity.

Employment status was categorized as part-time employment, full-time employment, student, retired, disabled, and unemployed. Each participant received a comprehensive physical examination for the evaluation of lumbar radiculopathy by one of six board-certified physiatrists specializing in spine care.

Specific physical examination tests received emphasis in this analysis due to their common usage, or because deficits on these tests were felt to have relatively greater clinical or functional importance. These tests elicit symptoms of neural tension affecting the low lumbar and midlumbar nerves roots, respectively, and have been well described previously Knee extension strength was measured with the single leg sit-to-stand test, and ankle plantarflexion strength was measured with the heel-raise test 24 - Any deficits were further characterized using manual muscle testing MRI imaging scans consisted at minimum of T1 and T2 weighted images of the lumbar spine in the sagittal and axial planes.

The recruiting physician recorded herniation level, nerve root impingement level, herniation morphology, and herniation location.

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Herniation morphology was classified as protrusion, extrusion, or sequestration Patient-reported disability and pain intensity were recorded at the baseline clinic visit. The primary outcome of this study was the patient-reported change in functional limitations and disability at 6 month follow-up, as measured by the Oswestry Disability Index ODI. The ODI is a condition-specific measure of disability, which has been used extensively in prior studies of low back pain and radiculopathy, and has demonstrated validity and reliability in these contexts ODI scores range from 0 to , with higher scores indicating greater disability The secondary outcomes of this study were change in leg pain and change in back pain at 6 month follow-up, as measured by a visual analogue scale VAS Follow-up information was obtained by mailed questionnaire at 1, 3, and 6 months.

To characterize the study population at baseline, we calculated means and standard deviations SD for continuous variables, medians and interquartile ranges IQR for ordinal variables, and frequencies and proportions for categorical variables. The method of last value carried forward was used to account for missing outcome data.

To examine whether age was related to outcome when treated as a continuous variable, we repeated the multivariate analyses replacing age group with age in years. Last, given the absence of any prior literature on differences in rates of recovery from LDH by age, we conducted secondary longitudinal analyses of outcomes by age group at baseline, 1 month, 3 months, and 6 months, while adjusting for covariates, using generalized estimating equations.

All analyses were performed using SAS software, version 9. Figure 1 presents a flowchart of study recruitment. One hundred and seventy patients were eligible to participate in this observational study. Of these, seven patients were not offered informed consent due to failure on the part of the recruiting physicians, and an additional three patients refused to participate. Of consented patients, three patients experienced clinical improvement and did not go on to receive MRI, and three patients were excluded for having nerve root impingement due primarily to causes other than LDH. Individuals who underwent surgery were younger than those who did not There were otherwise no demographic or clinical factors that were significantly associated with surgical treatment over the follow-up period data not shown.

The age of older adults ranged from 60 to Patients who were eligible to participate but were missed or refused were not materially different from study participants with respect to demographic features. Baseline characteristics of the study sample by age group are presented in Table 1.

Stem Cell Treatment Degenerative, Bulging or Herniated Discs Stop Back Pain

Older adults had higher comorbidity burden median [IQR] of 1 [0,3] vs. Some physical examination and MRI characteristics differed by age group. A positive straight leg raise test SLR was significantly less common in older adults, and conversely, a positive femoral stretch test FST was significantly more common in older adults. Midlumbar disk herniation and foraminal disk herniations were more common in older adults. Baseline VAS back pain, however, was slightly lower in older adults as compared to younger adults 4.

Associations between age group and outcomes of nonsurgical treatment at six-month follow-up are presented in Table 2. There were no statistically significant bivariate associations between age group and the primary outcome of ODI change score at 6 months. In multivariate analysis including the covariates of gender, race, employment status, prior LBP, tobacco history, comorbidity SACQ , duration of symptoms, baseline ODI, herniation level, herniation location, and herniation morphology, the association of age group with ODI remained nonsignificant.

Age group was not significantly associated with the secondary outcome of leg pain in bivariate analyses. In multivariate analysis including all covariates used in the full model for ODI described above with adjustment for baseline leg pain , age group continued to not be associated with leg pain change scores. Older adults showed significantly less improvement in back pain as compared to younger adults 2.

However, older adults had reported less back pain at baseline as compared to younger adults see Table 1. In multivariate analysis including all covariates used in the full models described above with adjustment for baseline back pain , adjusted back pain improvement was not significantly different in older adults as compared to younger adults 2. When age was treated instead as a continuous variable in a secondary analysis, age remained not significantly associated with change in ODI, leg pain, or back pain data not shown. Table 3 describes treatments utilized by study participants over the 6-month follow-up period.

Physical therapy was utilized more frequently in older adults than in younger adults To account for the influence of treatments received, we conducted secondary analyses of the associations between age group and 6-month change scores for disability and pain, while adjusting for the utilization of oral corticosteroids, physical therapy, transforaminal ESI, and baseline covariates. Our findings were not materially changed by accounting for these treatments.

No single treatment was significantly associated with outcomes for disability and pain data not shown. In longitudinal analyses, we examined the outcomes of disability and pain by age group at 1 month, 3 months, and 6 months, while adjusting for demographic and historical features which were significant in our primary analyses: Figure 2 depicts outcome scores over time, adjusted for comorbidity, duration of symptoms, and work status. Both groups demonstrated the largest improvements in ODI and pain scores over the first month of follow-up, with a slower rate of improvement thereafter.

The meaning of this interaction can be easily appreciated by simple visual inspection of longitudinal trends for adjusted pain scores in Figure 2. This figure demonstrates that trajectories of improvement between age groups were similar for the outcome of ODI. However, a greater amount of the total improvement in leg pain and back pain intensity in older adults was noted in the first month of follow-up, as compared to younger adults.

The primary finding of this study was that older adults demonstrated improvements in disability and pain with nonsurgical treatment that were not significantly different from those seen in younger adults over 6 months of follow-up, either with or without adjustment for potential confounders. No prior studies of nonsurgical treatment of MR-confirmed acute LDH have utilized repeated assessment with validated outcome measures at fixed intervals 30 - This has left a notable gap in our knowledge base regarding the course of improvement early in nonsurgically treated LDH.

A secondary finding of this study was that while rates of improvement in disability were not significantly different in older adults as compared to younger adults, a greater amount of the total improvement in pain intensity occurred in the first month of follow-up in older adults.

Compelling evidence has shown that the incidence of lumbar disc herniation LDH increases with age. In this study, retrospective clinical analysis of cases of LDH has been conducted to investigate the role of age in the incidence of LDH in the elderly. The aim of the study is to investigate the relationship between the process of aging and the occurrence of LDH in old adults.

The incidence of LDH drops with age in the elderly, especially after the age of 80 years. There is an obvious decrease in LDH in the elderly female. A decreasing incidence of LDH with aging occurs in the elderly. This investigation indicates that aging is not a contributor to the performance of LDH in the elderly although the incidence of LDH is proportional to age. The nucleus presses against the annulus, causing the disc to bulge outward. With further progress, the nucleus herniates completely through the annulus and squeezes out of the disc, placing pressure on the spinal canal or nerve roots.

Normally, daily activities cause the nucleus to press against the annulus. This pressure is not sufficient to cause disease.


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  7. However, the annulus tends to crack and tear with age and degeneration. With weakness in the annulus, the nucleus may begin to herniate squeeze through the damaged annulus. The pressure bulges the annulus outward in the beginning. Eventually, the nucleus herniates completely through the outer ring of the disc.

    Therefore, it seems that aging is a risk factor and a contributor to the incidence of LDH, which increases with age.

    Written informed consent was obtained from all participants. The comprehensive diagnostic process included medical history, physical examination, and diagnostic tests. Almost all patients had lumbar vertebrae or paravertebral tenderness. In general, Table 3 demonstrated that the incidence of LDH decreases with age in the elderly, especially after 80 years old.

    There is an obvious decrease in the elderly female Figure 1. Tables 4 — 6 showed that the aging factors hypertension, hyperlipidemia, and diabetes have no contribution to the incidence of LDH in the elderly. There is no difference in hypertension percentage between each age group. There is no significant change in the percentage of diabetic complication between each age group of patients with lumbar disc herniation.

    Contrary to past reports that the incidence of LDH increases with aging, this study has found that the incidence of LDH has a downward trend with aging in the elderly, especially after 80 years old.

    Lumbar Disk Disease (Herniated Disk)

    Abnormal activities, such as repetitive bending, twisting, and lifting, can increase abnormal pressure on the nucleus of the disc and injure the annulus, leading to herniation. Poor posture and incorrect lifestyle can place additional stress on the lumbar spine. Furthermore, there is no relationship between the incidence of LDH in the elderly and the age contributing factors hypertension, hyperlipidemia, and diabetes. Accordingly, we hypothesized that the volume and inflammation of the nucleus gets lesser since degeneration contributes to atrophy of the nucleus with the aging process.

    Thus, the pressure from the nucleus will become gradually less, with the result being lower incidence of annulus injury and occurrence of LDH, especially after 80 years old.