Why Is Disc Herniation Between L4 ( L4 ) ( 4 )

DOI: 2/8/2016. Patient is a 54-year old male laborer who sustained a work related injury/ fractured 3 ribs & back when he got stuck and fell on his left side against the concrete when he was operating jack hammer. The patient is subsequently diagnosed with Herniation of lumbar disc. As per workers’ compensation follow up dated 7/25/16, patient complains of low back and radiating pain. In the evaluation there was an S1 distribution with weakness that was quite significant. Of note, the test of the MRI scan revealed that L5/S1 had a broad-based disc bulge of 3.5 mm, bilateral facet arthropathy, and at L4/5 there is also a broad-based concentric bulge. Physical examination revealed that he is still having pain in the back going down into the buttock. It is not an acute radicular event.

Obtain a lumbar myelogram. If the myelogram confirms the disk herniation procedure with discectomy the following day.

Assessments are lumbosacral intervertebral disc disorder with radiculopathy, lumbar spondylosis without myelopathy or radiculopathy and myalgia.

Impressions are lumbar discogenic pain syndrome, left lumbar radiculitis, myofascial pain, lumbar degenerative disc disease, and chronic pain syndrome and shoulder pain.

11/13/14 MRI of the lumbar spine showed 4mm left paracentral and foraminal disc protrusion at L4-5, which mildly impinges upon the thecal sac and the proximal left L5 nerve root. The disc protrusion also moderately narrows the left foramen and lateral recess. There was also a 2mm posterior central disc protrusion at L5-S1. A 2mm disc bulge at L2-3 was seen. There was a mild degenerative facet and ligament flava hypertrophy at L4-5 and

Patient unable to walk heel to toe, perform the Romberg test, stand on one foot, or perform a shallow knee bend without risk of falling. The patient complains of lower back, hip, and knee pain. . Assessed patient’s pain at this time. Patient states that, “the pain is felt in her lower back, hips, and knees constantly and relieved with ibuprofen” she rated the pain a 4 on a scale from 0 to 10. Patient stated, “lower back always aches.” Described the pain as constant and dull. Affects her activities of daily living because she “isn’t able to cook, clean, or exercise.” In a supine position the patient, with help, was able to extend legs upwards about 40 degree and flex hips with limited range of motion. Patient was able to resist with light resistance when pressure was applied to the legs anteriorly and posteriorly. Sitting back in the patient’s chair, the patient was able to bend at the hip. No pain or tenderness felt when palpating the spinous process. The patient was able to actively flex and extend the ankle joints with limited range of motion and some resistance with support under the lower leg. The patient was able to flex and extend the feet with limited range of motion and some resistance. No pain or crepitus with flexion and extension of the feet and ankles. Inspected the patient’s skin of the anterior and posterior legs, ankles, and feet. The skin of the upper legs were dry, with

Possible symptoms of a herniated disc include pain that radiates through the back and possible down the arms or legs, depending on the location of the herniation. There can also be noted numbness and weakness of the arms and neck. Some people may not even know that they have a herniated disc because not all cases present with leg or back pain. Other signs and symptoms of a herniated disc may include muscle spasms or deep muscle pain. In extreme cases, a patient may present with weakness in both legs and/or the loss of bladder control and bowel control. This is a serious problem called cauda equine syndrome and requires immediate medical attention.

Moreover, now I learn most specific radiological techniques for different condition especially associated to spine. I learn importance of MRI and CT scan in different spinal pathological condition. To improved knowledge regarding types of MRI or CT scan method will most appropriate to condition, for instance, in the disc herniation condition, MRI will provide most appropriate result for soft tissue injury but in other cases CT myelogram is second choice techniques. Discography, is second last choice, before spinal surgery or fusion. I used to seen a 57 year old male patient with lower back pain, patient have improvement in pain with modality and strengthening exercises techniques but suddenly one day he was lifting trash pot and feel severe pain with radiating symptoms and feeling less sensation around inner thigh. Next day he came to me and complaining of this symptoms which are indicates for referral and further investigation. Afterwards, MRI reports revealed prolapsed intervertebral disc (PIVD-extrusion) at level lumbar 3 and 4 (L3-L4). I also learn certain condition (spinal stenosis), physical examination will helpful to detect pathological condition and which always should be confirmed by diagnostic imaging method and requirement for referral to appropriate

Roughly, 80% of the population will experience lower back pain once in their lifespan, while two-thirds of the population will experience neck pain. As ludicrous as it might appear, the ugly truth about slipped disc complications is that they are increasing at an alarming rate. Back pain and neck pain are the most common reasons of immobility in individuals under 45 years old. It is now very ubiquitous and not only found in elderly, or after a traumatic happening. A slipped disc can happen throughout the entire spine but is most common in the cervical and lumbar area. Inappropriate posture, unwarranted or protracted axial weight-bearing activities are the culprits; in other words, extended sitting or lifting and carrying of hulking objects that cause uneven distribution of weight across your spinal joint or the spinal discs. Over the time, axial loading (sitting or carrying weighty loads) can dehydrate your spinal disc. Dehydration of the

Intervertebral disc degeneration is a common disorder that is characterized by the progressive degeneration of the intervertebral discs, resulting in deformity and dysfunction. The structural and functional integrity of the spine in essence is compromised due to several issues, including inflammation, diminished oxygen, and deficiency of essential water and sugars, which are key components of intervertebral discs balance and proper function. In the United States, roughly 5% of the population experience chronic lower back pain problems, much of which is associated with the disorder. Intervertebral disc degeneration develops with age, and tends to be more prevalent in people who have problems with

DOI: 11/13/2014. Patient is a 32-year old male technician who sustained injury at the time he was breaking loose a pulser component, he felt a sharp pain to his right side, low back buttocks and right leg. The patient was subsequently diagnosed with lumbar degenerative disc disease, radiculopathy and, lumbar spinal stenosis. Per MRI of lumbar spine without contrast dated 12/23/14 revealed at L4-5 there is disc space height loss, disc bulging and facet degenerative change; at L5-S1 there is posterior disc bulging resulting in mild narrowing of the central canal, and; at T11 to T12 there is posterior disc bulging resulting in mild narrowing of the central canal. As per focused history and physical dated 3/17/15, patient is presented to the office

Herniated discs affect a large portion of the population, so it is easy to see why so many patients are undergoing procedures to place an artificial cervical disc Plano TX. Although invasive, the surgery offers effective pain relief while improving a patient’s mobility after developing a herniated disc. Considering one-thirds of adults 20 years of age and older show signs of a herniated disc, understanding this condition is essential. Using this guide, you will understand the causes, signs, and treatment options for herniated discs.

Neurologic—decreased vibratory sensation in the lower legs; bilaterally decreased knee reflexes; no asterixis; decreased vibratory sensation in the lower legs; bilaterally decreased knee reflexes; no asterixis; normal sensation and position sense in upper and lower extremities; cranial nerves II

The cervical and lumbar regions of the vertebral column are most likely to experience a herniated disc. This is so, because these regions have the least structural support, while having to endure the most strain. Since the nerves that supply the upper limb are found in the cervical region of the spinal cord, cervical herniated discs may cause pain here. Muscle weakness in the upper limb and neck pain may also occur as a result of injury to the cervical discs. Injury to the lumbar region typically causes lower back pain. If the herniated disc affects nerve fibers, pain that radiates through the leg and down to the foot may occur. This condition is known as sciatica

Prior to the physical examination and to accurately identify clinical findings, the patient should don a gown, if culturally permitted, to easily view the anatomical landmarks. To avoid excessive repositioning and client discomfort, the examiner would be most successful by positioning the patient in a standing position initially, followed by sitting, supine, and prone positioning. While in the standing position, the examiner would assess posture, signs of scoliosis, hyperlordosis and kyphosis. Scoliosis is assessed by requesting the patient to bend forward 90 degrees. Asymmetric rib deformity is indicative of a positive finding. The examiner may also identify lateral curvature of the spine accompanied by vertebral rotation in the thoracic or lumbar region. The most common finding with vertebral involvement is right thoracic scoliosis (Hay, 2014). Restrictions in movement are determined by passively and actively flexing, extending, rotating and laterally bending the spine. By instructing the patient to stand on one leg, allows for spinal expansion and assesses for pain. Spondylolysis (interarticularis fractures) is a positive finding. The clinician would then examine the patient in a seated position. This marks a prime opportunity to check for muscle strength, deep tendon reflexes and sensation. Motor strength tests help determine the degree of neurologic deficit. Sensation and