IVD Case Study

University:
The University Of Western Ontario
Course:
Pathology 3500B | Human Pathology
Academic year:

2023
Views:

446

Pages:

3
Author:

Kyuwon J.

● Mock up case study ○ patient :38 year old male ■ office worker ○ Lower back pain for 3 weeks ○ pain radiation on posterior left legs ■ calf and foot (sciatica) ○ tingling + numbness in left toe ○ no trauma, symptoms after lifting heavy boxes ○ Medications ■ Occasional use of NSAID ■ Non-contributory family history Physical examinations ● Normal spine alignments ● mild lumbar flattenings ● decrease in ankle reflex on the left ● Neurologic examination ○ Weakness (mild) in dorsiflexion on greater toes ○ Sensory loss in L5 dermatomes Risk factors ● Age 30-50(common) ● Sedentary life style ● heavy box => poor lifting ● Smoking => acceleration of degeneration of disc ● obesity Imaging ● MRI lumbar spine ○ L4-L5 intervertebral disc has seen posterolateral herniation ○ Normal disk does not have any alterations ● Blood work ○ Normal ■ exclude infection and inflammatory causes Pathophysiology ● Normal disc ○ Nucleus pulposus (gelatinous) within annulus fibrosus ■ Firbrocartilaginous rings ○ Function as a shock absorber + spinal flexibility ● Herniated disc ○ Annulus fibrosus becomes weakened ■ nucleus pulposus protruded ○ Protrusion is posterolateral ■ posterior longitudinal alignment becomes thinner ■ Nerve root compression may happen Most commonly seen in L4-L5 , L5-S1 ● Posterolateral herniation ○ most symptomatic since much of nerve compression is linked to his site ● Straight leg raise test ○ highly sensitive in lumbar disc herniation ● Conservative management ○ surgery for refractory cases ○ Neurological compromises Managements ● Conservatives ○ Rest in bed not top choice ■ mobilization is preferred ■ Muscle relaxants for short period of time ■ Physiotherapy ● Core strengthening ● Posture training ● Exercise ■ Epidural steroid injection could be done if the patient keeps noticing pain (radiculopathy) ● Surgical ○ done when conservative method fails within 6-12 weeks ■ Microdiscectomy ● Minimally invasive removal ● Herniated fragments ■ Laminectomy ● laminal removal from decompressions ■ Artificial disc replacements ● only for recurrent of severe degeneration