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LOWBACKPAIN&LUMBARDISCHERNIATIONLOWBACKPAIN&LUMBARDISCHLOWBACKPAINLOWBACKPAINPathophysiologyComplexChemicalcause:glutamate,substanceP,PLA2PathophysiologyComplexSymptomsCause:mechanicalstrainSpinelistSymptomsCause:mechanicalstraSignsNormalneurologicexaminationNosignofspinalnervecompressionSignsNormalneurologicexaminaImagingStudiesNarrowdiskspaceOsteophytosisAlsomaybenormalImagingStudiesNarrowdisksp脊柱問題損傷low+back+pain課件TreatmentAnalgesicsRestExercisesCorsetTreatmentAnalgesics脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件CourseandPrognosisSpontaneousremissionReturntonormalactivitiesCourseandPrognosisSpontaneLumbarDiscSyndromeLumbarDiscSyndrome脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件PathophysiologyNucleuspulposusbulgingNeuralstructurescompressionandirratationPathophysiologyNucleuspulposuSymptomsSciaticaAggravatedbycoughing,sneezingandintra-abdominalpressureincreasingSymptomsSciaticaSignsSensorychangeMotorweaknessAbnormaltendonreflexMuscleatrophySignsSensorychangeDiagnosticTestsStraightlegraisingtestBragardsigntestDiagnosticTestsStraightlegr脊柱問題損傷low+back+pain課件ImagingStudiesCTMRIImagingStudiesCT脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件DifferentialDiagnosisTumorInfectionDiscitisVertebralosteomyelitisAbscessDifferentialDiagnosisTumorTreatmentTreatmentConservativeManagementBedrestAnalgesicsAnti-inflammatorymedicationConservativeManagementBedresSurgicalTreatmentRadiofrequencyLaminectomyfordiskremovalPLIF,TLIFEndoscopicsurgerySurgicalTreatmentRadiofrequen脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件FacetSyndromeFacetSyndromePathophysiologyCollapseofdiskTwosmallnervebranchsPathophysiologyCollapseofdisClinicalFindingsDiffusedpainSpinallockingClinicalFindingsDiffusedpainTreatmentAnti-inflammatorydrugsMBB(mediabranchblock)TreatmentAnti-inflammatorydru脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件Case32y/oMale10yearswithdailyLBP,Disablinglumbagowithleftlowerextremityradicularpainfor3monthsConservativetreatmentwithdailymedicationsPH:normalSLR(+),EnhancedSLR(+)HypoesthesiainlateralsideofleftcalfandfootLevel5inMusclestrengthofbilateralhalluxdorsiflexionandplantarflexorNormalreflexofkneetendonandAchillestendonRectalfunctionandanalreflexwerepreservedPathologicalsyndrome(-)VASofBackandLegPain(4,6respectively)Case32y/oMale1st-OP1st-OP1st-OP1st-OP1st-OPL3/41st-OPL3/41st-OPL4/51st-OPL4/51st-OPL5/S11st-OPL5/S11st-OP1st-OP1st-OP1st-OP1st-OP1st-OPDiagnosis?DiagnosisforEtiologyMassiveLDHwithRadiculopathyPosteriorRimSeparationorOssificationofHerniatedDiscDiagnosisforInvolvedSegmentL5/S1
Diagnosis?TherapyOptionPleaseChoosetheTherapyYouPreferedConservativetreatmentOrthosisMedications(NSAIDs/Narcotics)ChropracticandRehabilitationSurgicalTreatment
DecompressionaloneorwithFusionOperativeMethod
ClassicTechnique
(Laminotomy,Hemilaminectomy,Laminectomy)MISTechnique(MED,PELD...)Others
Blocks,...
TherapyOptionPleaseChoose1st-OperationL5/S1DiscectomywithoutfusionunderMicroscopeImmobilizationwithBraceandBedRestfor3WeeksExerciseofincreasingtrunkextensorsstrengthandSLRASAPPainFreefromLumbagoandSciaticaVASofBackandLegPain(0,1)over3monthF/U1st-OperationL5/S1Discectomy2nd-Admission5.5monthsafterfirstoperationOutofworkduetodisablingdailyLBPwithleftsciaticpainDailymedications(NarcoticandCelebrex)for6weeksPH:DenialofinjuryandtraumaSLR(+),EnhancedSLR(+)NumbnessinlateralsideofleftcalfandpartoffootLevel4inMusclestrengthofleftfootplantarflextionDecreaseofleftAchillestendonreflexCaudaequinasyndrome(-)VASofBackandLegPain(4,7respectively)2nd-Admission5.5monthsafter2nd-OP2nd-OP2nd-OPL3/42nd-OPL3/42nd-OPL4/52nd-OPL4/52nd-OPL5/S12nd-OPL5/S12nd-OP2nd-OP2nd-OP2nd-OP2nd-OP2nd-OPDiagnosis?DiagnosisforEtiology
FBSS--RecurrentLumbarDiscHerniationwithRadiculopathy
DiagnosisforInvolvedSegmentL5/S1(Lumbosacralheniationinvolving1-stSacralRoot)
Diagnosis?TherapyOptionPleaseChoosetheTherapyYouPreferedConservativeTreatmentOrthosisMedications(NSAIDs/Narcotics)ChropracticandRehabilitationSurgicalTreatment
DecompressionaloneorwithFusionOperativeMethod
ClassicTechnique
(Laminotomy,Hemilaminectomy,Laminectomy)MISTechnique(MED,PELD...)Others
Blocks
TherapyOptionPleaseChoose脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件2nd-OperationL5/S1Mini-TLIFwithInstrumentionWalkaroundwithBraceonthethirdpostoperativedayPainFreefromLBPandRadicularPainVASofBackandLegPain(1,2)over3monthF/U;(0,1)over6monthF/U2nd-OperationL5/S1Mini-TLIF2nd-Postoperation2nd-Postoperation2nd-Postoperation2nd-Postoperation3month-F/U3month-F/U6month-F/U6month-F/U12month-F/U12month-F/ULOWBACKPAIN&LUMBARDISCHERNIATIONLOWBACKPAIN&LUMBARDISCHLOWBACKPAINLOWBACKPAINPathophysiologyComplexChemicalcause:glutamate,substanceP,PLA2PathophysiologyComplexSymptomsCause:mechanicalstrainSpinelistSymptomsCause:mechanicalstraSignsNormalneurologicexaminationNosignofspinalnervecompressionSignsNormalneurologicexaminaImagingStudiesNarrowdiskspaceOsteophytosisAlsomaybenormalImagingStudiesNarrowdisksp脊柱問題損傷low+back+pain課件TreatmentAnalgesicsRestExercisesCorsetTreatmentAnalgesics脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件CourseandPrognosisSpontaneousremissionReturntonormalactivitiesCourseandPrognosisSpontaneLumbarDiscSyndromeLumbarDiscSyndrome脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件PathophysiologyNucleuspulposusbulgingNeuralstructurescompressionandirratationPathophysiologyNucleuspulposuSymptomsSciaticaAggravatedbycoughing,sneezingandintra-abdominalpressureincreasingSymptomsSciaticaSignsSensorychangeMotorweaknessAbnormaltendonreflexMuscleatrophySignsSensorychangeDiagnosticTestsStraightlegraisingtestBragardsigntestDiagnosticTestsStraightlegr脊柱問題損傷low+back+pain課件ImagingStudiesCTMRIImagingStudiesCT脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件DifferentialDiagnosisTumorInfectionDiscitisVertebralosteomyelitisAbscessDifferentialDiagnosisTumorTreatmentTreatmentConservativeManagementBedrestAnalgesicsAnti-inflammatorymedicationConservativeManagementBedresSurgicalTreatmentRadiofrequencyLaminectomyfordiskremovalPLIF,TLIFEndoscopicsurgerySurgicalTreatmentRadiofrequen脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件FacetSyndromeFacetSyndromePathophysiologyCollapseofdiskTwosmallnervebranchsPathophysiologyCollapseofdisClinicalFindingsDiffusedpainSpinallockingClinicalFindingsDiffusedpainTreatmentAnti-inflammatorydrugsMBB(mediabranchblock)TreatmentAnti-inflammatorydru脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件脊柱問題損傷low+back+pain課件Case32y/oMale10yearswithdailyLBP,Disablinglumbagowithleftlowerextremityradicularpainfor3monthsConservativetreatmentwithdailymedicationsPH:normalSLR(+),EnhancedSLR(+)HypoesthesiainlateralsideofleftcalfandfootLevel5inMusclestrengthofbilateralhalluxdorsiflexionandplantarflexorNormalreflexofkneetendonandAchillestendonRectalfunctionandanalreflexwerepreservedPathologicalsyndrome(-)VASofBackandLegPain(4,6respectively)Case32y/oMale1st-OP1st-OP1st-OP1st-OP1st-OPL3/41st-OPL3/41st-OPL4/51st-OPL4/51st-OPL5/S11st-OPL5/S11st-OP1st-OP1st-OP1st-OP1st-OP1st-OPDiagnosis?DiagnosisforEtiologyMassiveLDHwithRadiculopathyPosteriorRimSeparationorOssificationofHerniatedDiscDiagnosisforInvolvedSegmentL5/S1
Diagnosis?TherapyOptionPleaseChoosetheTherapyYouPreferedConservativetreatmentOrthosisMedications(NSAIDs/Narcotics)ChropracticandRehabilitationSurgicalTreatment
DecompressionaloneorwithFusionOperativeMethod
ClassicTechnique
(Laminotomy,Hemilaminectomy,Laminectomy)MISTechnique(MED,PELD...)Others
Blocks,...
TherapyOptionPleaseChoose1st-OperationL5/S1DiscectomywithoutfusionunderMicroscopeImmobilizationwithBraceandBedRestfor3WeeksExerciseofincreasingtrunkextensorsstrengthandSLRASAPPainFreefromLumbagoandSciaticaVASofBackandLegPain(0,1)over3monthF/U1st-OperationL5/S1Discectomy2nd-Admission5.5monthsafterfirstoperationOutofworkduetodisablingdailyLBPwithleftsciaticpainDailymedications(NarcoticandCelebrex)for6weeksPH:DenialofinjuryandtraumaSLR(+),EnhancedSLR(+)NumbnessinlateralsideofleftcalfandpartoffootLevel4inMusclestrengthofleftfootplantarflextionDecreaseofleftAchillestendonreflexCaudaequinasyndrome(-)VASofBackandLegPain(4,7respectively)2nd-Admission5.5monthsafter2nd-OP2nd-OP2nd-OPL3/42nd-OPL3/42nd-OPL4/52nd-OPL4/52nd-OPL5/S12nd-OPL5/S12nd-OP2nd-OP2nd-OP2nd-OP2nd-OP2nd-OPDiagnosis?Diag
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