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Extra resources for Common Spinal Disorders Explained
The diagnosis can be confinned with MR!. The usual treaunent is surgical excision via either a costotransversectomy or an anterior transthoracic approach. Thoracoscopic techniques have been developed, but they are not yet widely used. Summary Lumbar disc herniations are common and typically cause symptoms in people aged 30-40 years, Classically, patients present with sciatica and varying degrees of back pain. The most common levels to be affected are L4-5 and L5-5 I, causing L5 and 51 r(X)t compression, respectively; the exact signs and symptoms will depend on the level involved.
If the slip is less than 25%, keep the patient under review and monitor the situation both clinically and radiographically. If the slip is less than 50%, restrict the sporting activity of the patient, as these slips are usually isthmic spondylolistheses, with lysis of the pars All patients with a spondylolisthesis of greater than 25%, or those in the high-risk category (including females, those with spina bifida, and those with wedging of the body of l5), should be referred for an onhopedic or spinal opinion.
Compression injUries are generally stable and the majority can be treated conservatively \vith a shon period of bed-rest followed by mobilization, \vith or without an orthosis. If there is more than 50% venebral body compression, or more than 30 of local kyphosis, there may be damage to the more posterior structures in the spine: it is usually possible to elicit this clinically. Q Funher investigations, including CT and MRl, help to detennine the extent of the damage. Erect lateral X-rays may also be helpful to demonstrate funher collapse of the fracture when upright.