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⚾ | Rakuten Mogi aims to return to the actual battle while watching the progress of surgery for lumbar disc hernia


Photo Rakuten, Eigoro Mogi [Photo: Yuji Arakawa]

Rakuten Mogi aims to return to the actual battle while watching the progress of surgery for lumbar disc hernia

 
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On the 25th, Mogi underwent "disc removal for lumbar herniated disk" at a hospital in Fukushima prefecture.
 

120 games this season with a hit rate of .259, 14 home runs Rakuten on the 26th, Eigoro Mogi infielder underwent surgery for herniated disc ... → Continue reading

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Herniated disc

Herniated disc(Tsukikanban herniation, spinal disc herniation)herniaIs a type ofIntervertebral discA part of the body protrudes beyond the normal intervertebral space.

Between the vertebral bodies, there is an intervertebral disc called the largest avascular region in the human body.The intervertebral disc has a gelatinous nucleus pulposus in the center and a peripherycollagenConsists of an annulus fibrosus rich in.A state in which a part of the nucleus pulposus or the annulus fibrosus protrudes is a herniated disc. The classification by Macnab is famous.

Many animalsvertebralWhile living in a direction perpendicular to gravity, the spine is parallel to gravity because humans are bipedal.For this reason, a large load is applied to the intervertebral disc in the standing position.

Disc herniation is inferiorLumbar spine (L4 / 5, L5 / S1) is the most, followed by the bottomCervical spineMany,thoracicThere are few.It is less in the thoracic spine because of the rib cage, which causes less mobility between the vertebral bodies than in the cervical and lumbar spine.In addition, due to the running of nerve roots, the lower lumbar spine is more likely to cause nerve root symptoms than the upper lumbar spine, and may be more likely to be detected.As we grow older, mobility in the lower cervical spine decreases, hernias are less likely to occur, and relatively higher cervical spine lesions are more likely to occur.That is, a herniated disc is more likely to occur in the part of the spine that moves well.

symptom

In the case of lumbar disc herniation, the symptoms are often unilateral leg pain, but in the case of a herniation that protrudes to the rear even if it is large or moderate, symptoms appear on both sides.Leg pain is caused by compression by the herniated disc.In terms of textbooks, L4 / 5 has L5 symptoms.In addition to low back pain, lower limb pain, numbness, and in some cases large edema are seen, and in addition to subjective symptoms such as heaviness and immobility that the legs cannot be lifted, sensory impairment is exhibited in the area controlled by the damaged nerve. Or, it may cause muscle weakness due to paralysis of motor nerves.In addition, convulsions such as leg cramps are more likely to be induced.RarelyUrination disorder(S2-5 symptom).

Nerve rootRadiating painSensory disturbanceWeaknessMuscle atrophyReflectionProvocation test
L1Inguinal region, medial thighInguinal region, medial thigh   None 
L2Back of the waist, flanks, anteromedial thighsAnterior medial thighKnee extension muscle weaknessQuadricepsDecreased patellar tendon reflexFNST
L3Back of the waist, hips, anterolateral thighsAnterior-lateral thighKnee extension muscle weaknessQuadricepsDecreased patellar tendon reflexFNST
L4Buttocks, posterolateral thigh, anterior lower leg, medial dorsum of the footMedial lower leg, inner edge of toeClubfoot, weakened dorsiflexionQuadricepsDecreased patellar tendon reflexFNST
L5From the top of the sacroiliac joint to the crotch, the outside of the lower limbs, and the back of the footOuter lower leg, 1 to 2 toe backFeet, reduced dorsiflexion of the toes, difficulty in heel standingGluteus medius, knee flexor, tibialis anterior, extensor hallucis longus, long, extensor short toeTibialis posterior tendon reflexSLR
S1From the top of the sacroiliac joint to the crotch, posterior surface of the lower limbs, and the outer edge of the footDorsal abdomen, outer edge of toesReduced plantar flexion of feet and toes, difficulty in standing on toesGluteus maximus, long, peroneus brevis, gastrocnemius, soleusAchilles tendon reflex declineSLR

In the case of a giant herniation, cauda equina symptoms may appear, which are similar to the cauda equina type of spinal canal stenosis.A well-known symptom is intermittent claudication, which is known to be caused by impaired blood flow around the nerve roots.

In the case of upper lumbar disc herniation, low back pain (so-called L2 disorder) and hip pain (L3 disorder, etc.) may be complained.In other cases, back pain is typically not complained.

Juvenile disc herniation has high intradiscal pressure and is more likely to exhibit stronger symptoms than the elderly.In addition, as represented by lumbar hip extension contracture (tension hamstrings) when the lower limbs are raised, a strong reaction is likely to occur.

Diagnosis

The following are examples of differential diagnosis.

Another disease that presents with symptoms similar to a herniated disc is "spinal cord tumor".The number of cases is small and can hardly be detected except by examination by MRI or CT, but it should be considered when the X-ray image is normal in spite of the severity of the symptoms complained by the patient.

Inspection

Lasegue Sign
Used as a preliminary test.
Radiography
The herniated disc itself is not visible on x-rays, but it is useful for seeing bony changes in the spine.
MRI
It is extremely useful for diagnosing disc herniation.The advantage is that it is not invasive and the hernia morphology can be easily grasped on the image.Disadvantages include that the spatial resolution may be inferior to that of CT, and that MRI imaging itself is difficult because it is difficult to rest when there is severe pain.
Myelography
A method of injecting a contrast medium into the dura mater and observing the degree of nerve compression in its shape. Due to the widespread use of MRI and the need for injections and drug administration, it is an invasive test, so it is performed less frequently, but it is often necessary in cases where surgery is considered.
Discography
In addition to myelography, it is less often done because of its high invasiveness (it hurts).Responsibility for herniation It may be effective for high-level diagnosis and diagnosis of lateral disc herniation.
CTInspection
I often shoot according to myelography and discography.In order to see the bone component of hernia, a simple CT may be taken and compared.

治療

In most cases, a herniated disc does not require surgery.Suspected to be caused by a herniated discSciatica"After 12 weeks, 73% of people showed a reasonable and significant improvement without surgery."[1] ..However, this study did not identify the number of individuals with sciatica due to herniated discs.

Initial treatment is usuallyNon-steroidal anti-inflammatory drug(NSAIDs), but long-term use of NSAIDs in people with persistent low back pain is difficult due to potential cardiovascular and gastrointestinal harm.

Asymptomatic disc herniation is known, the treatment of disc herniation depends on its symptoms, and its existence is not the target of treatment.Treatment of herniated discs is, in principle, conservative therapy.For thisPainkiller, Exercise therapy and traction,HyperthermiaRehabilitation such as is included.further,Nerve blockTherapy (nerve root block, epidural block, etc.) may be indicated.Exercise therapy performed in rehabilitation includes the McKenzie method, which is a low back pain exercise that bends the lower back and stretches the muscles around the hip joint (hamstrings and iliopsoas muscles).[2]

Medicine

On January 2014, 1, the first drug for the treatment of lumbar disc herniation, Hernicor (generic name: chondrase), was submitted to the Ministry of Health, Labor and Welfare for manufacturing and marketing approval.[3]Since this new drug has the effect of decomposing and shrinking the protruding intervertebral disc by injecting an enzyme that decomposes the intervertebral disc into the intervertebral disc, future treatment of disc herniation with the drug is expected.In addition, this drug is the first therapeutic agent in Japan to be injected directly into the intervertebral disc, and is characterized by the fact that it does not require general anesthesia and is less burdensome to the body than surgical therapy.In Japan, the product was approved for manufacturing and marketing on March 2018, 3, and was launched on August 23, 2018.[4]

手術

If conservative therapy does not respond, surgery is considered.Although surgical indications have not been established within the academic society, dysuria is generally regarded as an absolute surgical indication.In addition, surgery is considered for cases of muscle weakness and severe pain.In addition, even if there are no strong symptoms, it is often indicated if the symptoms persist for 3 months or longer.There are several surgical methods, but the classic and still mainstream is the Love method.There are also endoscopes (endoscopic discectomy (MED)) and microscopes (microscopic discectomy, Micro Love method), but the basic method is to remove the herniated disc, and social insurance is available. Applies.

In addition, laser treatment (Percutaneous Laser Disc Decompression; PLDD), percutaneous discectomy (PD), percutaneous endoscopic lumbar discectomy (PERD), 2003 ToAkira Dezawa(Teikyo University教授) Introduced to Japan, there is a surgical procedure called "Percutaneous Lumbar Discectomy (PED)". PED minimizes incision of the affected area and provides a short rest. It is attracting academic attention as it is possible to return to society by (treatment / rest) and prevent recurrence of herniation.[5]..Although it is less invasive and can be operated on by hospitalization for one night from a day trip, the effectiveness rate is low and the indications are limited. In addition, there are extremely large individual differences such as pain sensation due to local anesthesia, and some patients feel almost no pain during surgery and their symptoms improve immediately after surgery. In some patients, the symptoms finally improve.

It is said that 5% to 10% of surgical cases will recur.The improvement rate of recurrent cases is generally inferior to that of the first case.Treatment is in JapanOrthopedicsIt is performed by a spine surgeon centered on a doctor,NeurosurgeryBut there are some facilities.There is a spinal cord society, which is a related academic society, and in recent years, it has been accredited as a spinal surgery instructor, and it is published on the website, but since it is a self-reported accreditation system, please take that into consideration. There is a need.

Japanese Orthopedic AssociationAfter passing the specialist examination and obtaining the qualification of "orthopedic specialist", the certified doctor also obtains the qualification as "Nisseikai certified spinal spinal disease doctor", and then takes the practical examination and "inside the spine". Obtained the qualification of "Spine and Spinal Disease Doctor".We publish a list of "spine endoscopic surgery / technically certified doctors" certified by academic societies.[6].

Folk remedies

  • For acupuncture and moxibustion treatment between L4 / L5Large intestine hole(Dacho Yuketsu), to relieve pain.
  • chiropracticTherapy is not appropriate as it can exacerbate symptoms[7].

Disc herniation in non-human animals

In dogs, it occurs most often in cartilage dystrophic breeds, but can occur in all breeds.It is classified into Hansen type I and Hansen II type according to the degenerative mode of the intervertebral disc.

Epidemiology

Disc herniation is said to have a large genetic effect and is called CILP.proteinMutant,cartilageIt is considered that one of the onset factors is to hinder the growth of.

The latest research shows that genetic factors are involved in one of the causes of lumbar disc herniation.RIKENThe research group found out.[8]

prevention

In daily life, for example, when you bend down, you should be careful about movements and postures such as lowering your hips, not curling your back, and not putting a strain on your lower back, but only those who have experienced the onset can understand the degree of caution. Will.

Also, improve blood circulation by exercising, taking a bath, etc. to warm and cool your lower back.It is good to work on strengthening the muscles around the waist.

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References

外部 リンク

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