Lumbar disk herniations

The medical back belt with integrated neuromuscular electrical stimulation (NMES) is an orthopaedic device that is able to stabilize the back after lumbar disk herniation and stimulate the muscles to make back muscle growth possible and to prevent the back from having on-going pain (Fig. 6.1). 

Lumbar disk herniations and their medical treatments... 

Lumbar disk herniations appear frequently in both men and women it literally means a rupture or bulge . This disease is also called hernia nucleuspolposus and can differ per patient. There are three different places in the back where a disk herniation can take place in the cervical vertebrae, thoracic vertebrae and lumbar vertebrae. In most of the cases a disk herniation will appear in the lumbar vertebrae. 

In a cervical disk herniation, the pain radiates from the neck to the arms and a deaf feeling of the skin can be a possible consequence. A thoracic disk herniation indicates pain in the arms and a loss of power. In a lumbar disk herniation, the pain radiates to the legs, buttocks and feet. The skin also can have a deaf feeling and also a loss of power is possible. As the complaints worsen or a paralysis phenomenon appears the doctor has to act very fast to prevent permanent damage. 

CoUagenase specifically cataly2es the hydrolysis of coUagen, and is used in debridement of dermal ulcers and bums (191). It, like chymopapain, is also useful in the treatment of herniated lumbar disks (192,193). The rationale for coUagenase treatment in this instance is based on the preponderance of coUagen in herniated disk tissue, and the inabiUty of other en2ymes to dissolve coUagen (194). 

Swedish authors have summarized cases reported to three Swedish insurance companies within 2 years (178). They found 21 cases associated with the cervical spine, six associated with the thoracic spine, 13 with the lumbar spine, and 14 with the sacro-iliac joints. Cervical spinal manipulation had caused damage to the vertebral artery with subsequent paralysis in three cases and disk herniation in three cases. Lumbar spinal manipulation had caused disk herniation in six cases, three of whom suffered severe and persistent problems. 

Chronic exposure to whole-body vibration may result in an increased risk of low back pain, sciatic pain, and prolapsed or herniated lumbar disks compared to control groups not exposed to vibration. These injuries occur predominantly in crane operators, tractor drivers, and drivers in the transportation industry (Bovenzi and Hulshof, 1998). However, it is difficult to differentiate between the roles of whole-body vibration and ergonomic risk factors, such as posture, in the development of these disorders. 

Chymopapain [9001 -90-6] derived from the latex of the papaya tree, produces improvement in lower back pain and sciatica in the majority (75%) of recipients (185—189) when injected into the lumbar intervertebral disks of patients suffering from herniated disk (the nucleus pulposus). This treatment degrades the proteoglycans of the diseased nucleus pulposus, resulting in shrinkage of the disk and reduction of pressure on the nerve roots (190). 

Lumbar puncture is considered mandatory in patients with suspected bacterial meningitis but the procedure can be hazardous with a risk of brain herniation in patients with raised intracranial pressure, and imaging with computed tomography or MRI is recommended for selected patients to detect brain shift. Patients who are in an immunocompromised state, have new-onset seizures, moderate-to-severe impairment of consciousness or signs that are suspicious of space-occupying lesions (e.g. papilloedema - oedema of the optic disk) should undergo neuroimaging prior to lumbar puncture. 

The use of chymopapain for the treatment of sciatic has been extensively reviewed by Nachemson and Rydevik [71] and by Buttle [72], Chemonucleolysis is the name used for the treatment of sciatica pain by injection of chymopapain into a protruded or herniated lumbar intervertebral disk. 

Examples of neurologic etiologic factors include priapism in patients with degenerative stenosis of the lumbar canal, priapism secondary to cauda equine syndrome and herniated disk (Baba et al. 1995). 

The thoracic spine is subject to many conditions that affect the cervical and lumbar spine including somatic dysfunction, herniation of an intervertebral disk, arthritis, and other bony and soft tissue injuries and degenerative processes. Osteoporosis coimnonly manifests in the thoracic spine, with vertebral compression fractures and formation of the dowager s hump, caused by micro fractures of the anterior bodies of the vertebrae leading to a forward bending of the upper thoracic spine. This chapter discusses some of the conditions most commonly affecting the thoracic spine. 

Herniated disks are most eommon in the lower lumbar region beeause of narrowing of the posterior longitudinal ligament, the increased ineidence of degenerative disk disease, ligament... 

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