He aha ka maʻi degere degere (DDD)?

by Kauka Alex Jimenez | Paʻi Pain, ʻO ke akua, Kūʻai Back Pain, maʻi Pain, Health, Kōpae Herniated, Paʻa Paʻa Paʻa, 'ā'ī Pain, Sciatica, ʻO Sciatica Nerve Pain, ʻO Scoliosis, ʻO ke olakino'ōpū, Ka mālama Spine, Nā hōʻailona, Ka maika'i

ʻO ka maʻi Degenerative Disc Disease kahi manawa maʻamau no kahi kūlana kahi i hōʻino ʻia ai ka disverse intervertebral e hōʻeha ai i ka ʻeha mau, kahi e ʻeha ai i ke kua liʻiliʻi ma ka ʻaoʻao lumbar a i ʻole ka ʻāʻī o ka ʻāʻī. ʻAʻole ia he "maʻi" i kēlā me kēia, akā ʻo ka haki maoli ʻana o kahi disverse intervertebral o ka iwi kuamoʻo. ʻO ka disverse intervertebral kahi hanana e nānā nui i ka nānā ʻia ʻana ma hope koke iho nei, ma muli o nā hopena maʻi. Hiki i nā loli pathological hiki ke hana i ka hoʻohaʻahaʻa disk me fibrosis, narrower, a me disiccation disk. Hiki i nā hemahema anatomical like ʻole ke hana i loko o ka disverse intervertebral e like me sclerosis o nā endplates, fissuring a me ka hoʻoliʻiliʻi mucinous o ka anulus, a me ka hoʻokumu ʻana i nā osteophytes.

ʻO ka ʻeha hoʻi a me ka ʻāʻī ʻeha nui nā pilikia epidemiological nui, kahi i manaʻo ʻia e pili ana i nā loli degenerative i ka pā dis. ʻO ka ʻeha o ke kumu ka lua kumu o ka kipa ʻana i ka mea lapaʻau ma USA. Manaʻo ia ma kahi o 80% o nā pākeke US e hōʻeha nei i ka ʻeha ʻeha haʻahaʻa ma kahi o ko lākou manawa ke ola nei. (Modic, Michael T., a me Jeffrey S. Ross) No laila, ʻo ka hoʻomaopopo hohonu ʻana i ka maʻi disc degenerative e pono ai no ka mālama ʻana i kēia ʻano maʻamau.

Anatomy o nā Pili Hana Hoʻohui

Koi a ka Pūnaewele

ʻO ka pīkoi ke kumu nui, ka mea e mālama ai i ka pou a hāʻawi i nā pilikia me nā ʻano maʻi. ʻO ka piline ka hiku o ka vertebrae cervical, ʻumikūmālua pālua thoracic vertebrae, ʻelima lumbar vertebrae, a ʻehā sacral a me coccygeal vertebrae. Mālama ʻia ka palekana o ka kuʻina e nā kolamu ʻekolu.

Hoʻokumu ʻia ke kolamu mua e ka ligament longitudinal mua a me ka ʻaoʻao mua o ke kino vertebral. Hoʻokumu ʻia ke kolamu waena e ka ʻaoʻao hope o ke kino vertebral a me ka ligament longitudinal posterior. ʻO ka kolamu o hope e pili ana i kahi kino o hope i loaʻa i nā kaʻina transverse, laminae, facets, a me nā kaʻina spinous. (DDegenerative Disk Disease: Background, Anatomy, Pathophysiology`)

Anatomy o ka Intervertebral Disc

Kanaka intervertebral pili ma waena o nā kino o ka vertebral kokoke i ke kolamu vertebral. Ma kahi o kahi hapa o ka hapa o ka nui o ka kolone o nā iwi spinal i hoʻokumu ʻia e nā disc intervertebral. ʻO kēia disc ka mea i hoʻopili pū ʻia ai fibrocartilaginous, kāhea ʻia hoʻi i ka hoʻopili pū ʻana i kahi symphysis. ʻAe ka ʻae i kahi neʻe liʻiliʻi i ka vertebrae a paʻa pū i ka vertebrae. Hōʻike ʻia ka disc Intervertebral e kona kūwaho e kūʻē ana a i ke hoʻoweliweli ʻana i nā ʻano hōʻino. Hoʻopili ʻia kahi disc intervertebral mahele o nā ʻāpana he ʻekolu; ka gelatinous nucleus pulposus, waho annulus fibrosus, a me ka cartilage hoʻopau i nā mea kiʻekiʻe a maikaʻi loa i ke ʻoihana o nā kino vertebral.

ʻO ka nupepa nukleus ka mahele ʻāpana o ka gelatinous. ʻO ia ka proteoglycan a me ka wai wai i hoʻopaʻa ʻia e nā ʻano II Collagen a me nā elastin fibers i hoʻonohonoho kūlohi a me ka Irregularly. ʻO Aggrecan ka proteoglycan nui i loaʻa i ka pulusus inti. ʻO ia kahi kokoke i 70% o ka pulposus inti a kokoke kokoke i 25% o ka fibrosus annulus. Hiki iā ia ke mālama i ka wai a hāʻawi i nā waiwai osmotic, ka mea e pono ai e pale aku i ka hoʻoweliweli a hana ʻana e like me ka pīhoihoi haʻī. ʻO kēia helu kiʻekiʻe o ka aggecan ma kahi kaila maʻamau e hiki ai i ke kiko ke kākoʻo i ka hoʻouluulu ʻole me ka wāwahi ʻole a lawe ʻia nā ukana i annulus fibrosus a me ka vertebral kino i ka wā o ka neʻe o ka spine. (Wheater, Paul R, et al.)

ʻO ka ʻaoʻao waho ka mea i kapa ʻia ʻo annulus fibrosus, ka nui o nā fibagen kolagane i hoʻonohonoho ʻia ma ke ʻano kaia. Ke holo nei nā fibagen kolaguma i kahi oblique ma waena o lamellae o ka annulus i ke kuhi hou ʻana i ka hāʻawi ʻana i ka hiki ke pale aku i ka ikaika tensile. Hoʻonui ka ligameka i loko o ka ligulusus annulus fibrosus peripherally. Ma ka ʻaoʻao mua, hoʻonui hou i ka ligament mākeke i ka annulus fibrosus a me kahi aniani i ʻoi aku ka hoʻoikaika i ka ʻaoʻao posterior. (Choi, Yong-Soo)

ʻO ka maʻamau, aia hoʻokahi disk ma waena o kēlā me kēia paʻa o ka vertebrae koe wale ma waena o atlas a me axis, ʻo ia ka vertebrae cervical mua a ʻelua hoʻi i ke kino. Hiki i kēia mau diski ke neʻe ma kahi o 6? i nā koʻi āpau o ka neʻe a me ke kaʻapuni a puni kēlā me kēia axis. Akā ʻokoʻa kēia kūʻokoʻa o ka neʻe ma waena o nā ʻāpana like ʻole o ka kolamu vertebral. Loaʻa i ka vertebrae cervical ka laulaha ʻoi loa o ka neʻe no ka mea ʻoi aku ka nui o nā disverse intervertebral a aia kahi ākea concave haʻahaʻa a hoʻopili ʻia i luna o ke kino vertebral kino. Loaʻa iā lākou nā transversely aligned facet ami. Loaʻa i ka vertebrae Thoracic ka palena iki o ka neʻe ʻana i ka flexion, extension, a me ka rotation, akā loaʻa ka flexion lateral manuahi ke pili lākou i ka iwi ʻaoʻao. He loli maikaʻi ka lumbar vertebrae a hoʻolōʻihi hoʻi, no ka mea, he nui nā disverse intervertebral a aia nā hanana spinous ma hope. Eia nō naʻe, kaupalena ʻia ka lumbar rotation no ka mea aia nā ami facet ma kahi haʻahaʻa. (DDegenerative Disk Disease: Background, Anatomy, Pathophysiology`)

Ke Kahe koko

ʻO ka disverse intervertebral kekahi o nā hale nui i loko o ke kino me nā capillaries e hoʻopau ana i nā endplates. Loaʻa nā kinona i nā meaola mai nā kīʻaha i ka iwi subchondral e pili kokoke ana i ka cartilage hyaline ma ka hopena. Lawe ʻia kēia mau meaola e like me oxygen a me glucose i ka disk intervertebral ma o ka diffusion maʻalahi. (DiscIntervertebral Disc Sp Spine Or Orthobullets.Com )

Hāʻawi Kahele

Pilikia ka ʻimi ʻana i loko o nā disk intervertebral a ʻokoʻa e like me ka wahi o ka kolamu spinal. Manaʻo ʻia ka lawe ʻana o Sensory e ka mea P, ka helu helu, VIP, a me CPON. ʻO Sinu vertebral nerve, i kū aʻe mai ke aʻa aʻa ganglion, i loko o ka fibficial fibers o ka anulus. ʻAʻole e hoʻonui ʻia nā kaula o ke aʻalolo ma ʻō aku o nā ʻāpana superficial.

Hāʻawi ʻia nā disc disc lumbar i ka ʻaoʻao posterolateral me nā lālā mai ka lau mua o ka ventral rami a mai nā kamaʻāina hina ma kahi o kā lākou hana me ka ventral primami. Hāʻawi ʻia nā ʻaoʻao hope o nā huki a nā lālā mai nā rami communicantes. ʻO kekahi o nā ric communicantes hiki ke hele i ka disc intervertebral a lilo i loko o ke kao pili, e moe hohonu ana i ka kumu o ka psoas. (Palmgren, Tove, et al.)

Hāʻawi pū ʻia nā disc discvertvert cervical i ka ʻaoʻao hope i nā lālā o nā nerve vertebral. Ua loaʻa nō hoʻi nā nerbebord sinu vertebral ʻānō me he papa kiʻekiʻe i loko o ke kahawai vertebral e hoʻolako ana i ka disc ma kahi o ke komo ʻana a me ka mea i luna. (BOGDUK, NIKOLAI, et al.)

ʻO ka ʻĀina Hoʻopiʻi o ka maʻi Degenerative Disc

Ma kahi o 25% o nā kānaka ma mua o nā makahiki he 40 e hōʻike ana i nā loli degenerative disc ma kekahi pae. Ma kahi o 40 mau makahiki, hōʻike ʻia nā hōʻike MRI i nā loli i ʻoi aku ma mua o ka 60% o nā poʻe. (Suthar, Pokhraj) No laila, he mea nui ia e aʻo i nā hana degenerative o nā disc intervertebral e like me ka ʻike ʻia e hoʻohaʻawa i ka wikiwiki ma mua o nā iwi hoʻohui ʻē aʻe i ke kino, e alakaʻi ana i ka ʻeha a me ka ʻāʻī. Hoʻohui ʻia nā hoʻololi i ʻekolu disc intervertebral me nā loli i ke kino vertebral a me nā ʻili e hōʻike ana i kahi holomua a me ka hana hoʻomehana.

Ua hoʻokaʻawale ʻia ke kaʻina hana hoʻohaʻahaʻa o nā disk intervertebral i ʻekolu mau hanana, e like me Kirkaldy-Willis lāua ʻo Bernard, i kapa ʻia ʻo "caserade deegenerative". Hiki ke hoʻopili ʻia kēia mau pae a hiki ke hana i loko o nā makahiki he umi. Eia nō naʻe, ʻaʻole hiki ke ʻike ʻia kēia mau pae ma muli o ka hoʻokahuli ʻia o nā hōʻailona a me nā hōʻailona.

Kūlana 1 (Ke Ana Mokuahi)

Hōʻike ʻia kēia pae e ka degeneration. Aia nā loli histological, e hōʻike ana i nā waimaka a me nā wīwī i ka fibrosus annulus. E hoʻohuli kēia mau waimaka holo i loko o nā waimaka a no ka mea nui ka loko o ka annulus pulposus, hiki i kēia mau waimaka ke hōʻeha i ka ʻeha a i ʻole ʻāʻī ʻāʻī, kahi i hoʻopaʻa ʻia me ka hoʻehaʻeha. Ma muli o ke trauma i hoʻohuli ai i ka huki, hiki i nā endplates ke hoʻokaʻawale i ke kahe ʻana mai o ka hoʻokahe koko i ka disc a no laila, e hoʻoneʻe ana i kāna lako a me ka lawe ʻana i ka pau ʻole. Hiki i ka annulus ke kau i nā micro-fractures i nā fibrils collagen, ʻike ʻia ia i ka mikroscopy electron a me kahi scan MRI e hōʻike i ka desiccation, ka hoʻolilo ʻana i ka disc, a me kahi puʻuwai kiʻekiʻe i ka annulus. Hiki i nā mea huakaʻi helehelena ke hōʻike i kahi hopena synovial a hiki i ke kumu hōʻeha i ka synovitis e pili ana a me ka hiki ʻole ke neʻe i ka hoʻopili i nā hui zygapophyseal. ʻAʻole pono kēlā mau loli i kēlā me kēia kanaka. (Gupta, Vijay Kumar, et al.)

Hoʻokomo pū ka pulupus nucleus i kēia kaʻina ma muli o ka hōʻemi ʻia ʻana o kona hiki ʻana i ka wai ma muli o ka hōʻiliʻili ʻana o nā proteoglycans biochemically i hoʻololi ʻia. Lawe ʻia kēia mau hoʻololi e ka ʻelua mau enzyme i kapa ʻia ka metrixoproteinase-3 (MMP-3) a me nā mea paʻa o ka metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, a me Maynak Gupta) ʻO kā lākou nānā ʻole e alakaʻi i ka luku ʻana i nā proteoglycans. ʻO ka emi o ka hiki ke hoʻomoʻa i ka wai e alakaʻi i ka hoʻoemi iki o ka hydrostatic i loko o ka nucleus pulposus a kumu ʻo ia i ka lamellae annular. Hiki i kēia ke hoʻonui i ka neʻe i kēlā ʻāpana e hopena i ke koʻikoʻiʻeha i ka paia annular. Hiki i kēia mau loli ke alakaʻi i kahi kaʻina i kapa ʻia a annular delamination a me ka fissuring i ka annulus fibrosus. ʻO kēia mau kaʻina hana neʻe a kaola ʻelua a hiki ke alakaʻi i ka ʻeha, ka ʻoluʻolu kūloko, ka hypheloility, nā ʻalā o nā aʻalelā, nā hana hōʻeha. Eia nō naʻe, ʻo ka maʻamau o ka nānā ʻana o ka neurological ma kēia hana ke ʻano maʻamau.

Wāwae 2 (Phase of Instability)

Hana ʻia ke kahua o ka disfunction e ke ana o ka instability, ka mea e kū ana mai ka nihinini holomua o ka mana o ka hoʻopiʻi o ka hoʻopili ʻana. Nui paha nā loli i hiki i kēia manawa, ka hoʻohui pū ʻana a me ke resorption, kahi hiki ke alakaʻi i ka nalowale o ka nui o ka pūnāwai. Hiki pū paha nā waimaka he nui i kēia manawa me ka loli o ka manawa i nā kime zagopophyseal. Hiki iā lākou ke komo i ka degeneration o ka cartilage a me ka facet capsular laxity e alakaʻi i ka subluxation. Hoʻololi kēia mau hoʻololi biomekanika i ka hiki ʻole o ka māhele e pili ana.

ʻO nā ʻōuli i ʻike ʻia i kēia wā, ua like ia me nā mea i ʻike ʻia i ke kaʻina hana pono ʻole e like me ke ala e hiki ai ke kua, ʻeha ke kū no nā wā hoʻolōʻihi, a me kahi ʻāpana i hope me nā neʻe. Hele pū lākou me nā ʻōuli e like me ka neʻe ʻole o nā hono i ka wā palpation a me ka nānā ʻana i ka ʻōiwi e hoʻoluli a i ʻole hoʻololi i kahi ʻaoʻao ma hope o ke kū pololei ʻana i kekahi manawa ma hope o ka loli. (Gupta, Vijay Kumar et al.)

Wāwae 3 (Re-Stabilization Phase)

I kēia kolu ʻona a hope loa, alakaʻi ka hala i ka neʻe ʻana i ka wā liʻiliʻi me ka fibrosis a me ka hoʻokumu osteophyte a me ke alahao transdiscal. ʻO ka hōʻeha ʻia o kēia mau hoʻololi e hoʻohālikelike ʻia i nā hanana ʻelua, akā hiki ke ʻano ma waena o kēia mau mea. Hiki i kēia ʻikepili i hoʻopaʻa ʻia ke loaʻa i nā hopena heʻe ma ka pōkole. Hiki i kēia ke kumu i ka hoʻopili ʻana i ka waʻa intervertebral i ka ʻāpana kiʻekiʻe a keu loa me ka hopena o ka pedicles pili. ʻO nā ligament longitudinal, e kākoʻo ana i ka koloka vertebral, hiki paha ke lilo i hemahema i kekahi mau wahi e alakaʻi ana i ka laxity a me ka pupule o nā spinal. Hiki i ke iwi ʻōiwi ke kumu o ka ligamentum flavum e pohō a hiki i ke kumu o ka subluxation kaʻina haʻahaʻa. Ke alakaʻi nei kēia i ka hōʻemi o ka diameter i ka pahuhopu anteroposterior o ka lumi intervertebral a me ka stenosis o nā kanaki palena nerve.

Hiki ke kūleʻa ʻia nā osteophytes a me hypertrophy o nā facets ma muli o ke hoʻololi ʻana i ka luhi axial ma nā kino o ka pōiwi a me nā kino vertebral. Hiki i kēia mau mana ke hana i nā kaʻao articular ʻoi a me nā haʻahaʻa a me nā osteophytes hiki ke hoʻohoka i ka waʻa intervertebral aʻo nā mākaukau hypertrophied hiki ke kū i ka waenakonu waena. Manaʻo ʻia ka Osteophytes e hana ʻia mai ka lula ʻana o ka cartilage articular i ka periosteum ma hope o lākou e hoʻonaninani ai i nā kūmole endochondral a me ka ossification. Hoʻokumu pū ʻia nā osteophytes ma muli o nā loli i ke kūlohelohe o ka oxygen a ma muli o nā loli i ke kaomi o ke kao ma kahi o ka lawe ʻana i nā hemahema. Hiki i ka osteophytes a me periarticular fibrosis ke hopena i nā hana paʻa. Hiki paha i nā ʻōnaehana articular i ke kuhikuhi i ke ala ākea e hiki ai i ka retrospondylolisthesis e alakaʻi i ka pōkole o ka kanawai intervertebral, nā kanalona aʻa a loko, a me nā kuʻi spinal. (KIRKALDY-WILLIS, WH et al.)

ʻO kēia mau hoʻololi āpau e alakaʻi i ka ʻeha hope haʻahaʻa, e hoʻemi ana me ka paʻakikī. ʻO nā hōʻailona ʻē aʻe e like me ka hoʻemi ʻana i ka hoʻohaʻahaʻa, ka palupalu o ka naʻau, ka hoʻopaʻakikī, a me nā scoliosis hiki ke hele i ia. Pili nā synovial cell cells a me nā macrophages i kēia kaʻina ma ka hoʻokuʻu ʻana i nā mea ulu a me nā molika extracellular matrix, e hana ana i ka mea hoʻopuka. Loaʻa ka hoʻokuʻu ʻana o nā cytokines i pili me kēlā me kēia pae a loaʻa paha nā hopena therapeutic i ke kūkulu hou ʻana i ka mālama ʻana.

ʻO Etiology o nā hopena hopena i ka hopena o ka maʻi Degenerative Disc

ʻOihana a me ka Degeneration

He mea paʻakikī ke wehe i ka wā ma waena mai nā loli degenerative. Ua hōʻike aku ʻo Pearce et al e pili ana i ka wā kahiko a me ka degeneration e hōʻike ana i nā hana holomua i loko o ke kaʻina hana hoʻokahi e kū nei i kēlā me kēia kanaka akā ma nā pae like ʻole. ʻO ka hemahema, eia naʻe ke hele pinepine ʻia ma kahi wikiwiki ma mua o ka wā kahiko. No laila ua ʻike ia i nā poʻe maʻi o nā makahiki hana.

Aia he ʻano pilina ma waena o ka ʻōpala a me ka degeneration, akā ʻaʻohe kumu kumu ʻokoʻa. Ua nui nā haʻawina e pili ana i ka pono o ka ʻai, nā make ʻili, a me ka hōʻiliʻili ʻana i nā huahana matrix degraded a me ka maikaʻi ʻole o ka nucleus. Hoʻopili ʻia nā wai wai o ka disc intervertebral me ka hoʻonui nui ʻana. Hiki i ka pulposus nukleus ke loaʻa nā fissures e hiki ke hoʻonui i loko o ka fibrosus annulus. ʻO ka hoʻomaka ʻana o kēia kaʻina hana i kapa ʻia nā chondrosis inter vertebralis, kahi hiki ke hōʻailona i ka hoʻomaka o ka luku weliweli o ka disc intervertebral, nā endplates, a me nā kino vertebral. Hōʻalo kēia kaʻina i nā loli paʻakikī i ka molekule o ka pūnao a ua loaʻa iā ia nā biomekanika a me ka ʻōmaʻomaʻi kūloko e hiki ke hopena i ka hōʻino nui i ka mea pili.

Hoʻemi ka nui o ke kelepona i ka annulus me ka hoʻonui ʻana o ka makahiki. ʻO kēia ke kumu no ka hoʻowahāwahā ʻia o nā hunaola i ka diski a nalowale lākou i ka hiki ke hoʻonui. ʻO nā kumu ʻē aʻe e pili ana i ka hoʻohaʻahaʻa makahiki-ʻoi loa o nā disk intervertebral e like me ka nalowale o ka cell, hoʻemi i ka meaʻai, ka hoʻololi o ka translational o nā protein matrix, ka hōʻiliʻili o nā huahana o nā mole mika momona, a me ka luhi ʻole o ka matrix. ʻO ka hōʻemi ʻana i ka meaʻai i ka diski waena, ka mea e ʻae ai i ka hōʻiliʻili ʻana o nā huahana neoneo a me nā mole mika hoʻohaʻahaʻa e like me ka hoʻololi nui loa o kēia mau loli. Hoʻopilikia kēia i ka meaʻai a me ke kumu e hāʻule ai ka pae pH, kahi hiki ke hoʻololi hou i ka hana o ke kelepona a hiki i ka make ʻana o ka cell. Hoʻonui ka catabolism a hoʻemi i ka anabolism o nā pūnaewele senescent e hāpai i ka hoʻohaʻahaʻa. (Buckwalter, Joseph A.) Wahi a kekahi noiʻi, ua nui nā cell senescence i loko o ka nucleus pulposus hoʻohālikelike ʻia i ka annulus fibrosus a me nā herniated discs i loaʻa ka manawa kiʻekiʻe o ka cell senescence. (Roberts, S. et al.)

Ke hele nei ke kaʻina ʻelemakule no kekahi mau manawa, hoʻonui ʻia ka nui o ka chondroitin 4 sulfate a me ka chondroitin 5 sulfate, ka ikaika nui o ka hydrophilic, akā, lilo ka keratin sulfate i ka chondroitin sulfate ratio. Keratan sulfate ʻoi aku ka hydrophilic maʻalahi a loaʻa iā ia kahi liʻiliʻi liʻiliʻi e hana i nā aggregates paʻa me ka waila hyaluronic. Ma ka wā e palaha ʻia ana kahi hikiwē, a ua hoʻemi ʻia ke koʻokoʻo a me ka helu o ka molulika, ke emi iho nei o ka viscosity a me ka hydrophilicity o ka nucleus pulposus. Hoʻololi koke nā loli i ka disc intervertebral e ka hoʻemi ʻana o ka hoʻemi hydrostatic o ka nucleus pulposus a me ka hoʻohaʻahaʻa ʻana i nā meaʻai e ka diffusion. Ke emi ka wai o ka wai o ka matrix extracellular, e hoʻohaʻahaʻa ʻia ka kiʻekiʻe o ka disc intervertebral. ʻO ke kūʻē o ka disc i ke axial load e hoʻoemi ʻia. No ka mea ke hoʻoneʻe pololei ʻia ka ukana axial i ka annulus fibrosus, hiki i nā lewa annulus ke maʻalahi maʻalahi.

Ke hana nei kēia mau hana i nā loli i ka nānā ʻia i ʻike ʻia i ka maʻi disc degenerative. Ma muli o ka emi ʻana o ka wai i loko o ka annulus fibrosus a me ka nalowale e pili ana i ka hoʻopiʻi ʻana, hiki i ka ukana ke axial ke hoʻohuli ʻia i ka ʻaoʻao o ka facets facets no ka mea ma mua o ka mua a me ka ʻaoʻao waena o nā facets. Hiki i kēia ke hana i ka ʻeha o ka facet, hypertrophy o nā kino vertebral pili i ke kino, a me ka bony spurs a i ʻole ke kau ʻana o ka bony, i ʻike ʻia ʻo osteophytes, ma muli o nā disc degenerative. (Choi, Yong-Soo)

Nā Genetics a me ka Degeneration

Ua ʻike ʻia ka ʻāpana kūpuna i kumu nui i ka maʻi disk degenerative. Ua hōʻike ʻia nā haʻawina māhoe, a me nā noiʻi ʻana e pili ana i nāʻiole, i ke ʻano o nā gen i ka hoʻoliʻiliʻi disc. (Boyd, Lawrence M., et al.) ʻO nā ʻāpana kēlā code no collagen I, IX, a me XI, interleukin 1, aggrecan, ʻepekema D wikamina, matrix metalloproteinase 3 (MMP 3), a me nā protein ʻē aʻe i waena o nā genes. ʻ suggestedlelo ʻia e pili i ka maʻi disc degenerative. Loaʻa nā Polymorphism ma 5 A a me 6 A i nā ʻāpana hoʻolaha i nā ʻāpana e hoʻoponopono i ka hana MMP 3 i mea nui no ka hoʻonui ʻana o ka lumbar disc degeneration i ka poʻe kūpuna. ʻO ka launa pū ʻana ma waena o kēia mau ʻāpana like ʻole e hāʻawi nui i ka maʻi intervertebral disc degeneration ma ke ʻano he nui.

ʻAnoʻai a Mākeke

Manaʻo ʻia hoʻi ka degeneration ka maʻi ma muli o ka loaʻa ʻole o ka hāʻawi ʻana i nā meaʻai i nā pona disc intervertebral. Ma waho aʻe o ke kaʻina hana ʻōpiopio maʻamau, hōʻemi ʻia kaʻai o nā kōpae disc ma ka endplate calcification, i ka ulaula, a me ke kūlana kai. Hiki i ke kīnā wai e alakaʻi i ka hoʻokumu ʻana i ka waikawa lactic me ka hoʻohaʻahaʻa haʻahaʻa o ka mana o ka oxygen. ʻO ka hopena pH i hopena e hiki ke hoʻopilikia i ka hiki o nā ʻ cellspana disc ke hana a mālama i ka pākī extracellular o nā disc a hoʻokō i ka hoʻoneʻe disc intervertebral. Loaʻa i nā disc degenerated ka hiki ke pane maʻamau i ka ikaika o waho a hiki ke alakaʻi i kahi hūnā ʻia mai ka lūlū liʻiliʻi loa. (Taher, Fadi, et al.)

Hoʻokomo nā mea kanu i nā chondrocytes a me nā fibroblasts e loaʻa ai ka nui o ka matrix extracellular. Mālama pū kekahi i ke ʻano o ka metalloproteinases matrix. ʻO ka hoʻohālikelike o kēia mau mea ulu e komo i ka hoʻololi o ka ulu ulu ʻana, ka like o ka like like o ka insulin, a me ka ulu kumu fibroblast ulu. Hoʻoulu ʻia ka matrix degraded e ka nui o ka hoʻololi ʻana i ka nui o ka ulu nui a me ka ulu ulu ʻana o ka fibroblast.

Ka ʻaumua a me ke degere

ʻOiai nā makahiki āpau nā diski a pau, ʻo nā diski i loaʻa i nā ʻāpana lumbar haʻahaʻa e maʻalahi i nā loli degenerative ma mua o nā disk i loaʻa i ka ʻāpana kiʻekiʻe. Hōʻike kēia ʻaʻole wale ka ʻelemakule akā, me ka hoʻouka ʻana i ka mīkini, kahi kumu kumu. ʻO ka pilina ma waena o ka maʻi dis degenerative disc a me nā mea pili i ke kaiaulu ua wehewehe ʻia i kahi ʻano āpau e Williams a me Sambrook i ka makahiki 2011. (Williams, FMK, a me PN Sambrook) ʻO ka hoʻoili kino kaumaha e pili pū ana me kāu ʻoihana kahi mea pilikia i loaʻa kahi kōkua i ka diski. maʻi hōʻino. Aia kekahi hiki i nā kemika ke kumu i ka hoʻohaʻahaʻa disk, e like me ka puhipaka, e like me kekahi mau noiʻi. (Batti`, Michele C.) Ua hoʻopili ʻia ʻo Nicotine i loko o nā haʻawina māhoe e hana i ke kahe o ke koko i ka intervertebral disc, e alakaʻi ana i ka hoʻoliʻiliʻi disk. (BATTI`, MICHELE C., et al.) Eia kekahi, ua loaʻa kahi hui ma waena o nā leona atherosclerotic i loko o ka aorta a me ka ʻeha haʻahaʻa e hōʻike ana i ka loulou ma waena o atherosclerosis a me nā maʻi degenerative disc. (Kauppila, LI) Ua hoʻokomo ʻia ka paʻakikī degeneration disc i ka nui o ke kaupaona, momona, metabolic syndrome, a hoʻonui ʻia ka papa kuhikuhi o ke kino i kekahi mau noiʻi. ( Nā Haʻawina Hōʻuluʻulu Manaʻo o ka Juvenile Disc Degeneration A me kāna hui me ka momona a me ka momona, ʻeha haʻahaʻa, a me ke kūlana hana i hōʻemi ʻia. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg ʻAm 2011; 93 (7): 662--70 )

ʻEha i ka ʻōpū (Discogen Pain)

ʻO kaʻeha Discogenic, kahiʻano o kaʻeha nociceptive, e puka mai ana mai nā nociceptors i ka annulus fibrosus ke hoʻopili ʻia ka ʻōnaehana e ka maʻi degenerative disc. Aia nā Annulus fibrosus i nā pale nerve reactive reactive i ka papa waho o ka diski me nā kemika ʻē aʻe e like me ka vasoactive ʻōpū polypeptide, ka peptide pili i ka ʻaoʻao a me ka lāʻau P. (KONTTINEN, YRJ T., et al.) Ke loli ke degenerative i kū nā disverse intervertebral, hoʻololi ʻia ka hanana maʻamau a me ka ukana mechanical e alakaʻi ana i nā neʻe ʻole. Hiki i kēia disk nociceptors ke hoʻomaopopo i kahi ʻano maʻamau i nā stimulate mechanical. Hiki ke hoʻonāukiuki ʻia hoʻi ka ʻeha e kahi kaiaulu pH haʻahaʻa i hoʻokumu ʻia e ka loaʻa ʻana o ka lactic acid, e hoʻonui ai i ka hana o nā mea ʻeha o ka ʻeha.

ʻO ka maʻi mai ka maʻi disc degenerative e kū mai nō nā kumu he nui. Hiki paha ia ma muli o ka hoʻopilikia ʻana o ke kaila, ke kaumaha, a me ka huhū ma nā nerbona i ka pōkole. ʻO ka disc pono wale nō he mauʻu o nā nerve, akā hiki i kekahi mea hōʻeha ke hoʻomaopopo i kēia mau ʻuhane, a i ʻole nā ​​mea i loko o ka ligament longitudinal posterior. Hiki i nā neʻe Micro ma ke vertebrae hiki ke hōʻeha, e hōʻeha paha i nā hōʻeha ʻeha puʻuwai no ka mea make a ke kīleʻī ʻia a paʻa i lalo me ka nalowale o ke kūpaʻe a me ke kiʻekiʻe. Hoʻomaʻamaʻa nā ʻeha hōʻeha no ka mea ʻo ka hōʻiliʻili i nā wahi a i hōʻeha ʻia e ka ʻōpū a me nā ʻāʻīwili o nā pale a me nā ʻehaʻeha. Hiki ke hoʻonāukiuki ʻia kēia ʻeha ma ka hoʻokuʻu ʻana i nā ʻōmaka nā maʻi e hana ana i nā nerb i loko o nā foramen a i ʻole nā ​​kaila i lalo i nā kanalopihua.

Nā kikoʻī o ka pathological o nā disc degenerative, ke nānā ʻia ma lalo o ka mikroscope, e hōʻike ana aia he vascularized kaola maʻa a me ka nui o nā wahī i ʻike ʻia i nā pōpoki o ka papale o ka papale annulus fibrosus e hāloi ʻia i ka pulusus nucleus. He nui ka lihilihi a ka pūpū kiko i nā ʻili a nā kihi a hiki ke kōkua nui i nā ʻōnaehana pathological e alakaʻi ana i ka ʻeha discogenic. Hoʻopili kēia ma ka neovascularisation, intervertebral disc degeneration, disc tissue disc, a me ka hoʻokumu ʻana o nā fibrosis. Hoʻokuʻu nā ʻili i nā mea uʻi i nā mea like, e like me ke ake ʻana o nā nodrosis tumor a me nā interleukins, e hōʻailona paha i ke kaha ʻana o kekahi mau ala e hana i ka hōʻeha ʻana i ka ʻeha. ʻO nā mea'ē aʻe e hiki ai ke hoʻowalewale i kēia mau ala ke komo ʻana o ka phospholipase A2, kahi mea i hoʻoneʻe ʻia mai ka kahe aila o ka arachidonic. ʻIke ʻia ia i nā piʻi nui o nā maka i waho o ke kolu o ka makahiki o ka annulus o ka disc degenerative a ua manaʻo e hoʻoulu ʻia i nā nociceptors i laila e hoʻokuʻu i nā mea maʻi e hoʻowalewale ai i ka ʻeha. Lawe kēia mau mea i ka hōʻeha axonal, intraneural edema, a me ka demyelination. (Brisby, Helena)

Kuhi ʻia ka ʻeha hope mai ka intervertebral disc ponoʻī. No laila ke kumu e emi mālie ai kaʻeha i ka manawa ke pau ka disc degenerating discighing pain. Eia nō naʻe, kū ka ʻeha mai ka disiki ponoʻī ma 11% wale nō o nā mea maʻi e like me nā noiʻi endoscopy. ʻO ke kumu maoli o ka ʻeha hope ma muli o ka hoʻonāukiuki ʻana i ka palena medial o ke aʻalolo a kuhikuhi ʻia ka ʻeha ma ka lima a i ʻole ka wāwae e ala ana ma muli o ka hoʻonāukiuki ʻana i ke kumu o ke aʻalolo. ʻO ka lapaʻau ʻana no ka hoʻohaʻahaʻa disk e nānā nui i ka ʻeha o ke ʻeha e hōʻemi i ka ʻeha o ka mea maʻi no ka mea ʻo ia ka hōʻailona hōʻoki loa e hoʻopilikia i nā ola o ka mea maʻi. No laila, he mea nui e hoʻokumu i ke ʻano o ka ʻeha no ka mea ʻaʻole ia ma muli wale nō o nā hoʻololi o ka intervertebral disc akā akā ma muli o nā kumu ʻē aʻe e like me ka hoʻokuʻu ʻia ʻana o nā kemika a me ka hoʻomaopopo ʻana i kēia mau ʻano hana hiki ke alakaʻi i ka ʻehaʻeha maikaʻi. (Choi, Yong-Soo)

Hoʻolaha kaukaila i ka maʻi maʻi Discenerative Disc

ʻO nā maʻi me ka maʻi degenerative disc ke alo i kahi nui o nā hōʻailona e hilinaʻi ana i ka pūnaewele o ka maʻi. ʻO ka poʻe i kahi lumbar disc degeneration e hōʻemi i ka ʻeha hope, nā hōʻailona radicular, a me ka nāwaliwali. ʻO ka poʻe i loaʻa ka degeneration cervical disc ka mea ʻeha a me ka ʻāʻī ʻeha.

Hiki ke hoʻonui ʻia ka ʻeha haʻahaʻa e nā neʻe a me ke kūlana. ʻO ka maʻamau, hoʻomāhuahua ʻia nā ʻōuli e ka flexion, ʻoiai e hoʻomaha pinepine ka hoʻolōʻihi iā lākou. Hiki i nā ʻeha wili liʻiliʻi, ʻoiai ke lele ʻana i ka lāʻau kolepa, hiki ke hoʻomaka i nā ʻōuli. ʻIke ʻia ka ʻeha ma lalo o ka hele ʻana a i ʻole ka holo ʻana, ke hoʻololi pinepine nei i ke kūlana a i ka wā e moe ana i lalo. Eia nō naʻe, ʻeha mau ka ʻeha a ma nā hihia he nui, ʻokoʻa ia mai kekahi kanaka a kanaka a ʻeha ka hapanui o nā kānaka mai kahi haʻahaʻa haʻahaʻa o ka ʻeha mau o ka ʻaoʻao haʻahaʻa e hoʻomau mau nei i ka ʻeha ʻana o ka ʻūhā, ka ʻūhā, a me ka wāwae. E hoʻonui ka nui o ka ʻeha i kēlā me kēia manawa a mau no kekahi mau lā a laila e emi mālie. ʻO kēia "flare-up" kahi ʻāpana koʻikoʻi a pono e mālama ʻia me nā analgesics ikaika. ʻIke ʻia ka ʻeha ʻoi loa ma ke kūlana noho a hoʻonui ʻia i ke kūlou ʻana, hāpai a me ka neʻe pinepine ʻana. Hiki ke loli ke koʻikoʻi o ka ʻeha me kekahi mau manawa me ka ʻeha mau ʻana i kekahi mau manawa me ka ʻehaʻeha ʻana o ka ʻeha me ka pinepine ʻole. (Jason M. Highsmith, MD)

ʻO ka ʻeha a me ka ʻoluʻolu i loko o ka axial spine ka mea maʻamau i loaʻa mai i nā nociceptors i loaʻa i loko o nā disc intervertebral, facet joints, sacroiliac joints, dura mater o nā aʻa nerve, a me nā hana myofascial i loaʻa i loko o ka axial spine. E like me ka mea i hōʻike ʻia i loko o nā pauku mua, hiki i nā loli anatomical degenerative e hoʻopiʻi i ka pōkole o ka kanalopona i kapa ʻia he spinalosis spinal, he nui ʻana o nā kaʻina o nā iwi muri i kapa ʻia ʻo osteophytes, hypertrophy o nā moʻo hana haʻahaʻa a maikaʻi loa, spondylolisthesis, ka hoʻopiʻi ʻana o ka ligamentum flavum a me ka herniation disc. . ^ E Ha yM. Kūpono kēia mau loli i ka hōʻiliʻili o nā hōʻailona i ʻike ʻia e like me ka claudication neurogenic. Aia paha hiki i nā hōʻailona e like me ka ʻeha haʻahaʻa a me ke ʻeha hoʻi e hui pū me ka ʻāʻī a nānā ʻole paha i nā wāwae, nāwaliwali o ka naʻau, a me ka wāwae o ka wāwae. ʻO ka pau ʻole o ke kakaka i ʻole ʻeha a ke kīpē paha e kuhikuhi i ka hoʻopili ʻana i nā spinal cord a koi pono i kahi nānā olakino e pale ai i nā pilikia mau. Hiki i kēia mau hōʻailona ke hōʻeha.

Hiki i ka ʻeha ke hoʻoili i nā ʻāpana ʻē aʻe o ke kino ma muli o ka maopopo ʻana e kaʻi ʻana i nā iwi kuʻi i kekahi mau lālā i nā ʻokoʻa ʻelua o ke kino. No laila, ke kaomi ʻana o ka disc degenerated ma luna o kahi aʻa spinal nerve, hiki ke hoʻāʻo i ka ʻeha ma ka wāwae kahi i hoʻoili ai ka nerve. ʻO kēia ʻano, i kapa ʻia ka radiculopathy, hiki ke hele mai i nā kumuwaiwai e kū mai, ma muli o ke ʻano o ka degeneration. ʻO ka disc bulging, inā kūloko ma waena o ka hopena, hiki ke hoʻopilikia i nā aʻa o ka lula o ka cauda equina, inā e hoʻokūkū nui ia i ka posterolaterally, e pili paha i ka aʻa o ke aʻa e hele mai ana ma ka waʻa o intervertebral e kū mai ana a me nā nalu ma waena o ka mahele o ka maʻi ventral e hoʻopilikia i ka wā o ka disc protrudes hope aʻe. Pēlā nō, ʻo ka osteophytes protruding ma ka ʻaoʻao o luna a i lalo o ka ʻaoʻao o ka posterior o nā kino vertebral hiki ke hoʻopiʻi i ka palupena o nā palupalu a ʻo ia e hana ai i nā hōʻailona like. Hiki i ke ʻōnaehana hana koʻikoʻi hypertrophy ke kau aku paha i nā aʻa o ke nerve ma muli o kā lākou projection. Hiki i nā ʻupena i nā aʻa neʻe ma mua o ka puka ʻana mai ke kahawai intervertebral haʻahaʻa a me nā aʻa nerve i loko o ke kaʻe o ke aʻa kumu a me nā ʻeke dural. ʻO kēia mau mea maʻi, ma muli o ka hoʻopili ʻana i ke nerve, ua hōʻike ʻia ma nā noi cadaver. Manaʻo ka hoʻohālikelike neural e hiki mai ke kūloko ʻia ka neuro foraminal diameter me kahi 70% hōʻemi. Eia kekahi, hiki ke hoʻoneʻe ʻia i ka hoʻohālikelike neural i ka wā e hoʻopili ʻia ai ka pale o ka posterior i ka haʻahaʻa ma mua o 4 i ke kiʻekiʻe o ke kiʻekiʻe, a i ʻole ke hoʻemi ʻia ke kiʻekiʻe foraminal a emi mai i ka 15 milimita e alakaʻi ana i ka stenosis foraminal a me ka hoʻopiʻi ʻana o nā aʻa. (Taher, Fadi, et al.)

Paʻi Diagnostic

E loiloi mua nā mea maʻi me ka mōʻaukala pololei a me ka nānā kino kūpono a me nā hoʻokolohua kūpono a me ka hoʻokau hoʻonāukiuki. Eia nō naʻe, ʻike pinepine ʻia ka mōʻaukala ma muli o ka ʻehaʻeha ʻo ia i hiki ʻole ke hoʻonohonoho pono ʻia a me ka paʻakikī ʻo ka hoʻoholo ʻana i ka wahi kūpono anatomical i ka wā hoʻonāukiuki ma muli o ke ʻano o nā hana anatomical pili.

Ma o ka mōʻaukala o ka mea hoʻomanawanui, hiki ke ʻike ʻia ke kumu o ka ʻehaʻeha o ke kua i ke kū ʻana mai nā nociceptors i nā disk intervertebral. Hiki i nā mea maʻi ke hāʻawi i ka mōʻaukala o ke ʻano mau o nā hōʻailona a me ka numbness o ka ʻāina gluteal e pili pū ana, a me ka ʻāʻī ʻana i ka iwi kuamoʻo e ʻoi mau ai ka ʻino me ka hana. Hiki ke hoʻoulu ʻia ke aloha e ka palpating ma luna o ka iwi kuamoo. Ma muli o ke ʻano o ka maʻi he mau a ʻeha hoʻi, ʻo ka hapa nui o nā mea maʻi e ʻeha paha i ka naʻau a me nā ʻano hopohopo. Manaʻo ʻia ʻo ke kaumaha ke hāʻawi maikaʻi ʻole i ka ukana maʻi. Eia naʻe, ʻaʻohe pilina pili i waena o ka maʻi a me ke ʻano a me nā maʻi hopohopo. He mea maikaʻi e makaʻala e pili ana i kēia ʻano olakino noʻonoʻo pū kekahi. I mea e kāpae ai i nā pathologies koʻikoʻi ʻē aʻe, pono e nīnau ʻia nā nīnau e pili ana i ka luhi, ka pohō kaumaha, ke kuni, a me nā haʻalulu, kahi e hōʻike ai i kekahi mau maʻi ʻē aʻe. (Jason M. Highsmith, MD)

ʻO kekahi ʻano etiology no ka ʻeha hoʻi o ka haʻahaʻa ʻokoʻa e hoʻokaʻawale i ka wā e nānā ana i ka mea maʻi no ka maʻi degenerative disc. ʻO nā pathologies ʻōpū, kahi e hiki ai ke hoʻāla i nā ʻeha o ka naʻau e like me ka auric aneurysm, renal calculi, a me nā maʻi pancreatic, pono e haʻalele ʻia.

Loaʻa i nā maʻi dis Degenerative disc kekahi mau diagnoses ʻokoʻa e noʻonoʻo ʻia ke hōʻike ʻia kahi mea maʻi me ka ʻeha o ke kua. Pākuʻi ʻia kēia mau mea; ʻehaʻeha haʻahaʻa idiopathic, zygapophyseal ami degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, a me lumbar radikulopathy. (DiscDegenerative Disc Disease Ph Physiopedia )

Nānā

Hoʻohana ʻia nā hoʻokolohua e hōʻoia i ka hoʻopaʻa ʻia ʻana o ka maʻi disc degenerative. Hiki ke hoʻokaʻawale ʻia kēia mau mea i nā noi ʻana o ka laboratorium, ka nānā ʻana i nā haʻawina, nā hōʻike hoʻokalakupua o ka nerve, a me nā kaʻina hana diagnostic.

Ke KiʻiʻImi

Hoʻohana nui ʻia ke kiʻi ʻana i nā maʻi disk degenerative e wehewehe i nā pilina anatomical a me nā hiʻohiʻona morphological o nā pāpaʻi i hoʻopili ʻia, a he waiwai maikaʻi loa kāna i ka hoʻoholo ʻana i nā koho e hiki mai ana. ʻO kēlā me kēia ʻano hana kiʻi, e like me ka radiography maʻamau, CT, a i ʻole MRI, hiki ke hāʻawi i ka ʻike kūpono. Eia nō naʻe, hiki ke loaʻa kahi kumu kumu ma 15% wale nō o nā mea maʻi no ka mea ʻaʻole ʻike ʻia nā loli radiological maopopo i ka maʻi dis degenerative disc i ka loaʻa ʻole o ka herniation disk a me ka deficit neurological. Eia kekahi, ʻaʻohe pilina ma waena o nā hoʻololi anatomical i ʻike ʻia ma ke kiʻi ʻana a me ke koʻikoʻi o nā ʻōuli, ʻoiai aia nā pilina ma waena o ka helu o nā osteophytes a me ke koʻikoʻi o ka ʻeha hope. Hiki ke ʻike ʻia nā loli degenerative i ka radiography i ka poʻe asymptomat e alakaʻi nei i ka paʻakikī i ka hoʻopili ʻana i ka pili olakino a me ka wā e hoʻomaka ai ka lāʻau. (DiscDegenerative Disc Disease Ph Physiopedia )

Palapala Radiography

Hiki i kēia hōʻemi a me nā kumu pālahalaha māmā me ka hiki ke ʻike i nā ʻike nui e pili ana i nā deformities, alignment, a me nā loli bony degenerative. I mea e hoʻoholo ai i ka hele ʻana o ka hakakā o ka spinal a me ke kaulike sagittal, hana hoʻokipa ākea, a i ʻole hoʻoponopono ʻia e hana ʻia.

ʻume Mākenēki Resonance Imaging (MRI)

ʻO MRI ke ʻano hana e hoʻohana pinepine ʻia e ʻike pono ai i nā hoʻololi degenerative i ka disk intervertebral pono, hilinaʻi, a me ka laulā. Hoʻohana ʻia ia i ka loiloi mua o nā mea maʻi me ka ʻāʻī o ka ʻāʻī ma hope o ka radiography maʻamau. Hiki iā ia ke hāʻawi i nā kiʻi invasive ʻole ma nā pāpū he nui a hāʻawi i nā kiʻi maikaʻi o ke diski. Hiki i ka MRI ke hōʻike i ka hydration disc a me ka morphology-ma muli o ka proton density, kahi kemika, a me ka ʻike o ka wai. Pono e noʻonoʻo ʻia i ke kiʻi maʻi a me ka mōʻaukala o ka mea hoʻomanawanui i ka wehewehe ʻana i nā hōʻike MRI e like me ka mea i hōʻike ʻia e like me 25% o nā radiologists hoʻololi i kā lākou hōʻike ke loaʻa ka ʻike maʻi. Ua hana ʻo Fonar i ka scanner MRI hāmama mua me ka hiki o ka mea hoʻomanawanui e nānā ʻia i nā kūlana like ʻole e like me ke kū ʻana, ka noho ʻana, a me ke kūlou ʻana. Ma muli o kēia mau hiʻohiʻona ʻokoʻa, hiki ke hoʻohana i kēia scanner MRI hāmama no ka nānā ʻana i nā mea maʻi i ke kau ʻana i ke kaumaha a kū i luna i nā pou e ʻike i nā loli pathological i ʻike pinepine ʻole ʻia i ka scan MRI maʻamau e like me ka maʻi lumbar degenerative disc maʻi me ka herniation. Maikaʻi nō hoʻi kēia mīkini no nā mea maʻi claustrophobic, ke nānā lākou i kahi kīwī kīwī nui i ka manawa o ka kaʻimi ʻana. (DDegenerative Disk Disease: Background, Anatomy, Pathophysiology.)

ʻO ka nukleus pulposus a me annulus fibrosus o ka disc ka mea hiki ke ʻike ʻia ma MRI, e alakaʻi ana i ka ʻike o ka ʻāwili disc me ka loaʻa ʻole i ka mea. Hiki i ka MRI ke hiki ke hōʻike i nā waimaka makahiki a me ka ligament longitudinal posterior, hiki ke hoʻohana ʻia no ka hoʻonohonoho ʻana i ka herniation. Hiki i kēia ke hoʻoweliweli maʻalahi i ka wehe ʻana i nā herniations disc fragment. Hiki i kēia ʻikepili ke wehewehe i nā disc pathologic e like me ka extruded disc, protruded disc, a me nā disc disc.

Nui nā hanana grading e pili ana i ka ikaika MRI hōʻailona ikaika, ke kiʻekiʻe disc, ka hoʻokaʻawale ma waena o ka nucleus a me ka annulus, a me ka ʻōnaehana disc. ʻO ke ʻano, na Pfirrmann et al, ua hoʻohana nui ʻia a ʻae ʻia ʻo ia e nā lāʻau lapaʻau. Wahi a ka ʻōnaehana hoʻololi ʻia, he 8 mau māka no ka maʻi lumbar disc degenerative. Hōʻike ka pae 1 i ka disc intervertebral maʻamau a pae aku i ka pae 8 e pili ana i ka pae hope o ka ʻōpū o ka maʻi, e hōʻike ana i ka holomua o ka maʻi ʻōpena. Aia kekahi mau kiʻi kūpono e kōkua i ka maʻi maʻi. Ke hāʻawi nei lākou i ka hoʻokaʻawale maikaʻi o ka kiko a me ka wehewehe kikoʻī ʻana i ka ʻōnaehana disc, hoʻohana ʻia nā kiʻi kaupaona sagittal T2 no ka helu papa. (Pfirrmann, Christian WA, et al.)

Ua wehewehe ka Modic i nā hoʻololi i kū ʻia i nā kino vertebral e pili kokoke ana i nā disc degenerating e like me ka hoʻololi ʻana o ka Type 1 a me Type 2. I nā loli Modic 1, ua hōʻemi ʻia ka nui o nā kiʻi kaupaona T1 a hoʻonui i nā kiʻi koʻikoʻi T2. Manaʻo ʻia kēia manaʻo e hele ʻia no ka mea ua loaʻa nā papa i nā sclerosis a me ka ʻōpū i ka iwi e pili ana i ka maʻi a me ka hoʻonui ʻana i ka cousion e hoʻonui ʻia ai. ʻO kēia hoʻonui o ka diffusion coefficient a me ke kūpaʻa hope loa i ka diffusion ua lawe ʻia mai e nā mea ʻenehana i hoʻokuʻu ʻia ma o ka mīkini autoimmune. Hoʻololi i ka loli modus 2 ka luku ʻia ʻana o ka huina o ka iwi a me ka pili ʻana o ka vertebral pili ma muli o ka hopena maʻi a me ka infiltration o ka momona i ka ʻōpū. Hiki i kēia mau loli ke hoʻonui i ke kīnā palena i nā kiʻi kaupaona T1. (Modic, MT et al.)

Hoʻohālikelike Tomography (CT)

Inā loaʻa ʻole ka MRI, ua noʻonoʻo ʻia ka tomography Computed e hōʻike ana i ka hōʻike hoʻāʻo a he hiki ke ʻike i ka herniation disc no ka mea ʻoi aku ka maikaʻi ma waena o nā mole posterolateral o nā pālani bony vertebrae, me ka momona perinee, a me ka waihona herniated disc. ʻOiai paha, ke hoʻokō nei i nā herniations lateral, ke hoʻomau nei ʻo MRI i ka modaging modaging o ke koho.

He nui nā pono o ka scan ʻo CT ma luna o ka MRI e like me ka liʻiliʻi o ke kalepona claustrophobic, ke kumu haʻahaʻa, a me ka ʻike maikaʻi ʻana o nā loli bonny ka ʻili a nalia paha ma kekahi mau modalities. Hiki i ka CT ke ʻike i nā loli degenerative mua o nā ʻōpū facet a me ka spondylosis me ka pololei o ka pololei. ʻIke maikaʻi ʻia hoʻi ka hana hoʻāʻo ʻo Bony ma hope o ka fusion.

Hiki ke hoʻolaha ʻia ka herniation Disc a me ka hoʻopili ʻana i nā aʻa e pili ana i ka hoʻohana ʻana i nā mana i hoʻomohala ʻia e Gundry a me Heithoff. He mea koʻikoʻi no ka protrusion disc e moe pololei ma luna o nā kumu nerve e hāhai ana i ka disc a no ka lele a me ka asymmetrical me kahi kūlana dorsolateral. Pono ke hoʻohālikelike i nā aʻa neʻe a hoʻomaha paha. ʻO ka mea hope loa, hiki i ka nerve ke kokoke i ka impingement (kahua o ka herniation) ke hoʻonui a hoʻonui i nā pahu me ka edema hopena, kaulana nui o nā uaua vei, a me nā exudates a me nā hopena i ka wā e hoʻopiʻi ai i ke kumulāʻau.

Lumbar Discalani

Ua kue kēia ʻano hana a, inā paha ke ʻike nei i ka ʻike o ka ʻeha e pili ana i ka hana ke ʻole a ʻaʻole nō i ʻike ʻia. Hiki ke hele mai nā hopena maikaʻi ʻole ma muli o ka hyperalgesia kikowaena i nā mea maʻi me ka hoʻomanawanui ʻo ka maʻi (loaʻa ʻo ka mana neoneo) a me ko nā psychosocial. Ua nīnau pinepine ʻia e hoʻokumu i ka wā e lilo ai ka maʻi nui i ka maʻi discogenic. Ke kākoʻo nei ka poʻe e kākoʻo ana i kēia noiʻi i nā loina paʻa loa no ka koho ʻana o nā maʻi a i ka manawa e wehewehe ana i nā hopena a manaʻoʻiʻo ʻo kēia wale nō ka hōʻike e hiki ke hōʻike i nā ʻeha discogenic. Hiki ke hoʻohana ʻia ka pākuʻi lumbar i kekahi mau kūlana, ʻoiai ʻaʻole ia i ʻepekema ʻia. Pākuʻi kēia; ka nānā ʻana i ka herniation lateral, hōʻike i kahi discaticatic i waena o nā helu abnormalities, e nānā ana i nā ʻano like ʻole i ʻike ʻia ma ka CT a i ka MRI, ka loiloi o ka kuʻina ma hope o ka hana ʻana, ke koho ʻana i ka pae fusion, a me nā hiʻohiʻona ʻimi o ka noho ʻana o ka maʻi discogenic.

ʻOi aku ka hopohopo i ka eliciting pathophysiology ma mua o ka hoʻoholo ʻana i ka anatomy o ka disc. No laila, ʻo ka loiloi hōʻeha discogenic ʻo ke kumu o ka discographic. Hiki i ka MRI ke hōʻike i kahi disc abnormally e nānā me ke ʻeha, aʻo ka ʻeha ʻeha nui ʻike ʻia i ka discography kahi i liʻiliʻi ai nā ʻike MRI. I ka wā o ka hōʻaʻai ʻana o ka saline maʻamau a i ʻole ke ʻano kūlike, hiki i kahi kuhi spongy ke hele mai me nā abnormal disc e kiʻi i nā mea he nui o ka hoʻohālikelike ʻana. Hiki i ka mea hoʻāla ke hiki ke hoʻonui i loko o ka nucleus pulposus ma nā waimaka a me nā manawa i loko o ka annulus fibrosus i nā mea maʻamau abnormal. Ke hoʻoikaika nei i kēia ʻāpana hoʻowalewale hiki ke hoʻonāukiuki i ka ʻeha ma muli o ke kūloko o ka hoʻonaninani ʻana i ka meningeal nerve, a hoʻoliʻi i ka iwi spinal nerve, mua a me ka nui o ka manuahi. Hiki ke hoʻonāukiuki ʻia ka ʻehaʻeha ma ka wā e hiki aku ai i ka ʻokoʻa kumu i ke kahua o ka hoʻonāukiuki o ke aʻa e ka abnormal disc. Eia nō naʻe, ua loaʻa i kēia ʻano hoʻokolohua hōʻole i nā hoʻopiʻi e like me ka hōʻeha o ke aʻa, ke aʻalolo a i ʻole bacterial diskitis, hoʻohālikelike i ka allergy, a me ka hoʻōho o ka ʻeha. (Bartynski, Walter S., a me A. Orlando Ortiz)

Hoʻohui Hoʻohui Paʻa

I mea e loiloi ai i ka hoʻoulu ʻia ʻana o ka aʻa a me ka stenosis cervical i kahi kūpono, pono paha ka hui ʻana o ka imaging.

CT Kahuna

Ma hope o ka hana mua ʻana i ke kau hala, hoʻomaka ka disc disc i loko o 4 mau hola. Hiki ke hoʻohana i ka hoʻoholo ʻana i ke kūlana o ka disc e like me ka herniated, protruded, extruded, i ʻole a i hoʻonohonoho ʻia. Hiki ke hoʻohana ʻia i nā mea kuʻi i ka hopena o ka nui o nā hopena pā o ke ʻili a i ʻole ka disc disc ma hope o ka hana ʻana i ka spinal.

ʻO CT Myelography

Manaʻo kēia hōʻike i ke ala maikaʻi loa no ka loiloi ʻana i ka hoʻopiʻi o ke aʻa. Ke hoʻokō ʻia ʻo CT ma ka hui ʻana a ma hope iho o ka myelography, hiki ke loaʻa nā ʻike e pili ana i ka bony anatomy like ʻole.

Nā Kūlana Diagnostic

Nā Lapa Palani Hoʻoiho No ka Transforaminal (SNRB)

Ke kānalua ka maʻi multenervel degenerative disc ma kahi scan MRI, hiki ke hoʻohana ʻia kēia hoʻokolokolo no ka hoʻoholo ʻana i ke aʻa kuʻuna kūikawā. ʻO SNRB kahi hopena hōʻike a me ka hoʻāʻo ʻana i ka therapeutic i hiki ke hoʻohana no ka stenosis spinalosis lumbar. Kūkulu ka hōʻike i kahi papa demotomal pae o ka hypoesthesia ma ke kao ʻana i kahi anesthetic a me kahi mea kūlike ma lalo o ka alakaʻi fluoroscopic i ka pae ʻai kumu ʻole o ka pīpī. Aia kekahi correlation ma waena o ka multilevel cervical degenerative disc disease tohu maʻi a me nā hopena ma MRI a me nā ʻike o SNRB e like me Anderberg et al. Aia ka 28% correlation me nā hopena SNRB a me ka ʻeha radicular dermatomal a me nā wahi o ka nele o ka neurologic. Loaʻa nā hihia koʻikoʻi o ka degeneration ma MRI e hoʻoponopono ʻia me 60%. ʻOiai ʻaʻole i hoʻohana maʻamau, ʻo SNRB kahi hōʻike maikaʻi loa i ka loiloi ʻana i nā mea maʻi ma mua o ka hana ma ka multilevel degenerative disc maʻi kūikawā ma ka kuʻina me nā hiʻohiʻona hauoli a me nā ʻike ma MRI. (Narouze, Samer, a me Amaresh Vydyanathan)

Nā Kumuhana Pololei Hou

ʻO nā hoʻokolohua hoʻokalakupua a me nā hoʻokolohua nerve nerve sensory, i kapa ʻia he mau haʻawina electromyographic, he maʻamau me ka hoʻokolohua ʻana o ka nila kuʻikuʻi e hōʻike paha i nā hōʻailona compression nerve i loaʻa i ka mōʻaukala olakino. Hiki ke hoʻonohonoho ʻia nā aʻa huhū huhū ma o ka hoʻohana ʻana i nā injection e anesthetize i nā aʻalolo i hoʻopili ʻia a i ʻole nā ​​mea loaʻa ʻeha ma nā wahi diski, hui sacroiliac, a i ʻole nā ​​ami facet e discography. (OurnJournal Of Electromyography & Kinesiology Kalena)

Nā Papahana Hoʻokololei

Hana pinepine ʻia nā hoʻokolohua Laboratory e haʻalele i nā maʻi ʻē aʻe.

E like me ka seronegative spondyloarthropathies, e like me ka ankylosing spondylitis, he kumu maʻamau ia o ka ʻeha o ka hope, pono ʻia e hoʻāʻo ʻia ka maʻi ʻo HLA B27 immuno-histocompatibility. Kuhi ʻia ʻo 350,000 mau kānaka ma US a me 600,000 ma ʻEulopa ua hoʻopilikia ʻia e kēia maʻi maʻi i ʻike ʻole e eology. Akā ʻaʻole ʻike iki ka HLA B27 ma nā ʻApelika ʻAmelika. ʻO nā seronegative spondyloarthropathies hiki ke hoʻāʻo i ka hoʻohana ʻana i kēia gala e loaʻa ai ka psoriatic arthritis, maʻi bowel maʻi, a me ka reactive arthritis a Reiter syndrome. Hiki i ka Serum immunoglobulin A (IgA) ke hoʻonui i kekahi mau maʻi.

ʻO nā hoʻāʻo ʻana e like me ka level o ka erythrocyte sedimentation rate (ESR) a me C-reactive protein (CRP) i ka hoʻāʻo ʻana no ka hopena ʻoi aʻe ka hopena o nā mea hoʻohālikelike i ʻike ʻia i nā kumu hoʻopiʻi o ka ʻeha hoʻi hope e like me ka osteoarthritis a me ka malignancy. E koi ʻia nō ka helu koko piha, e helu pū me nā helu ʻokoʻa no ka etiology. Ke kānalua nei nā maʻi Autoimmune i ka wā a lilo ka hopena o Rheumatoid (RF) a me nā hoʻokolohua anti-nuclear anti (ANA) i hoʻomaikaʻi. ʻO ka serum uric acid a me nā loiloi synovial no ka crystals e pono ai i nā pilikia i nā pilikia e neʻe ai i ka gout a me ka pyrophosphate dihydrate.

lapaʻau

ʻAʻohe kumu lapaʻau definitive i ʻae ʻia e nā kauka āpau e pili ana i ka mālama ʻana o ka maʻi disc degenerative no ka mea heʻokoʻa ke kumu o ka ʻeha i kēlā me kēia kanaka a pēlā nō ka ʻano nui o ka ʻeha a me nā ʻano ākea ākea ma ka hōʻike kauka. Hiki ke kūkākūkā ʻia nā koho lapaʻau i ka ʻaoʻao o lalo; ke ʻano mālama ʻana, mālama ʻana i nā maʻi lapaʻau, a me nā ʻoihana hoʻōla.

Hoʻolauleʻa Conservative

Ke komo nei kēia ʻano hana me nā mea lapaʻau hana me ka hoʻoulu ʻana o ka hana, nā ʻano kūlohelohe, nā inikua, nā hoʻonaʻauao hope, a me nā ʻano kula hope.

Hoʻomaʻamaʻa-Haʻaleʻa hopena me ke ʻano hoʻoweliweli

Wahi a ka maʻi maʻi o ka mea maʻi, hiki ke kuhikuhi ʻia nā ʻano ʻano ʻokoʻa like ʻole. Ua manaʻo ʻia ʻo ia kekahi o nā kumu nui o ka hoʻokele conservative e mālama i ka maʻi ʻeha hope haʻahaʻa. Hiki ke hoʻololi ʻia nā hana no ka hoʻomaʻamaʻa ʻana i nā hana holomua, a hoʻomaʻamaʻa aerobic, a me nā hana hoʻoikaika kino. ʻO kekahi o nā pilikia nui o kēia ʻoihana e loaʻa i kona hiki ʻole ke loiloi i ka pono ma waena o nā mea maʻi ma muli o nā ʻano like ʻole o ka hoʻoponopono regimen, kūʻai a me ka ikaika. Wahi a nā haʻawina, ʻo ka hana kūpono no ka ʻeha hoʻi hope haʻahaʻa haʻahaʻa me ka lōʻihi o ke ʻano o nā hōʻailona i loaʻa ma o ka hana ʻana i nā papahana hoʻoikaika ʻia i loko o ka hana hana o ka mea maʻi. Ua nānā nui nā hoʻomaikaʻi ʻana i waena o nā poʻe maʻi e loaʻa ana i nā maʻi maʻi me kēia ʻano noʻonoʻo me ka hoʻomaikaʻi ʻana i ka hana kūpono a me ka hōʻemi hōʻeha ʻana. ʻO nā lāʻau lapaʻau pilikino i hoʻolālā ʻia no kēlā me kēia mea maʻi ma lalo o ka mākaʻikaʻi kaua a me ka hana pono o ka mea maʻi e like me ka mea iʻoi loa ka maikaʻi loa o ka poʻe ʻehaʻeha hope. Hiki i nā mea hoʻokele conservative hiki ke hoʻohana i ka hui ʻana e hoʻomaikaʻi i kēia ala. (Hayden, Jill A., et al.)

Hoʻomaʻamaʻa mau nā aerobic, inā e hana mau, e hoʻomaikaʻi i ka hoʻomanawanui. No ka hoʻomaha ʻana i ka pīhoihoi kūlohelohe, hiki ke hoʻohana ʻia nā hana hoʻomaha. Hoʻoholo ʻia hoʻi ka ʻauʻau ʻana he hana hana no ka ʻeha o hope. Hiki i ka papahele o ka papahele ke hoʻohui i nā hana hoʻonui, nā koina hamstring, nā kaila haʻahaʻa haʻahaʻa, ke kuli i ka piko a nā pou, nā kaulike o nā noho, hoʻololi pono, nā ʻōpū o ka ʻōpū, a me nā kaukau mauna a me ka hana kino.

Ke ʻano hana kino

Hoʻopili ʻia kēia ʻano hana me ka hoʻoulu ʻia ʻana o ke aʻalolo, nā mea hoʻomaha, nā ʻōpū hau, biofeedback, nā pale wela, phonophoresis, a me iontophoresis.

Stimulation Nile Kuʻu Transcutaneous (TENS)

Ma kēia ala loiloi ʻole, ua hāʻawi ʻia ka hoʻoulu ʻana o ka uila i ka ʻili e hōʻeuʻeu i nā nīneka peripheral i nā nui o ka wahi e hōʻoluʻolu i ke ʻano ma kahi ākea. Hoʻolaha kēia ʻano hana i ke kaumaha ma hope o ka noi ʻana akā he kānalua ka lōʻihi. Me kekahi mau noiʻi, ua ʻike ʻia ʻaʻole loaʻa ka hoʻomaikaʻi koʻikoʻi i ke kaumaha a me ke kūlana hana i hoʻohālikelike ʻia me ka placebo. Hiki i nā mea hana e hana nei i kēia mau TENS ke maʻalahi i ka maʻalahi o ka keʻena outpatient. ʻO ka hopena kūpono wale nō ka hilahila ʻeha i ʻike ʻia i ka hapakolu o nā mea maʻi. (Johnson, Mark I)

Kula hope

Ua hoʻokomo ʻia kēia ʻano me ka pahuhopu e hōʻemi i nā hōʻailona hōʻeha a me kā lākou hana hou ʻana. Ua hoʻokumu mua ʻia ma Sweden a nānā i ka posture, ergonomics, hana hoʻihoʻi kūpono, a me ka hoʻonaninani o ka lumbar wahi. Hoʻomaopopo ʻia nā mea maʻi i ka noho kūpono e noho, kū, hoʻokiʻekiʻe i kaupaona, hiamoe, holoi holoi i ka maka, a me nā niho palipū e pale aku ai i ka ʻeha. Ke hoʻohālikelike ʻia me nā modalities mālama hou, ua hōʻike ʻia ka lāʻau hoʻihoʻi ma hope o ka hana hou a me ka manawa waena no ka hoʻomaikaʻi ʻana i ka ʻeha a me nā kūlana hana.

Hoʻomoʻauao Haumāna

Ma kēia ala, kuhikuhi ke kahu ʻo ia i ka mea maʻi e pehea e mālama ai i ko lākou mau ʻehaʻeha. ʻO ka anatomy spinal maʻamau a me nā biomechanics e pili ana i ka hana o ka hōʻeha i aʻo ʻia i ka mua. ʻO hope, e wehewehe ʻia i ka maʻi maʻi nā maʻi spinal model, ka maʻi degenerative disc maʻi. No ka mea maʻi pilikino, ua hoʻoholo ʻia ke kūlana kaulike a laila noi ʻia e mālama i kēlā kūlana e pale i ka loaʻa ʻana o nā hōʻailona.

Hoʻopuka Bio-Psychosocial i ka Multidisciplinary Back Therapy

Hiki i ka ʻehaʻeha hope ke hoʻonāukiuki i ka mea hoʻomanawanui, e alakaʻi ana i nā haunaele psychological a me ke ʻano haʻahaʻa. Hiki i kēia ke hoʻololi maikaʻi i nā hopena therapeutic e hāʻawi ana i nā ʻōnaehana lapaʻau lapuwale. No laila, pono e aʻo ʻia nā mea maʻi ma ke aʻo ʻana i ka noʻonoʻo i kapa ʻia ʻo `` behavioural '' a me `` bio-psychosocial '' i loaʻa i ke kōkua mai ka ʻeha. Ma waho aʻe o ka mālama ʻana i nā kumu olaola o ka ʻeha, psychological, a me nā kumu kaiaulu e pono e kamaʻilio ʻia i kēia hana. I mea e hōʻemi ai i ka ʻike o ka mea hoʻomanawanui i ka ʻeha a me ke kīnā ʻole, nā ʻano hana e like me nā mea i hoʻololi ʻia, nā ʻano hoʻomaha, ka mālama ʻana i nā pane physiological e ka hana aʻo, a me ka hoʻoikaika ʻana.

lomilomi Inc

No ka maʻi haʻahaʻa haʻahaʻa haʻahaʻa, ʻo kēia mea e pono ai ka mea pono. Ma kahi o 1 mau makahiki, ua loaʻa ke ʻano massage me ka mea maʻamau no kekahi mau maʻi ke hoʻohālikelike ʻia i nā acupuncture a me nā ʻano hoʻomaha ʻē aʻe. Eia nō naʻe, ʻoi aku ka maikaʻi o kaʻenehana ma mua o ka TENS a me ka lāʻau lapaʻau hana inā ʻoi aku ka mea maʻi o kēlā me kēia mea ma luna o ka mea āpau. (Furlan, Andrea D., et al.)

Hoʻoponoponoʻana i ka'ōpū

Hoʻokomo kēia hana i ka hana ʻana o kahi hui ma waho o kona ʻano maʻamau o ka neʻe o ka neʻe, akā, ʻaʻole iʻoi aku i kēlā me ke ʻano anatomical maʻamau. ʻO kēia kahi lāʻau lapaʻau e pili ana i ka manipulasi lever lōʻihi me ka wikiwiki o ka wikiwiki. Manaʻo ʻia e hoʻomaikaʻi hou i ka ʻeha hope ma o nā hana ʻano like e like me ka hoʻokuʻu ʻana i nā nika paʻa, ka luku ʻana i nā mea artical a me nā peri-articular, a ma ka hoʻokaʻawale ʻana i nā ʻāpana o ka spine i hana i ka hemo. Hiki iā ia ke hōʻemi i ka hoʻolauna ʻana o ka pā disc, hoʻomaha i nā uaua hypertonic, hoʻoulu i ka lihilele nociceptive ma o ka hoʻololi ʻana i ka hana neurophysiological a me ka hoʻohuli ʻana i nā menisci ma ka ʻaoʻao articular.

Manaʻo ka spinal manipulat e ʻoi aku ka maikaʻi ma ka efficacy inā hoʻohālikelike i ka hapanui o nā ala e like me TENS, hoʻokolohua hoʻokūkū, nā lāʻau lapaʻau NSAID, a me ka hana kula hope. ʻO nā noiʻi i loaʻa i kēia manawa he kūpono e pili ana i kona pono i ka wā lōʻihi a i ka manawa pōkole. Mālama loa ia e lawelawe i nā ʻoihana loea i hoʻomaʻamaʻa ʻia me nā hihia o ka herniation disc a me ka cauda equina i hōʻike wale ʻia ma lalo o 1 ma 3.7 miliona mau kānaka. (Bronfort, Gert, et al.)

Lumbar Kākoʻo

ʻO ka poʻe maʻi e loaʻa ana i ka ʻeha haʻahaʻa haʻahaʻa ʻoi aku ma muli o nā hana degenerative ma nā pae he nui me nā kumu he nui paha ka pōmaikaʻi o ke kākoʻo lumbar. Hōʻikeʻike ka hewa e pili ana i kona hoʻoponopono pono ʻana me kekahi mau noiʻi e koi ana i ka hoʻomaikaʻi maʻalahi i ka hoʻomaha koke a me ka lōʻihi a ʻo kekahi e hōʻike nei i ka holomua ʻana i ka hoʻohālikelike ʻia me nā ʻano lāʻau ʻē aʻe. Hiki i ke kākoʻo lumbar ke hoʻopaʻa, hoʻoponopono maikaʻi, hoʻemi ʻana i ka ikaika o ka mīkini, a hoʻopaʻa i ka neʻe ʻana o ka pōkole. Hiki iā ia ke hana like me kahi pletebo a hōʻemi i ka hōʻeha ʻana ma o ka hoʻolalelale ʻana i nā wahi i hoʻopili ʻia a kau aku i ka wela.

ʻĀpili Lumbar

Ke hoʻohana nei kēia ala i kahi harness i hoʻopili ʻia i ka pūlapa iliac a hoʻoneʻe i ka lima lōʻihi ma ka axial spine e hoʻomaha ai i ka ʻeha hope o ka hope. Hoʻopili ʻia ka pae a me ka lōʻihi o ka ikaika e like me ka mea maʻi a hiki ke ana ʻia iā ia me ka hoʻohana ʻana i nā polokalamu i ka wā e hele ana a moe ana. Hōʻalo ʻia nā laction trumb e ka wehe ʻana i ka pehu disc intervertebral a me ka hoʻēmi ʻana i ka haku lumbar lordosis. Hoʻomaʻamaʻa ʻia nā hōʻailona o ka maʻi disc degenerative ma o kēia ala ma muli o ke ʻano loea pōkole a me nā pono e pili ana. Hoʻonui ia i ka hoʻoweliweli a me ke kaumaha o ke kaumaha, hoʻokaʻawale i nā luhi i ka facet a me ka annulus, a me nā hōʻailona hōʻailona nociceptive wale nō. Eia nō naʻe, ʻaʻohe hōʻike nui e pili ana i kona hopena i ka hoʻohaʻahaʻa ʻana i ka ʻeha ʻana a i ʻole ka hoʻomaikaʻi ʻana i ka hana o kēlā me kēia lā. ʻO nā mea hou aku i nā pilikia e pili ana i ka hana lumbar traction ma lalo o ka noiʻi a ua loaʻa kekahi mau ninaninau i kahi i hoʻopiʻi ai ʻo ia i ka hoʻoulu ʻana i ke aʻeha, nā pilikia hanu, a me ke hoʻololi ʻana o ke koko ma muli o ka ikaika nui a me ka kau ʻole ʻana i ka hoʻopiʻi ʻana. (Harte, A et al.)

ʻO ka lāʻau lapaʻau

Hoʻokomo ʻia i ka lāʻau lapaʻau me ka mālama ʻana i nā lāʻau lapaʻau me nā hoʻomaha hoʻomaha, nā inikini steroid, NSAIDs, opioids, a me nā analgesics ʻē aʻe. ʻAʻole pono kēia, i ka hoʻohui ʻana i ka mālama conservative, i ka hapa nui o nā mea maʻi me ka maʻi degenerative disc. Hoʻokomo ka Pharmacotherapy i ka mālama ʻana i ke kīnā, hōʻemi i ke ʻeha a me ke ʻano o ka hoʻomaikaʻi ʻana i ka maikaʻi o ke ola. Mālama ʻia ia e like me ka mea hoʻomanawanui o ka mea ʻole no ka mea ʻole o ka ʻae e pili ana i ka mālama ʻana.

Nā Hoʻopiʻi Māmā

Hiki ke loaʻa ka maʻi disc degenerative i ka hoʻomaha hoʻomaha o ka maʻa ma o ka hōʻemi ʻana i ka nui o ka pīpī a ma laila e hoʻomaha ai i ke ʻeha. ʻO ka maikaʻi o ka hoʻomaha ʻāʻā o ka naʻau ma ka hoʻomaikaʻi ʻana i ke kaumaha a me ke kūlana hana i hoʻokumu ʻia ma o kekahi mau ʻano noiʻi. ʻO Benzodiazepine ka mea hoʻomaha hoʻomaha o ka ʻiʻo maʻamau i kēia manawa e hoʻohana ʻia.

Nā Pūʻali'Aiwi'UpokoʻEne-Steroidal (NSAIDs)

Hoʻohana pinepine ʻia kēia mau lāʻau me ka hana mua i ka maʻi degenerative e hāʻawi ana i ka analgesia, a me nā hopena anti-inflammatory. Aia nā hōʻike ikaika e hōʻemi ana i ka ʻeha hope o ka hope. Eia naʻe, kaupalena ʻia kona hoʻohana ʻana e nā mea hōʻeha gastrointestinal, e like me ka gastritis koʻikoʻi. Hiki i nā mea pale COX2 kuʻi, e like me celecoxib, hiki ke pale i kēia pilikia ma o ka hoʻopio wale ʻana i nā ʻona COX2. ʻAʻole i ʻae ʻia kā lākou hoʻohana ma muli o nā hopena kūpono e hoʻonui i ka maʻi cardiovascular me ka hoʻohana lōʻihi.

Nā lāʻau lapaʻau Opioid

ʻO kēia kahi kiʻekiʻe i luna i ka ʻeha ʻeha o WHO. Mālama ʻia ia no nā mea maʻi e ʻeha nei i ka ʻehaʻeha e pane ʻole i nā NSAID a me nā mea me nā haunaele GI hiki ʻole ke loaʻa me ka NSAID therapy. Eia nō naʻe, ʻokoʻa ka nui o ke kauka lāʻau narcotics no ka mālama ʻana i ka ʻehaʻeha ma waena o nā kauka. Wahi a nā puke, 3 a 66% o nā mea maʻi e lawe paha i kekahi ʻano o ka opioid e hōʻoluʻolu i ko lākou ʻehaʻeha. ʻOiai ua kahakaha ʻia ka hōʻemi pōkole o nā ʻōuli, aia kahi makaʻu o ka hōʻino narcotic lōʻihi lōʻihi, kahi kiʻekiʻe o ke ahonui, a me nā pilikia hanu i ka poʻe kahiko. ʻO kausea a me ka luaʻi kekahi o nā hopena hopena pōkole i loaʻa. (Review Review Pūnaewele: Opioid Lapaʻau No Ka Paʻi Kua Paʻa Paʻa: Prevalence, Efficacy, A me ʻAhahui Me Ka Hoʻohālikelike--)

Kūʻē Kūʻē

ʻO nā anti-depressants, ma nā haʻahaʻa haʻahaʻa, he waiwai analgesic a maikaʻi paha ia i nā maʻi ʻeha hōʻeha ʻeha hope e hōʻike pū me nā maʻi kaumaha. ʻO ka ʻeha a me ka ʻeha paha e hoʻonāukiuki i ka hiamoe o ka mea maʻi a hoʻēmi i ka paepae ʻeha. Hiki i kēia ke kūkā me ka hoʻohana ʻana i nā anti-depressants i nā haʻahaʻa haʻahaʻa ʻoiai inā ʻaʻohe hōʻailona e hoʻomaikaʻi ana i ka hana.

ʻO ka maʻi lapaʻau

Nā ʻōlelo Hōʻea ʻO nā Epidural Steroid

ʻO nā inikini steroid epidural ka hoʻohana ʻia i ka pakanui paʻa ʻana no ka mālama ʻana i ka maʻi disc degenerative maʻi a me ka radiculopathy pili. Aia ka ʻokoʻa ma waena o ke ʻano o ka hana i hoʻohana ʻia a me kona ʻano. ʻO 8- 10 mL kahi hui o methylprednisolone a me ka paʻakai maʻamau ua manaʻo ʻia he hopena kūpono a palekana. Hiki ke hāʻawi ʻia nā ʻikepili ma o nā alanui interlaminar, caudal, a i ʻole trans alanui. Hiki ke hoʻokomo ʻia i kahi lāʻau ma lalo o ke alakaʻi o ka fluoroscopy. ʻO ka hoʻohālikelike mua, a laila huli i ka anesthesia kūloko a hope loa, e hoʻoili ʻia ana ka hāmeʻe i loko o ke ʻano o ka maʻi i ka pae i hoʻopili ʻia ma o kēia ala. Loaʻa ka hōʻeha nui o ka hōʻeha ma muli o ka hui pū ʻana o nā hopena mai loko o ka anesthesia kūloko a me ka steroid. Hiki ke loaʻa i ka hōʻoluʻolu ʻeha ma o ka hanana kūloko kūloko ma o ke kāohi ʻana i ka hōʻailona hōʻailona hōʻeha a ʻoiai ke hōʻoia pū nei i ka maʻi. Hoʻemi ʻia ka ʻehaʻeha hoʻi ma muli o ka hana o nā steroid i ka pani ʻana i ka kaaka ʻana i ka pro-inflammatory.

I loko o nā makahiki he 121 i hala iho nei, ua hoʻonui ʻia ka hoʻohana ʻana o ka lāʻau lapaʻau steroid epidural e 2%. Eia nō naʻe, aia kahi hoʻopaʻapaʻa e pili ana i ka hoʻohana ʻana ma muli o ka hoʻololi ʻana i nā pae pane a me nā hopena maikaʻi ʻole. ʻO ka maʻamau, manaʻo ʻia kēia mau injection he kumu pōkole wale nō ia o nā ʻōuli. Hoʻokomo paha kekahi mau kauka lāʻau lapaʻau i 3 i nā iniki ʻekolu i loko o hoʻokahi pule, ʻoiai he like nā hopena lōʻihi no ka mea maʻi i hāʻawi wale ʻia i hoʻokahi injection. No hoʻokahi makahiki, ʻaʻole pono e hāʻawi ʻia i nā injection he 4. No ka hōʻoluʻolu koke ʻana a me ka maikaʻi o ke ʻeha, hiki ke hoʻohui ʻia ka morphine preservative-free i ka injection. ʻOiai nā anesthetics kūloko, e like me ka lidocaine a me ka bupivacaine, i hoʻohui ʻia no kēia kumu. Hōʻike ʻia nā hōʻike no ka hōʻoluʻolu ʻeha lōʻihi. (ʻO kahi ho'āʻo hoʻokolohua i mālama ʻia e Placebo e loiloi ai i ka hopena o ka ʻehaʻeha e hoʻohana ana i ka Ketamine me nā Epidural Steroids No ka Paʻi Haʻihaʻi Loa.)

Aia nā hopena pae kūpono ma muli o kēia lāʻau, i ka hoʻohui i nā kumukūʻai kiʻekiʻe a me nā maʻi kūpono. Hiki ke hoʻopili pono ʻia nā pono inā ʻaʻole i hoʻohana ʻia ka fluoroscopy i ka nui o ka 25% o nā hihia, ʻoiai me ka mua o nā limahana ʻike. Hiki ke hoʻomaopopo ʻia ka hoʻonā maʻi ʻana ma ka pruritus hilinaʻi. ʻO ke kaumaha a i ʻole ka noho ʻana paha e hiki ke hele mai ma hope o ka hoʻonā ʻana me ka morphine a no laila e pono ke nānā ʻia ka mea maʻi i nā hola 24 ma hope o ka hōʻalo ʻia.

Nā ʻōkuhi Helu

Hāʻawi ʻia kēia mau ʻōkuhi i nā mea huakaʻi facet, i kapa ʻia hoʻi i nā hoʻopili zygapophysial, kahi i waiho ʻia ma waena o ʻelua vertebrae pili. Hiki ke hoʻopaʻa pololei ʻia ka hanu ma ka pakanui a i ʻole ka lālā medial e pili ana i ka rami dorsal. Aia he hōʻike e hoʻomaikaʻi ana kēia ala i ka hiki ke hana, maikaʻi ke ola, a hoʻolaʻa hoʻi i ka hōʻeha. Ua manaʻo ʻia e hoʻolako i nā pono pōkole pōkole a lōʻihi, ʻoiai ua hōʻike ʻia nā noiʻi i nā injections facet a me nā inikini steroid epidural e like me ka efficacy. (Wynne, Kelly A)

Nā Hoʻohui hewa

He hui diarthrodial ka hui synovial pū me ka hoʻoulu nerve mai nā mana axeline a me nā non-myelin nerve. Hiki i ka hoʻonāukiuki ke mālama pono i ka maʻi disc degenerative e pili ana i ka hoʻopili sacroiliac e alakaʻi ana i ka hōʻoluʻolu a me ka manawa pōkole mai nā hōʻailona e like me ka haʻahaʻa o ke kua a me ka ʻeha ʻana i nā wāwae, ʻūhā, a me nā kāhā. Hiki ke ʻōlelo hou ʻia nā kuhi i kēlā me kēia 2 i ka 3 mau mahina akā pono e hana wale ʻia inā pono nā clinically. (MAUGARS, Y. et al.)�

ʻO Intapiscal Non-Operative Therapies no ka maʻi Discogenic

E like me ka mea i hōʻike ʻia ma lalo o nā hoʻokolokolo ʻana, hiki ke hoʻohana ʻia i ka discography ma ke ʻano he diagnostic a me therapeutic. Ma hope o ka ʻike ʻia ʻana o ka maʻi maʻi, hiki ke hoʻāʻo ʻia ka nui o nā minimally invasive ma mua o ka hoʻomaka ʻana i ka ʻoihana. Hiki ke hoʻohana i nā mea uila a me kona wela ke hoʻohālikelike i ka posterior posterior e hoʻoikaika ana i ka fibagen fibers, denaturing a luku i nā mea hoʻopukapuka o nā maʻi a me nā nociceptors, a me nā kuhi. ʻO nā ʻano i hoʻohana ʻia ma kēia kapa ʻia i kapa ʻia ʻo ka ʻai uila (intETiscal electrothermal therapy (IDET) a i ʻole radiofrequency posterior annuloplasty (RPA), kahi i hoʻoiho ʻia kahi electrode i ka disc. He hōʻike hōʻike hōʻike ʻo IDET ma ke kōkua ʻana i nā hōʻailona no ka maʻi maʻi disc degenerative, ʻoiai ua palena iki ka RPA e pili ana i ka pōkole pōkole a me ka wā lōʻihi. Hiki i kēia mau kaʻina hana ke hoʻopiʻi i nā hoʻopiʻi e like me ka hōʻeha o ka aʻa nerve, catheter malfunction, maʻi, a me ka post-prosedur disc herniation.

Nā Kūlana Ola

Mālama ʻia kahi lāʻau lapaʻau no nā mea maʻi me ka mālama ʻole i ka conservative therapy e noʻonoʻo nei i ka maʻi o ka maʻi, ka makahiki, nā maʻi ʻē aʻe, nā kūlana o ka nohona pili waiwai, a me ke kiʻekiʻe o nā hopena i manaʻo ʻia. Ua manaʻo ʻia aia ma kahi o 5% o nā mea maʻi me ka maʻi dis degenerative disg i loaʻa i ka ʻokiʻoki, no ka maʻi lumbar a i ʻole ka maʻi cervical. (Rydevik, Bj rn L.)

Nā Hoʻolaha Paʻi Lumbar

Hōʻike ʻia ke kīʻaha lumbar i nā mea maʻi me ka ʻehaʻeha loa, me ka lōʻihi o 6 a 12 mau mahina o ka hoʻomaʻemaʻe ʻole ʻana o ka lāʻau lapaʻau, ka poʻe i loaʻa i ka stenosis ʻōiwi koʻikoʻi. ʻO ke kīʻaha he maʻa koho ia koe ma ka hihia o ka cauda equina maʻi maʻi. ʻElua mau ʻano hana e manaʻo e hoʻopili i ka iwi kuamoʻo a i ʻole decompression a i ʻole ʻelua. (DDegenerative Disk Disease: Background, Anatomy, Pathophysiology.)

ʻO ka huiʻana o ka'ōpū pili i ka hoʻōki i ka neʻe ʻana i ka mahele vertebral hōʻeha e hōʻeha ai i ka ʻeha ma ka hoʻopiʻi ʻana i kekahi mau vertebrae pū me ka hoʻohana ʻana i kahi iwi kuʻi. Manaʻo ʻia he mau hopena ma ka hopena lōʻihi no nā poʻe maʻi me ka maʻi degenerative disc e loaʻa ʻana i nā malinalign spinal a i ʻole ka hapa nui. Nui nā ala hoʻokele e pili ana i ka hoʻokele fusion. (Gupta, Vijay Kumar, et al)

• ʻO ka lumbar spinal posterolateral guttur fusion

Hoʻopili kēia ʻano hana i ka waiho ʻana i kahi iwi i loko o ka posterolateral ma o ka pōkole. Hiki ke hōʻiliʻili ʻia ka iwi kiaʻi mai ka hope iliac crest. Hoʻokaʻawale ʻia nā iwi mai kona periosteum no ka hoʻopiʻi kūleʻa ʻana. Pono kahi liko hope i ka manawa hana a ʻo ka mea maʻi a pono hoʻi e noho i ka haukapila no kahi o 5 a 10 lā. Pono ka neʻe ʻana a me ka hoʻokuʻu ʻana ʻana i nā uahi pono no ka hoʻopala maikaʻi. Eia nō naʻe, ʻo kekahi mau pilikia e like me ka hui ʻole, ka maʻi, ka maʻi, ke koko a me ka hui pū ʻana me ka ʻeha o hope.

• Nā kikowaena lumbar interbody fusion

Ma kēia ala, hiki ke hana ʻia nā ʻenehana decompression a diskectomy paha ma o kēia ala like ʻole. Ua hoʻopili pono ʻia ka iwi kuilima ma ka lumi disc a me ka ligamentum flavum. No ka maʻi degenerative disc, hoʻonui ʻia ka wahi interlaminar ma o ka hoʻokō ʻana i ka ʻāpana medial facetectomy. ʻO nā koho braces he koho me kēia ala. Loaʻa ia nā hemahema inā i hoʻohālikelike ʻia i ke ala kūloko e like me nā keli liʻiliʻi e hoʻokomo ʻia, ʻo ka papakū o ka papahana i loaʻa no ka fusion, a me ka hikiʻole i ka wā e hana ai ka hana ma nā maʻi spinal deformity. ʻO ka pilikia nui e pili ana i ka ʻole hui ʻole.

• ʻO ka wīwīwīwīwī lumbar interbody

Hoʻohālike kēia kaʻina hana i ka posterior akā e hoʻokokoke ʻia ana ma ka ʻōpū ma mua o ka hope. Loaʻa ka pono iā ia e hoʻonāukiuki i nā muse hope a me ka hoʻoulu ʻana o ka nerve. Ua hoʻohālikelike ʻia i nā mea maʻi me ka osteoporosis a he nui ka hopena o ke koko, e hoʻokaʻawale ana ʻo retrograde i nā kāne, non-uni, a me ka maʻi.

• Hoʻohui lumbar interbody fusion

He ʻano hoʻololi i kēia ala o ka ʻaoʻao poster e lilo nei i kaulana. Hāʻawi ia i kahi haʻahaʻa haʻahaʻa me ka hōʻike maikaʻi a hōʻike ʻia he hopena maikaʻi loa me kekahi mau hoʻopiʻi e like me ka leʻaleʻa CSF, ka hopena neʻe ʻana o ka neurological, a me ka maʻi hōʻeha.

Hōʻīwaha Disc Arthroplasty

ʻO kēia he ala hou i ka disc fusion a ua hoʻohana ʻia e mālama i ka maʻi disc lumbar degenerative e hoʻohana ana i kahi disc disc e hoʻololi ai i nā disc i ʻae ʻia. Ka nui o ka prosthesis a i ʻole ka nīnū i hoʻoneʻe ʻia e hiki ke hoʻohana i ka kūlana kauka.

Pāʻani pili i ka wehe ʻana i kahi o ka disc o ke kino vertebral, ka mea e kau nei i ka nerve e hoʻokuʻu i kēlā a hāʻawi i kahi lumi no kona hoʻihoʻi ʻana ma o nā kaʻina i kapa ʻia ʻo diskectomy a me ka laminectomy. Kahi ʻia ka pono o ke kaʻina hana ʻoiai he hanana maʻamau. Ua liʻiliʻi ʻia nā ʻōpiopio me kahi haʻahaʻa haʻahaʻa o ka hoʻihoʻiʻana o nā hōʻailona me ka hauʻoli nui o ka mea maʻi. (Gupta, Vijay Kumar, et al)

• Lectar discectomy

Hana ʻia ke kīʻaha ma o kahi ala waena waena e ka kaʻana ʻana i ka ligamentum flavum. ʻIke ʻia ke aʻa aʻa i hoʻopili ʻia a ʻoki ʻia ka bulging annulus e hoʻokuʻu iā ia. Pono e hana i nā ninaninau piha piha ma hope a kūpono i nā mea maʻi e hoʻi i ka home 1 5 mau lā ma hope. Pono e hoʻomaka koke i nā hana hoʻohaʻahaʻa e ukali ʻia e ka hana māmā a laila ka hana kaumaha ma 2 a me 12 mau pule pākahi.

• ʻO ka lumbectomy lumbar

Hiki i kēia hana ke hana i kahi pae hoʻokahi, a ma o nā pae he nui. ʻO ka laminectomy ka mea pōkole e like me ka mea e hiki ke pale i ka palaoa spinal. Ua hōʻailona ka poʻe maʻi i ka hōʻoluʻolu o nā hōʻailona a me ka hōʻemi i ka radiculopathy ma hope o ke kaʻina hana. Hiki i nā pilikia ke komo ʻana i ka bowel a me ka puhipuhi o ka palaki, ka leʻa CSF, ka pohō o ka nerve, a me ka maʻi o ka maʻi.

Nā Hoʻoikaika Pūnaewele

Hōʻike ʻia ka maʻi diserical cer degenerative disc no ke kahakaha ke loaʻa kahi ʻeha hiki ʻole ke hoʻopili ʻia me nā motika holomua a me nā hemahema sensory. ʻOi aku ka maikaʻi ma mua o 90% o ka ʻoki kino ke loaʻa kahi hōʻike radiographic o ke aʻa aʻa paʻa. Nui a hewahewa nā koho e like me ka diskectomy cervical mua (ACD), ACD, a me ka fusion (ACDF), ACDF me ka hoʻopaʻa kūloko, a me ka foraminotomy hope. (DDegenerative Disk Disease: Background, Anatomy, Pathophysiology.)

ʻO nā Kauka-Pūnaehana Pūnaewele

Ua puka mai nā ʻōkuhi cell Stem ma ke ʻano he lāʻau lapaʻau no ka maʻi degenerative disc me nā hopena i hoʻohiki ʻia ai. Ua ʻike ʻia ka hoʻomaka ʻana o nā chondrocytes autologous e hōʻemi i ka hōʻeha discogenic i kahi 2 mau makahiki. Ke hoʻokau nei kēia mau pilikia ma nā hoʻokolokolo kanaka. (Jeong, Je Hoon, et al.)

ʻO Gene Therapy

Ke hoʻoiho nei ʻo Gene i kahi mea e pani ai i ke kaʻina disc degenerative a me ka hoʻokomoʻana i ka hoʻoponopono hou ʻana i ka disc me kēia manawa i lalo o ka noiʻi. No kēia, pono ke ʻike ʻia nā hua manu i ke wā e hoʻonāukiuki ana i ka hana o ka degeneration e hāpai ana i nā ʻano o nā gen. Hāʻawi kēia mau mea koho i ka manaʻolana no ka mālama ʻana i ka wā e hiki mai ana ma ke hoʻoponopono ʻana i nā discs intervertebral. (Nishida, Kotaro, et al.)

ʻO ka maʻi disc degenerative kahi maʻi olakino e hōʻike ʻia e ka ʻeha hope ma muli o kahi hōʻeha intervertebral i hōʻino ʻia, e like me ka ʻeha ʻeha o ke kuʻi lumbar a i ʻole nā ​​ʻāʻī ʻeha ma ka cervical spine. ʻO ia kahi uha o kahi disc intervertebral o ka pōkole. Hiki i nā loli pathological nui ke hele i ka disc degeneration. Hiki i nā ʻāpana anatomical ʻano ʻē aʻe pū kekahi i ka disc intervertebral. ʻO ka ʻeha hoʻi a me ka ʻāʻī ʻeha he mau pilikia nui e pili ana i ka maʻi, kahi i manaʻo ʻia e pili ana i ka maʻi degenerative disc. ʻO ka ʻeha hope ke kumu ʻelua o ke kipa ʻana o nā kauka i ka United States. Manaʻo ia ma kahi o 80% o nā pākeke US e hōʻeha nei i ka ʻeha ʻeha haʻahaʻa ma kahi o ko lākou manawa ke ola nei. No laila, pono i kahi ʻike hohonu o ka maʻi disc degenerative no ka mālama ʻana i kēia ʻano maʻamau. - Kauka Alex Jimenez DC, CCST Insight

ʻO ka laulā o kā mākou ʻike i kaupalena ʻia i ka chiropractic, musculoskeletal, nā lāʻau lapaʻau, ke olakino, a me nā pilikia olakino koʻikoʻi a me / a i ʻole nā ​​ʻatikala hana, nā kumuhana, a me nā kūkā kamaʻilio. Hoʻohana mākou i nā hana olakino & olakino hana e mālama a kākoʻo i ka mālama ʻana no nā ʻeha a i ʻole nā ​​maʻi o ka ʻōnaehana musculoskeletal. ʻO kā mākou mau pou, kumuhana, kumuhana, a me nā ʻike e uhi ana i nā mea olakino, nā pilikia, a me nā kumuhana e pili a kākoʻo pololei a i ʻole ʻole i kā mākou keʻena olakino o ka hana. * Ua hoʻāʻo kā mākou keʻena e hoʻāʻo i nā ʻōlelo kākoʻo a ua ʻike ʻia ka noiʻi noiʻi kūpono a i ʻole nā haʻawina e kākoʻo ana i kā mākou mau pou. Hana mākou i nā kope o ke kākoʻo ʻana i nā noiʻi noiʻi i loaʻa i ka papa a i ʻole ka lehulehu ma ke noi. Hoʻomaopopo mākou ua uhi mākou i nā mea e koi ai i kahi wehewehe hou aʻe pehea e kōkua ai ia i kahi hoʻolālā mālama a i ʻole ka mālama mālama. no laila, e kūkākūkā hou aʻe i ke kumuhana ma luna, e ʻoluʻolu e nīnau iā Dr. Alex Jimenez a i ʻole e leka uila iā mākou ma 915-850-0900. Ua laikini ka mea hāʻawi ma Texas * & New Mexico *

Kuhi ʻia e Kauka Alex Jimenez DC, CCST

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