Lifestyle and spine

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  • ..

  • ..

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    ..

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    (Lumbar intervertebral disc herniation)

    ..

    30-50

    (Life time prevalence)

    1.6

    (Annulus fibrosus)

    1 (Nucleus pulposus)

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    1

    1

    1.

    (Posture) McKenzie 2

    , (valsava),

  • 4 |

    ( 2)

    2 (Intradiscal

    pressure of lumbar spine) 2

    3

    (Nucleus pulposus)

    3

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    2.

    1

    Kirkady-Wiillis4

    (Herniated nucleus pulposus, HNP)

    1 4

  • 6 |

    /

    (Obesity) (Obesity)

    25

    5,6

    (chronic constipation)

    79

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    (chronic cough)

    10

    /

    squat jump

    /

    /

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    1. (Lumbar axial back pain)

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    2. (Radicular leg pain or sciatica pain)

    (Inflammatory process) (Mechanically compressive process)

    (Hip flexion)

    (Knee extension) (Ankle dorsiflexion)

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    (Knee flexion)

    3. (Neurological deficit)

    /

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    /

    /

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    (Prognosis)

    Hakelius 11

    (Bed rest)

    80 6 90 12

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    93 24

    (Symptomatic treatment) (Bed rest)

    30

    30

    (Sciatica)

    (Conservative treatment) 90

    (Second recurrent sciatica)

    90 50

    (Third recurrent sciatica)

    90

    1.

    (Bed rest)

    (Lumbar support)

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    ,

    (Body stretching)

    McKenzie (McKenzie extension exercise) ( 4)

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    4 McKenzie extension

    exercise

    2.

    Lumbosacral support (LS support)

    12

    (Warm)

    (Muscle atrophy)

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    3. :

    (Neurostabilized drug)

    Gabapentin Pregabalin

    Paracetamol, NSAIDs, Opioids

    Steroid

    Steroid Steroid Steroid

    steroid

    4.

    1. (Bed rest)

    3-6

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    2.

    3.

    (Endoscopic discectomy),

    (Microscopic discectomy)

    1. (Obesity)

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    25

    2. (Smoking)

    3. (Occupation)

    4. (Chronic cough)

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    5. (Constipation)

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    1. Google Image Result for http://upload.wikimedia.org/wikipedia/commons/d/d9/Cervical_vertebra_english.png [Internet]. [cited 2014 Aug 12]. Available from: http://www.google.co.th/imgres

    2. Nachemson A. In vivo discometry in lumbar discs with irregular nucleograms. Some differences in stress distribution between normal and moderately degenerated discs. Acta Orthop Scand 1965;36:41834.

    3. McFarlane DB. Notes on Anatomy and Physiology: The Intervertebral Discs [Internet]. [cited 2014 Aug 12]. Available from: http://ittcs.wordpress.com/2010/06/01/anatomy-and-physiology-the-intervertebral-discs/

    4. Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 1978;3:31928.

    5. Helivaara M. Body height, obesity, and risk of herniated lumbar intervertebral disc. Spine. 1987;12:46972.

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    6. Bstman OM. Body mass index and height in patients requiring surgery for

    lumbar intervertebral disc herniation. Spine 1993;18:8514.

    7. Batti MC, Videman T, Gill K, Moneta GB, Nyman R, Kaprio J, et al. 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine 1991;16:101521.

    8. Fogelholm RR, Alho AV. Smoking and intervertebral disc degeneration. Med Hypotheses. 2001;56:5379.

    9. Akmal M, Kesani A, Anand B, Singh A, Wiseman M, Goodship A. Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration. Spine 2004;29:56875.

    10. Helivaara M, Knekt P, Aromaa A. Incidence and risk factors of herniated lumbar intervertebral disc or sciatica leading to hospitalization. J Chronic Dis. 1987;40:2518.

    11. Hakelius A. Prognosis in sciatica. A clinical follow-up of surgical and non-surgical treatment. Acta Orthop Scand Suppl 1970;129:176.

    12. Snijders CJ, Hermans PFG, Niesing R, Spoor CW, Stoeckart R. The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clin Biomech Bristol Avon. 2004;19:3239.

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    ..

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    (Lumbar spinal stenosis) ..

    50-60 50-60

    (Vertebral body of first lumbar) (Vertebral body of first sacrum) (Dura matter) ( 1)

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    1 13

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    3 Kirkady-Wiillis 1. (Dysfunction phase) (Facet joint) (Intervertebral disc) 2. (Instability phase) 3. (Restabilization phase) (Ligament) (Facet capsule) (Osteophyte) (Spinal canal)

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    (Spinal canal stenosis) (Neurogenic claudication) 1 Kirkady-Wiillis4

    1 4

    (Genetic) (Trefoil) (Congenital lumbar spinal canal stenosis) 2

    2 (Axial view)5

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    (Elderly)

    7

    /

    (Obesity) (Obesity) 25 6,7 (Smoking) (Intervertebral disc) 810 (Facet joint)

    (Floor activities)

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    11 28 10 15 2 10

    /

    / /

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    (Occupation)

    (Dysfunction

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    phase) (Core muscle) (Instability phase) (Restabilization phase) (Lumbar spinal stenosis) 300 - 500 (Neurogenic claudication) ( 3)

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    3 12

    /

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    /

    /

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    (Prognosis) 15 45-50 20-30 13

    1. 1.1. 1.2. (Hyperlordosis) (Hyperlordosis) (Normal lordosis) (Hypolordosis)

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    1.3. (Hypolordosis) 1.4. (Hyperlordosis) (Normal lordosis) (Hypolordosis) pelvic tilt exercise ( 4) 14 10

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    4 Pelvic tilt exercise14 1.5. 15 (Knee to chest exercise) - ( 5)

    5 Knee to chest exercise15

    2. : (Neurostabilized drug)

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    Gabapentin Pregabalin Paracetamol, NSAIDs, Opioids Steroid Steroid Steroid Steroid steroid

    3. 1. 3-6 2. 3. 2 1. (Decompression alone)

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    (Direct vision) (Microscope) (Endoscope) 2. (Decompression with fusion and fixation)

    1. (Obesity) 25 2. (Smoking) 3. (Occupation)