间盘源性腰痛.pptVIP

间盘源性腰痛-复制疼痛好还是抑制疼痛好？;DEFINITION：;椎间盘内破裂 （IDD Internal Disc Disrupation / Derangement） 纤维环放射状撕裂 Radial Tear of annulus 痛性纤维环撕裂 Painful Annulus Tear 痛性椎间盘病 　 Pain Dark Disc Disease 退变性椎间盘疾病（DDD Degenerative Disc Disease) 腰椎僵硬　 Lumbar Spondylosis 孤立性椎间盘吸收 Isolated Disc Resorption 节段不稳（Segmental Instability);The concept of “internal disruptions” was proposed by Crock, in 1970 and 1986. Low back pain?may occurred without nerve root compression.;0—Normal 1—Contrast agent?infiltrate to inner 1/3 of Annulus 2—Contrast agent?infiltrate to outer 1/3 of Annulus 3—Contrast agent? infiltrate across the?outer?annulus CTD shows grade 2 may inducing pain!;Modified Dallas Discogram;Pathogenesis：;椎间盘造影术后的CT轴向扫描;Pathogenesis：;SP--;NF--;Exclude： Back pain but not “back” disease（2%） Seldom severe disease（infection,AS） Muscular\fasical\radicular pain Acute injury;Chou R, et al. Ann Int Med 2007 Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. ;Diagnosis：;Clinical characters;; provocative pain; Morphological changes of?the contrast agent;5.Discography: “gold standard” ?;Lindblom 1940 propose 1950 widespread Block et Ohnmeiss ： psychological problems--- False Positive Carragee： False Positive ：50％ Domestic：False Positive ：47% ;Doctor--------patient Subjective-------objective;CASE REVIEW:;X-RAYMRI:;MRI:black discs and HIZ;How to select the responsible disc?;Provoke Inhibit;CASE REVIEW:;CASE REVIEW:;Research-Method:;Research-Method:;Provoking: contrast agent (Omnipaque) ----administered intradiscally at responsible disc or adjacent disc---- observe the patients reactions.;Inhibting: lidocaine(Concentration of?1%) ---- administered intradiscally at responsible level ----observe the patients’ reactions.;Results:;Inhibiting pain group( 6 patients ): All positive ---- pain disappear, Average