Mr. Green, a 37-year-old Trinidadian taxi driver was complaining to his family doctor about lower back pain, which began just after the last carnival. On questioning he told the doctor that he and his friends had a lot of fun participating in recent carnival activities. Mr. Green’s dancing apparently involved excessive movements of his trunk, which led to his lower back problem.
On examination of his back, the doctor noticed moderate tenderness of the lower paravertebral muscles and movements of the lumbar spine were painful and limited. Radiographic study revealed a spina bifida occulta of the 1st sacral vertebra, while an isotope scan of the lumbar vertebrae was normal. A muscle relaxant was prescribed.
Mr. Green’s father often suffered with lower backbone problems, because he had a slipping lumbar vertebra and Mr. Green wondered if he could have a similar problem with his own vertebra, which might lead to his present condition.
Lumbago, or low back pain, affects around 80% of people sometime in their life. Wikipedia states that it is the second-most common neurological ailment, and first in the job place, with headaches alone beating it out. Most often, the pain stems from benign, or non-specific, musculoskeletal problems such as sprains or strains. Classification of low back pain includes acute (less than 4 weeks), subacute (4-12 weeks), and chronic (12+ weeks).
ReplyDeleteThere are many reasons people suffer from low back pain. Inactivity and a sedentary lifestyle are two main causes. Sitting long hours at a desk, hunched over work, hunched over in the car to and from work, and hunched over while sitting at home in furniture that promote poor posture are some of the most common, repetitive habits that induce and/or exacerbate low back pain. As we age, the fibrocartilege discs between the vertebrae thin and diminish in size. Prolonged sitting further compresses these spaces as gravity exerts its force upon the body; as one goes throughout the day, one shrinks.
Other forms of injury include, but are not limited to, lifting heavy objects without properly developed muscles/core and/or lifting posture, exerting too much force on the lumbar region of the spine (or anywhere else for that matter) which cause herniation of the intervertebral discs, and the development of chronic disease such as osteoporosis, arthritis, degenerative discs, the shifting of the vertebrae more than they ought from spondylolisthesis, fracture of vertebra, and even tumors.
Youtube video- Sacroiliac Joint pain, animation - Everything You Need To Know - Dr. Nabil Ebraheim
Problem 2, Hypothesis 5:Spina Bifida Occulta does not affect the lumbar vertebrae.Therefore the results of the isotopes scan were normal.
ReplyDeleteSpina bifida is broken down into two categories: spina bifida occulta and open spina bifida. These subtypes are distinguished by the absence or presence of nerves, fluid that surrounds the nerves (CSF), and the meninges that are included within the deformity.Spina bifida occulta is the mildest form of this birth defect. Even within spina bifida occulta, there is a spectrum of severity.
The most minor form of spina bifida occulta affects only one vertebra and usually only one of the lowest vertebra in the small of the back. The vertebrae are formed from the spinal arch after the neural tube closes. If the neural tube does not close properly, the plates in the spinal arch cannot fuse together, thus causing this ‘cleft’. If one of the lower vertebrae is left unfused, there is likely no problem with the spinal cord or nerve roots, thus a person with this form of spina bifida occulta is almost always asymptomatic.Since there is no opening to the skin, spina bifida occulta can only be seen on x-ray or MRI. Certain clinical findings such as dimpling of the skin or a hairy patch at the base of the spine may trigger further investigation by a physician.
Occulta is often called hidden spina bifida, as the spinal cord and the nerves are usually normal and there is no opening on the back. In this form of spina bifida, there is only a small defect or gap in the small bones (vertebrae) that make up the spine. In many cases, spina bifida occulta is so mild that there is no disturbance of spinal function at all. Most people are not aware that they have spina bifida occulta unless it is discovered on an x-ray which they have for an unrelated reason. However, one in 1,000 individuals will have such neurological deficits or disabilities as bowel or bladder dysfunction, back pain, leg weakness, or scoliosis.
Reyad, It is good information.You should read carefully and express it in short, in your own words to make sure that you understood it.
DeleteI will apreciate if you can corelate the knowledge with our problem of Mr Green.
W.r.t. Hypothesis #8:
ReplyDeleteMr. Green’s condition was not contributed to by the fact that his father had a slipped disc, but may have been due to insufficient intake of folic acid (a common B vitamin) in his mother’s diet, a key factor in causing spina bifida and other neural tube defects or even if a sibling or his mother has any form of spina bifida.
Please mention the reference for others to see if they wish so.
DeleteRefer: http://www.ninds.nih.gov/disorders/spina_bifida/detail_spina_bifida.htm
ReplyDelete