Tulang belakang manusia mempunyai tisu lembut / bukan struktur bertulang yang dipanggil
cakera di antara vertebra. Gelincir struktur ini melangkaui batas-batas yang
biasa dipanggil Cakera Tergelincir. Ia boleh berlaku di mana-mana arah tetapi bermasalah
apabila ia berlaku ke terusan tunjang atau foramen yang neural (rantau dari saraf
yang keluar dari tulang belakang).
Mengapakah ia berlaku?
Cakera tergelincir boleh berlaku akibat trauma akut atau tekanan kronik yang
disebabkan oleh aktiviti fizikal tertentu. Dengan penuaan perubahan degeneratif
mengambil tempat di dalam cakera yang menjadikan ia lebih mudah terdedah kepada gelincir tanpa apa-apa kejadian pemendakan.
Apakah gejala?
Gejala-gejala bergantung kepada sudut tapak, dan hala tuju gelicir cakera. Ia biasa
berlaku di kawasan lumbar atau serviks (leher) dan boleh menyebabkan sakit belakang
atau sakit leher. Jika cakera yang gelicir menyebabkan himpitan saraf tertentu
sebagai contohnya saraf lengan maka akan ada radiasi kesakitan pada anggota tersebut.
Bagaimana untuk mendiagnosis?
Modaliti pengimejan yang terbaik yang diperolehi pada hari ini adalah Magnetic Resonance Imaging (MRI). Ia
secara langsung dapat menunjukkan tapak dan sudut / jenis prolaps dan juga sama
ada mana-mana pemampatan neural hadir atau tidak. Ini membantu memutuskan garis
konservatif rawatan atau pembedahan. Ia juga membantu dalam merancang jenis pendekatan
pembedahan diperlukan.
Dah 3 hari menjalani sesi rawatan refleksologi bersama En Ibrahim, di Serkam. hasilnya..., alhamdulillah..
hari ke dua sudah boleh bergerak begitu baik.., aljamdulillah, syukur pada Allah..
SETIAP daripada kita pasti pernah mengalami sakit belakang terutama di bahagian pinggang.
Biasanya ia disebabkan duduk terlalu lama, posisi tidur tidak betul, mengangkat beban atau melakukan aktiviti lasak.
Sakit dengan rasa tidak selesa untuk beberapa hari, mungkin tidak
terlalu serius. Namun andai berlarutan hingga melebihi enam minggu
diikuti rasa sengal dan kebas di seluruh bahagian kaki, anda harus
segera berjumpa doktor.
Anda mungkin mengalami disc tergelincir di bahagian tulang belakang.
Perunding Pembedahan Ortopedik Hospital Gleneagles Kuala Lumpur, Dr. Lim
Heng Hing berkata, masalah sakit belakang terutama melibatkan disc
tergelincir berlaku pada 60 hingga 80 peratus penduduk dunia sekali
dalam seumur hidup.
“Sakit belakang terbahagi kepada dua jenis iaitu jika melibatkan belakang sahaja dipanggil spondylosis.
“Namun jika berasa sakit hingga ke paha dan betis seperti rasa kebas
serta sengal, ia petanda anda mengalami disc tergelincir,” katanya
ketika ditemui baru-baru ini.
Bagaimana disc tergelincir berlaku?
Menurut Dr. Lim, disc tergelincir adalah masalah kecederaan pada tulang
lembut (disc) yang juga dikenali sebagai disc intervertebral. Dalam
istilah perubatan ia disebut spinal disc herniated/ prolapsed.
“Disc intervertebral boleh diumpamakan sekeping tulang lembut di antara
tulang vertebra. Ia terdiri daripada satu tisu yang kuat (annulus
fibrosus) di mana di dalamnya terkandung sejenis bahan yang lembut
(nucleus polposus),” ujar beliau.
Jelasnya, kecederaan pada disc intervertebral menyebabkan kerosakan pada
annulus fibrosus. Akibatnya, ia menjadi bengkak dan seringkali juga
pecah pada disc intervertebral.
Bengkak yang berlaku akan menekan urat saraf di belakangnya. Keadaan
menjadi lebih serius apabila ia pecah menyebabkan isinya atau nucleus
polposus (mengandungi bahan inflammatori) keluar dan menekan urat saraf.
Ini menyebabkan sakit belakang yang teramat sangat yang akan merebak
turun ke kaki. Pesakit juga akan berasa kebas dan lemah kaki.
Kerana itu kaedah rawatan biasa yang diberi kebanyakan doktor dengan
cara pengambilan ubat antiinflammatori bagi melawan bahan yang
terkandung dalam nucleus pulposus.
“Cuba bayangkan disc ini seperti tayar kereta yang membantu menyerap
hentakan menjadikan kita tidak berasa sakit ketika lompat atau
terhentak,” katanya.
Secara umum katanya, tulang mempunyai 26 disc dari tengkuk hingga ke
pinggang, iaitu 12 pada bahagian torak atau dada, tujuh pada tengkuk dan
lima di tulang lumbar atau tulang belakang pada bahagian pinggang.
Disc tergelincir boleh juga berlaku di bahagian lain seperti leher namun yang paling biasa adalah pinggang.
“Penyakit ini tergolong dalam kumpulan degenaratif iaitu melibatkan
faktor usia. Semakin meningkat usia, satu demi satu lapisan akan
bergerak dan bercerai lalu berlakulah masalah disc tergelincir andai
tidak dijaga dengan betul,” katanya.
Bergantung pada bila ia berlaku, misalnya ketika berusia 20 tahun ke
bawah, maka proses penyembuhannya cepat kerana ia diganti dengan yang
baru.
Menghuraikan lebih lanjut, Dr. Lim berkata, badan manusia mempunyai
proses penyembuhan semula jadi tanpa bantuan sebarang rawatan.
Cukup dengan berehat dan tidak melakukan aktiviti lasak, badan dengan sendirinya akan sembuh perlahan-lahan.
Bagaimanapun, semakin meningkat usia seseorang, semakin rendah proses penyembuhan semula jadi berlaku.
Di kalangan mereka yang berusia 30 hingga 40 tahun, disc tergelincir dianggap gangguan yang biasa berlaku.
Selepas usia 40, disc menjadi lebih keras kerana kehilangan air dan
kurang kenyal (senang pecah). Namun, pokok pangkalnya jelas Dr. Lim, ia
bergantung kepada bagaimana kita menjaga pergerakan fizikal dengan
mengikut posisi sewajarnya bagi mengelak disc tergelincir.
“Perlu diingat disc tergelincir mengambil masa yang panjang untuk
terjadi. Pergerakan yang tidak dikawal terutama ketika duduk, baring,
bersandar, mengambil dan mengangkat barang menyumbang kepada masalah ini
untuk jangka masa yang panjang,” katanya.
Rawatan terkini
Bergantung kepada tahap kecederaan jelas Dr. Lim, jenis rawatan untuk pesakit berbeza.
Ia bermula dengan rehat secukupnya bagi melegakan tekanan untuk
kecederaan ringan dan membolehkan disc melalui proses penyembuhan semula
jadi. Biasanya mengambil masa lebih kurang enam minggu.
Pesakit juga boleh mengambil tiga jenis ubat bagi melegakan kesakitan ringan, antibiotik dan ubat penenang.
Dalam satu kajian yang pernah dijalankan, lebih 70 peratus pesakit pulih
selepas 12 minggu tanpa menjalani pembedahan, ujar beliau.
Menjalani rawatan fisioterapi adalah satu cara yang berkesan. Namun
seandainya rawatan di atas tidak berjaya, pesakit perlu menjalani
pembedahan yang sesuai bagi merawat masalah mereka.
Mungkin ada yang bertanya, mengapa terdapat pesakit masih mengalami kesakitan walaupun selepas dibedah?
Kata Dr. Lim. “Ini disebabkan rawatan yang tidak betul diberikan kepada
mereka. Paling utama adalah merawat bahagian disc yang koyak supaya
bahan jeli yang menyebabkan saraf berasa sakit tidak mengalir keluar dan
menekan saraf.”
Antara rawatan pembedahan yang biasa digunakan:
l Pembedahan invasif minimal Intra Discal Electro Thermal (IDET) dengan
cara mengecilkan kawasan benjolan pada disc menggunakan tenaga haba.
l Nucleoplasty untuk kecederaan tidak begitu serius. Menggunakan sejenis
bahan seperti jarum panjang dimasukkan ke bahagian tulang belakang
(tempat masalah), doktor akan membuang lebihan tisu pada disc
menggunakan tenaga radiofrekuensi. Kaedah ini hanya mengambil masa
kira-kira 60 minit atau kurang. Namun nucleoplasty tidak boleh dilakukan
andai disc terlalu sempit atau tulang belakang tidak stabil dan berada
pada kedudukan sewajarnya.
Rawatan terkini PercuDyn.
Secara klinikal, bahan ini berkebolehan merawat disc tergelincir dengan
mengurangkan pergerakan tambahan dan tekanan antara disc di kawasan yang
dirawat tanpa menyebabkan kesan degeneratif jangka panjang. Ia seakan
satu skru berputar yang boleh dipasang pada semua paras tulang lumbar
termasuk L5-S1.
Nasihat Dr. Lim:
l Masalah disc tergelincir kebanyakan berpunca daripada kecuaian sendiri
yang tidak mengambil berat tentang postur badan dan cara pergerakan.
l Masalah yang berpunca daripada kemalangan juga boleh diatasi secara
perlahan-lahan dengan tidak membebankan lagi pergerakan di bahagian
tersebut.
l Ahli sukan seperti pemain golf dan tenis lebih cenderung mendapat disc
tergelincir andai tidak menggunakan pergerakan yang betul. Misalnya
ketika melakukan hayunan, bahagian yang perlu berputar adalah pinggul
bukannya pinggang.
l Senaman regangan perlu dilakukan secara perlahan-lahan. Jika dilakukan
dengan kasar, sedikit demi sedikit bahagian disc akan tercedera.
l Senaman dan bersukan mengikut cara yang betul membantu menguatkan tulang.
l Beri peluang badan untuk sembuh secara semula jadi.
l Tilam berjenama mahal yang dikatakan mampu melegakan sakit belakang
belum tentu berkesan. Secara asasnya, tilam tersebut memadai berkeadaan
baik dan tidak menyebabkan badan kita tenggelam ketika baring di
atasnya.
l Pengambilan kalsium melalui suplemen dan makanan tidak menjamin
mencegah disc tergelincir. Ia membantu mencegah osteoporosis (ketumpatan
tulang merosot).
l Rawatan alternatif seperti akupuntur hanya membantu mengurangkan rasa
sakit kerana ia menghalang aktiviti saraf. Namun, pesakit boleh mencuba
terutama jika melibatkan kecederaan gred ringan.
Saturday, 30 June 2012
Prolapsed Disc - How to Fix Injured Discs Without Needing Surgery
Approaches to Repairing a Prolapsed Disc
Fixing a prolapsed disc usually means different things to each person. In most cases it either would mean:
1. get rid of the back pain, or
2. treat the prolapsed disc.
The effect will be the very same although the actual outlook is
different. Should you only want to remove the back pain - meaning the
symptoms - you could just take some non-steroidal anti-inflammatory
pills, or prescription drugs, or obtain repeated cortisone shots. Even
if you possibly achieve your goal of getting rid of your back pain, you
obviously haven't solved the true problem.
At the same time, if you ever decide to fix a prolapsed disc through really addressing the actual root cause
and the symptoms as well, you'll have a more realistic probability of
both ending the pain and also fixing the condition for good.
What Causes a Prolapsed Disc?
Aside
from some cases which involve shock, a prolapsed disc doesn't happen
suddenly. Even if it feels as if you "threw your back out" all of a
sudden, it more probably was a whole process of becoming weaker over
time that allowed the disc to slip.
In simple terms, prolapsed discs, also known as herniating or slipped discs, are typically brought on by unequal pressure on the disc.
Think of driving a car which is out of line because more pressure is
being put on one edge of the car. Now if you keep on driving without
fixing this issue, of course you will eventually have a blowout on one
side, and it all seems to have happened suddenly.
A similar scenario takes place in your back, where some muscles that are
too weak will lead to wrong back postures and in the end you'll wake up
with a "sudden" injured disc.
What you might find shocking is a lot of people have a prolapsed disc
free of pain. It's only when the disc or inside substance from your
prolapsed disc push against a nerve that pain comes up.
A prolapsed disc often causes severe lower back pain. The disc
often presses on a nerve root which can cause pain and other symptoms in
a leg. In most cases, the symptoms ease off gradually over several
weeks. The usual advice is to do normal activities as much as possible.
Painkillers may help. Physical treatments such as spinal manipulation
may also help. Surgery may be an option if the symptoms persist.
This leaflet is about prolapsed disc in the
lumbar spine (lower back). There is a separate leaflet about disc
problems in the neck, called Cervical Spondylosis.
nderstanding the back
The
spine is made up of many bones called vertebrae. These are roughly
circular and between each vertebra is a disc. The discs are made of
strong rubber-like tissue which allows the spine to be fairly flexible. A
disc has a stronger fibrous outer part, and a softer jelly-like middle
part called the nucleus pulposus.
The spinal cord, which contains
the nerves that come from the brain, is protected by the spine. Nerves
from the spinal cord come out from between the vertebrae to relay
messages to and from various parts of the body.
Strong ligaments
attach to the vertebrae. These give extra support and strength to the
spine. Various muscles also surround, and are attached to, various parts
of the spine. (The muscles and ligaments are not shown in the diagram
below, for clarity.)
What is a prolapsed disc?
When
you have a prolapsed disc (commonly called a slipped disc), a disc does
not actually slip. What happens is that part of the inner softer part
of the disc (the nucleus pulposus) bulges out (herniates) through a
weakness in the outer part of the disc. A prolapsed disc is sometimes
called a herniated disc. The bulging disc may press on nearby structures
such as a nerve coming from the spinal cord. Some inflammation also
develops around the prolapsed part of the disc.
Any disc in the
spine can prolapse. However, most prolapsed discs occur in the lumbar
part of the spine (lower back). The size of the prolapse can vary. As a
rule, the larger the prolapse, the more severe the symptoms are likely
to be.
Who gets a prolapsed disc?
Bouts
of back pain are very common. However, less than 1 in 20 cases of acute
(sudden onset) back pain are due to a prolapsed disc. (Most cases of
back pain are classed as simple low back pain. This is thought to be
caused by a minor problem in a muscle, ligament, or other structure in
the back - for example, a strained muscle. See separate leaflet called Non-specific Lower Back Pain in Adults for a general overview of the different types of back pain.)
The most common age to develop a prolapsed disc is between 30 and 50 years. Twice as many men as women are affected.
What causes a prolapsed disc?
It
is not clear why some people develop a prolapsed disc and not others,
even when they do the same job or lift the same sort of objects. It
seems that some people may have a weakness in the outer part of the
affected disc. Various things may trigger the inner softer part of the
disc to prolapse out through the weakened outer part of the disc. For
example, sneezing, awkward bending, or heavy lifting in an awkward
position may cause some extra pressure on the disc. In people with a
weakness in a disc, this may be sufficient to cause a prolapse. Factors
that may increase the risk of developing a prolapsed disc include: a job
involving lots of lifting, a job involving lots of sitting (especially
driving), weight-bearing sports (weight lifting, etc), smoking, obesity,
and increasing age (a disc is more likely to develop a weakness with
increasing age).
What are the symptoms of a prolapsed disc?
Back pain
The pain is often severe, and
usually comes on suddenly. The pain is usually eased by lying down flat,
and is often made worse if you move your back, cough, or sneeze.
Nerve root pain (usually sciatica)
Nerve root
pain is pain that occurs because a nerve coming from the spinal cord is
pressed on (trapped) by a prolapsed disc, or is irritated by the
inflammation caused by the prolapsed disc. Although the problem is in
the back, you feel pain along the course of the nerve in addition to
back pain. Therefore, you may feel pain down a leg to the calf or foot.
Nerve root pain can range from mild to severe, but it is often worse
than the back pain. With a prolapsed disc, the sciatic nerve is the most
commonly affected nerve. (The term sciatica means nerve root pain of
the sciatic nerve.) The sciatic nerve is a large nerve that is made up
from several smaller nerves that come out from the spinal cord in the
lower back. It travels deep inside the buttock and down the back of the
leg. There is a sciatic nerve for each leg.
Other nerve root symptoms
The irritation or
pressure on the nerve next to the spine may also cause pins and needles,
numbness or weakness in part of a buttock, leg or foot. The exact site
and type of symptoms depend on which nerve is affected.
Cauda equina syndrome - rare, but an emergency
Cauda
equina syndrome is a particularly serious type of nerve root problem
that can be caused by a prolapsed disc. This is a rare disorder where
the nerves at the very bottom of the spinal cord are pressed on. This
syndrome can cause low back pain plus: problems with bowel and bladder
function (usually unable to pass urine), numbness in the saddle area
(around the anus), and weakness in one or both legs. This syndrome needs
urgent treatment to preserve the nerves to the bladder and bowel from
becoming permanently damaged. See a doctor immediately if you develop
these symptoms.
Some people do not have symptoms
Research
studies where routine back scans have been done on a large number of
people have shown that some people have a prolapsed disc without any
symptoms. It is thought that symptoms mainly occur if the prolapse
causes pressure on or irritation of a nerve. This does not happen in all
cases. Some prolapses may be small, or occur away from the nerves and
cause minor or no symptoms.
How does a prolapsed disc progress?
In
most cases, the symptoms tend to improve over a few weeks. Research
studies of repeated MRI scans have shown that the bulging prolapsed
portion of the disc tends to get smaller (regress) over time in most
cases. The symptoms then tend to ease, and go in many cases. In only
about 1 in 10 cases is the pain still bad enough after six weeks to
consider surgery (see below).
Do I need any tests?
Your
doctor will normally be able to diagnose a prolapsed disc from the
symptoms and by examining you. (It is the common cause of sudden back
pain with nerve root symptoms.) In most cases, no tests are needed, as
the symptoms often settle within a few weeks.
Tests such as X-rays or scans may be advised if symptoms persist. In particular, an MRI scan can show the site and size of a prolapsed disc. This information is needed if treatment with surgery is being considered.
What are the treatments for a prolapsed disc?
Exercise and keep going
Continue with normal
activities as far as possible. This may not be possible at first if the
pain is very bad. However, move around as soon as possible, and get back
into normal activities as soon as you are able. As a rule, don't do
anything that causes a lot of pain. However, you will have to accept
some discomfort when you are trying to keep active. Setting a new goal
each day may be a good idea - for example, walking around the house on
one day, a walk to the shops the next, etc.
In the past, advice
had been to rest until the pain eases. It is now known that this was
wrong. You are likely to recover more quickly and are less likely to
develop chronic (persistent) back pain if you keep active when you have
back pain rather than rest a lot. Also, sleep in the most naturally
comfortable position on whatever is the most comfortable surface.
(Advice given in the past used to be to sleep on a firm mattress.
However, there is no evidence to say that a firm mattress is better than
any other type of mattress for people with back pain.)
Medication
If you need painkillers,
it is best to take them regularly. This is better than taking them now
and again just when the pain is very bad. If you take them regularly the
pain is more likely to be eased for much of the time and enable you to
exercise and keep active.
Paracetamol is often
sufficient if you take it regularly at full strength. For an adult, this
is 1000 mg (usually two 500 mg tablets), four times a day.
Anti-inflammatory painkillers.
Some people find that these work better than paracetamol. They include
ibuprofen which you can buy at pharmacies or get on prescription. Other
types such as diclofenac or naproxen need a prescription. Some people
with asthma, high blood pressure, kidney failure, or heart failure may
not be able to take anti-inflammatories.
A stronger painkiller
such as codeine is an option if anti-inflammatories do not suit or do
not work well. Codeine is often taken in addition to paracetamol.
Constipation is a common side-effect from codeine. This may make back
pain worse if you need to strain to go to the toilet. To prevent
constipation, have lots to drink and eat foods with plenty of fibre.
A muscle relaxant such as diazepam is sometimes prescribed for a few days if the back muscles become very tense and make the pain worse.
Physical treatments
Some people visit a
physiotherapist, chiropractor, or osteopath for manipulation and/or
other physical treatments. It is debatable whether physical treatments
would help all people with a prolapsed disc. However, physical
treatments provide some short-term comfort and hasten recovery in some
cases.
Surgery
Surgery may be an option in some
cases. As a rule, surgery may be considered if the symptoms have not
settled after about six weeks or so. This is the minority of cases as,
in about 9 in 10 cases, the symptoms have eased off and are not bad
enough to warrant surgery within about six weeks.
The aim of
surgery is to cut out the prolapsed part of the disc. This often eases
symptoms. However, it does not work in every case. Also, as with all
operations, there is a risk from surgery. A specialist will advise on
the pros and cons of surgery, and the different techniques that are
available.
Can further bouts of back pain and/or prolapsed disc be prevented?
Evidence
suggests that the best way to prevent bouts of back pain and prolapsed
disc is simply to keep active, and to exercise regularly. This means
general fitness exercise such as walking, running, swimming, etc. There
is no firm evidence to say that any particular back strengthening
exercises are more useful than simply keeping fit and active. It is also
sensible to be back aware. For example, do not lift objects when you
are in an awkward twisting posture.
A reliable source of
information. It is written by a team consisting of a GP, orthopaedic
surgeon, physiotherapist, osteopath, and psychologist and provides
comprehensive advice. Roland, M.O et al. (2002) The Back Book. London: The Stationery Office.
Egton Medical Information Systems Limited. Registered in
England. No 2117205 Registered Office: Fulford Grange, Micklefield
Lane, Rawdon, Leeds, LS19 6BA
Sakitnya, Allah je yang tahu.. xde perkataan untuk membayangkan kesakitan ni pada masa yang sama, semua orang sibuk dengan urusan yang xdapat dielakkan.. macam selalulah, aku pasrah dan redha.. Allah akan sentiasa bersama aku dalam menempuh liku2 hidup.. Allah akan sentiasa memelihara aku dari segala musibah...
Esok akan ke HOSPAT... semoga ada jalan penyelesaian di situ....
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Vitaminini banyakditemui padabrokoli, bayam, dan sayur-sayuran berdaunhijau. Vitamin K, berfungsi membantusimpanankalsiumdalam tulang, sehingga membuatnyalebih padat. Ketika tulangandakuat, maka tubuhsemakinfitdan risikomengalamikecederaan yangmenyebabkansakitbelakangpunberkurang. Sumber asal : VIVAnews
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Aside
from some cases which involve shock, a prolapsed disc doesn't happen
suddenly. Even if it feels as if you "threw your back out" all of a
sudden, it more probably was a whole process of becoming weaker over
time that allowed the disc to slip.
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