Degeneratieve aandoeningen

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Degeneratieve afwijkingen van de wervelzuil – discushernia – spinaal kanaalstenose
Degeneratie – slijtage – van de wervelzuil kan de tussenwervelschijf aantasten maar eveneens de facetgewrichten, die dan hypertrofisch en pijnlijk worden, en de ligamenten. De tussenwervelschijf (discus) bestaat uit een centrale gelatineuze kern die omgeven wordt door concentrische ringen van fibreus weefsel. Chronische veranderingen in de discus zijn mogelijk hetgeen kan leiden tot verlies van discushoogte maar ook tot uitstulpen (bulging) van delen van de discus. Het bindweefsel dat deze kern omgeeft kan ook acuut scheuren, hetgeen leidt tot een discushernia die een plotse druk kan geven op de zenuw en hierdoor pijn, verminderde sensibiliteit en zelfs verlamming kan veroorzaken in het gebied dat door deze zenuw wordt bezenuwd.
De facetgewrichten zijn achteraan gelokaliseerd en hebben gelijkaardige karakteristieken aan andere gewrichten in het lichaam. Net als andere gewrichten kunnen ze degeneratieve veranderingen ondergaan waarbij er verlies van kraakbeen optreedt (met pijn tot gevolg) en overgroei (hypertrofie) van het omgevende bot. Dit hypertrofische bot kan eveneens druk op de zenuwen veroorzaken.
Ook de ligamenten kunnen sterk hypertrofisch worden en hierdoor dan druk veroorzaken met dezelfde problemen tot gevolg.

Behandeling

De behandeling van pijn in het been of in de rug ten gevolge van degeneratieve ziekte van de wervelzuil hangt voornamelijk af van of de aandoening acuut of chronisch is en of er enkel een geïsoleerd degeneratief lijden bestaat (bijvoorbeeld een discushernia) of de slijtage meer uitgebreid is.
Conservatieve behandeling (rust, medicatie, kinesitherapie) is vaak de eerste keuze behandeling zolang medicatie er in slaagt om de pijn onder controle te houden en zolang er geen tekens van verlamming bestaan.
Wanneer de conservatieve behandeling faalt, kunnen injecties rondom de zenuw of de zak met zenuwen, of ter hoogte van de facetgewrichten gegeven worden om de pijnsymptomen te doen verminderen.
De operatieve behandeling wordt aangeboden in geval de conservatieve behandeling faalt of in geval de zenuw tekens vertoont van belangrijke verdrukking (aanhoudende belangrijke pijn in het betrokken lidmaat en/of tekens van verlamming). Welke heelkundige ingreep wordt gekozen is afhankelijk van waar de bron van het probleem zich bevindt, en kan gaan van het minimaal invasief verwijderen van een discushernia tot een open fixatie met verwijderen van de volledige tussenwervelschijf en facetgewrichten en complete decompressie van de zenuwen. Onze dienst is vertrouwd met alle verschillende behandelingenvan spinale pathologie; de gekozen ingreep zal deze zijn die op de minst invasief mogelijke manier de ziekte van de patiënt het best aanpakt.

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Degeneration of the spine can affect the lumbar disc but also facet joints, that can become hypertrophic and painful, and the ligaments.

The lumbar disc consists of a central gelatineous nucleus that is surrounded by concentric rings of fibrous tissue. It can undergo chronic changes, where the hydration status of the gelatinous nucleus progressively decreases leading to loss of disc height, but also to bulging of parts of the disc or the entire disc posteriorly. These anatomical changes can lead to back pain but also to pain caused by compression of the neurological structures that are located just behind the disc. The fibrous tissue surrounding the nucleus can also acutely rupture, leading to a herniated disc that can cause acute compression of the nerve and pain, decreased sensibility and even paralysis in the area that is innervated by this nerve.

The facet joints are located posteriorly and have similar characteristics to other joints in the body. Just like the other joints, they can undergo degenerative changes leading to loss of cartilage (and pain as a results) and hypertrophy of the surrounding bone. This hypertrophied bone can also compress the nerve.

Finally, the ligaments, especially the yellow ligament, can become heavily hypertrophied, leading to compression of the dural sack but sometimes also of the individual nerves.

Disc degeneration, artrhosis of the facet joints and hypertrophy of the yellow ligament often goes together, leading to significant pain but also multidirectional dompression of the neural structures.

Treatment

Treatment of pain in the back or in the leg as a result of degenerative spine disease mostly depends on whether or not the pathology is acute or chronic and whether or not there is an isolated degenerative disease (for example an isolated herniated disc) or whether the degeneration of the spine is more universal (affecting multiple structures and levels of the vertebral spine)

Conservative treatment (rest, medication, physiotherapy) is often preferred in the first stage as long as pain can be controlled with medication and no signs of paralysis are seen.

If this conservative treatment fails, injections can be administered in order to decrease pain symptoms. These injections can be administered peridurally but also in the transforaminal area (the trajectory of the nerve) or of the nerves innervating the facet joints.

Surgical treatment is offered in case conservative treatment fails or in case the nerve shows signs of significant compression (indicated by persisting pain in the limb and/or signs of paralysis). The type of surgical treatment that is then chosen depends on where the source of the problem is located, and can go from minimally invasive resection of a disc hernia to an open fixation with removal of the entire disc and facet joints and complete decompression of the nerves. Our department is familiar with all different approaches to spine pathology; the type of surgery chosen will be the least invasive surgical approach that best addresses the patient’s pathology.

[:fr]

Degeneration of the spine can affect the lumbar disc but also facet joints, that can become hypertrophic and painful, and the ligaments.

The lumbar disc consists of a central gelatineous nucleus that is surrounded by concentric rings of fibrous tissue. It can undergo chronic changes, where the hydration status of the gelatinous nucleus progressively decreases leading to loss of disc height, but also to bulging of parts of the disc or the entire disc posteriorly. These anatomical changes can lead to back pain but also to pain caused by compression of the neurological structures that are located just behind the disc. The fibrous tissue surrounding the nucleus can also acutely rupture, leading to a herniated disc that can cause acute compression of the nerve and pain, decreased sensibility and even paralysis in the area that is innervated by this nerve.

The facet joints are located posteriorly and have similar characteristics to other joints in the body. Just like the other joints, they can undergo degenerative changes leading to loss of cartilage (and pain as a results) and hypertrophy of the surrounding bone. This hypertrophied bone can also compress the nerve.

Finally, the ligaments, especially the yellow ligament, can become heavily hypertrophied, leading to compression of the dural sack but sometimes also of the individual nerves.

Disc degeneration, artrhosis of the facet joints and hypertrophy of the yellow ligament often goes together, leading to significant pain but also multidirectional dompression of the neural structures.

Treatment

Treatment of pain in the back or in the leg as a result of degenerative spine disease mostly depends on whether or not the pathology is acute or chronic and whether or not there is an isolated degenerative disease (for example an isolated herniated disc) or whether the degeneration of the spine is more universal (affecting multiple structures and levels of the vertebral spine)

Conservative treatment (rest, medication, physiotherapy) is often preferred in the first stage as long as pain can be controlled with medication and no signs of paralysis are seen.

If this conservative treatment fails, injections can be administered in order to decrease pain symptoms. These injections can be administered peridurally but also in the transforaminal area (the trajectory of the nerve) or of the nerves innervating the facet joints.

Surgical treatment is offered in case conservative treatment fails or in case the nerve shows signs of significant compression (indicated by persisting pain in the limb and/or signs of paralysis). The type of surgical treatment that is then chosen depends on where the source of the problem is located, and can go from minimally invasive resection of a disc hernia to an open fixation with removal of the entire disc and facet joints and complete decompression of the nerves. Our department is familiar with all different approaches to spine pathology; the type of surgery chosen will be the least invasive surgical approach that best addresses the patient’s pathology.

[:de]

Degeneration of the spine can affect the lumbar disc but also facet joints, that can become hypertrophic and painful, and the ligaments.

The lumbar disc consists of a central gelatineous nucleus that is surrounded by concentric rings of fibrous tissue. It can undergo chronic changes, where the hydration status of the gelatinous nucleus progressively decreases leading to loss of disc height, but also to bulging of parts of the disc or the entire disc posteriorly. These anatomical changes can lead to back pain but also to pain caused by compression of the neurological structures that are located just behind the disc. The fibrous tissue surrounding the nucleus can also acutely rupture, leading to a herniated disc that can cause acute compression of the nerve and pain, decreased sensibility and even paralysis in the area that is innervated by this nerve.

The facet joints are located posteriorly and have similar characteristics to other joints in the body. Just like the other joints, they can undergo degenerative changes leading to loss of cartilage (and pain as a results) and hypertrophy of the surrounding bone. This hypertrophied bone can also compress the nerve.

Finally, the ligaments, especially the yellow ligament, can become heavily hypertrophied, leading to compression of the dural sack but sometimes also of the individual nerves.

Disc degeneration, artrhosis of the facet joints and hypertrophy of the yellow ligament often goes together, leading to significant pain but also multidirectional dompression of the neural structures.

Treatment

Treatment of pain in the back or in the leg as a result of degenerative spine disease mostly depends on whether or not the pathology is acute or chronic and whether or not there is an isolated degenerative disease (for example an isolated herniated disc) or whether the degeneration of the spine is more universal (affecting multiple structures and levels of the vertebral spine)

Conservative treatment (rest, medication, physiotherapy) is often preferred in the first stage as long as pain can be controlled with medication and no signs of paralysis are seen.

If this conservative treatment fails, injections can be administered in order to decrease pain symptoms. These injections can be administered peridurally but also in the transforaminal area (the trajectory of the nerve) or of the nerves innervating the facet joints.

Surgical treatment is offered in case conservative treatment fails or in case the nerve shows signs of significant compression (indicated by persisting pain in the limb and/or signs of paralysis). The type of surgical treatment that is then chosen depends on where the source of the problem is located, and can go from minimally invasive resection of a disc hernia to an open fixation with removal of the entire disc and facet joints and complete decompression of the nerves. Our department is familiar with all different approaches to spine pathology; the type of surgery chosen will be the least invasive surgical approach that best addresses the patient’s pathology.

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