Thank you for explaining. I do have some confused questions. Would you please clarify these for me? a. I understand that the lateral herniation you said is lateral to the nerve root. May I ask what kind of nerve root is? Is that existing nerve root or traversing nerve root? Based on the figure, I assume that this is the traversing nerve root as it is mostly affected by herniated discs. Is that right? b. What confused me is the type of herniation (posterolateral herniation, lateral herniation, central herniation) applying to this case? Again, based on the figure , can I assume that it is the posterolateral herniation? Is that correct? If it is, would that apply to lateral herniation as well? As the posterolateral herniation affects the traversing nerve root and lateral herniation affects existing nerve root. In order to clarify my question, let me give an example here. Let take L4-L5. Left herniation. - If the question asks for the posterolateral herniation, which side a patient can be listed? how can I answer this question? Thank you for your time!
Thanks for your question! a) The herniation can compress the spinal nerve root at and/or medial to the IVF b) In the case of a posterolateral disc herniation on the left side of the patient, the patient's antalgic position would be leaning to right. The right postural lean would slightly draw the spinal nerve root away from the herniation. Please send word if you need any further clarification!
@@NeuroDocUniverse Thank you for your clarification. a. Per your answer, I understand your point is the traversing nerve root as the existing nerve root is located a bit lateral to the IVF. Am I correct? b. So, how can I apply this theory into the type of herniation because the doctor usually says this is the lateral/posterolat/central herniation? We already mentioned the antalgic lean for the posterolateral herniation. How about the antalgic position for lateral herniation for lateral and central herniation? Can you explain in these types? Thank you for your time.
@@minhngo3162 thanks for your follow-up questions. a) The posterolateral or lateral disc herniation is actually medial to the IVF and may affect the sensory rootlet before actually compressing the mixed spinal nerve root. I'm unable to add a picture to this reply, so I recommend taking a look at an anatomical drawing or dissection for reference. b) The terms "lateral/posterolateral herniation" are often used interchangeably. A central herniation, however, is located in the midline of the posterior aspect of the disc and vertebral bodies. Depending on where the ventral herniation is located, a person may have cord compression symtoms (cervical and thoracic) or compression of the cauda equina (caudally from L2). In the case of a central disc herniation a person may present with back pain and no nerve root symptoms. Please send a follow-up note if you have more questions!
What if you have it on both sides? Mine switch sides after i lay down Sometimes. No pain go down my leg. Been 7 weeks and currently in physical therapy. My therapist said its very rare to see both sides
Justin, I cannot comment clinically on your specific case. However, generally speaking, a disc lesion that feels like it changes sides after reclining suggests a significant instability in the area that may be caused by damage to the annulus (outside of the disc). The switching can also be caused by a significant amount of extracellular inflammation in the area moving with gravity. or position.
I find the Slump test to be more sensitive in detecting nerve tension. If that's negative, it could be a case of mechanical LBP in someone who also happens to have a protrusion (several are asymptomatic) and it will respond well to mobilization. If Slump is positive, I would use distraction either in neutral or in slight flexion to open up the disc space and try to decompress the area.
This is the best explanation on youtube! Thank you so much
Thank you!! Finally, I get it. Very helpful!
This was so helpful! Thank you!
Thanks Dr. B.!
OMG, thank you ... million times thank you.
thank you!!
Love it
Well done. Thank you!
Thank YOU!
Thank you for explaining. I do have some confused questions. Would you please clarify these for me?
a. I understand that the lateral herniation you said is lateral to the nerve root. May I ask what kind of nerve root is? Is that existing nerve root or traversing nerve root? Based on the figure, I assume that this is the traversing nerve root as it is mostly affected by herniated discs. Is that right?
b. What confused me is the type of herniation (posterolateral herniation, lateral herniation, central herniation) applying to this case? Again, based on the figure , can I assume that it is the posterolateral herniation? Is that correct? If it is, would that apply to lateral herniation as well? As the posterolateral herniation affects the traversing nerve root and lateral herniation affects existing nerve root.
In order to clarify my question, let me give an example here. Let take L4-L5. Left herniation.
- If the question asks for the posterolateral herniation, which side a patient can be listed? how can I answer this question?
Thank you for your time!
Thanks for your question!
a) The herniation can compress the spinal nerve root at and/or medial to the IVF
b) In the case of a posterolateral disc herniation on the left side of the patient, the patient's antalgic position would be leaning to right. The right postural lean would slightly draw the spinal nerve root away from the herniation.
Please send word if you need any further clarification!
@@NeuroDocUniverse Thank you for your clarification.
a. Per your answer, I understand your point is the traversing nerve root as the existing nerve root is located a bit lateral to the IVF. Am I correct?
b. So, how can I apply this theory into the type of herniation because the doctor usually says this is the lateral/posterolat/central herniation? We already mentioned the antalgic lean for the posterolateral herniation. How about the antalgic position for lateral herniation for lateral and central herniation? Can you explain in these types?
Thank you for your time.
@@minhngo3162 thanks for your follow-up questions.
a) The posterolateral or lateral disc herniation is actually medial to the IVF and may affect the sensory rootlet before actually compressing the mixed spinal nerve root. I'm unable to add a picture to this reply, so I recommend taking a look at an anatomical drawing or dissection for reference.
b) The terms "lateral/posterolateral herniation" are often used interchangeably. A central herniation, however, is located in the midline of the posterior aspect of the disc and vertebral bodies. Depending on where the ventral herniation is located, a person may have cord compression symtoms (cervical and thoracic) or compression of the cauda equina (caudally from L2). In the case of a central disc herniation a person may present with back pain and no nerve root symptoms.
Please send a follow-up note if you have more questions!
awesome!
Interesting. What can someone do for a medial disc herniation? If we do Mackenzie excercises won't we be pushing back into the herniation?
I like that one!
There are several sources of false positive results for these tests. Sensitivity and specific values for each test would be useful
LAteral = Lean Away
What if you have it on both sides? Mine switch sides after i lay down Sometimes. No pain go down my leg. Been 7 weeks and currently in physical therapy. My therapist said its very rare to see both sides
Justin, I cannot comment clinically on your specific case. However, generally speaking, a disc lesion that feels like it changes sides after reclining suggests a significant instability in the area that may be caused by damage to the annulus (outside of the disc). The switching can also be caused by a significant amount of extracellular inflammation in the area moving with gravity. or position.
Central disc protrusion at L5S1. Negative leg raise test. consistentlow back pain. advice?
I find the Slump test to be more sensitive in detecting nerve tension. If that's negative, it could be a case of mechanical LBP in someone who also happens to have a protrusion (several are asymptomatic) and it will respond well to mobilization. If Slump is positive, I would use distraction either in neutral or in slight flexion to open up the disc space and try to decompress the area.
How are You doing now