Disc Herniation - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim's educational animated video illustrates spine concept associated with low back pain.
Acute low back pain: or low back pain with sciatica:
where the pain radiates to the leg and foot, both conditions are treated conservatively for at least 6 weeks by physiotherapy, anti-inflammatory and limited activity, even if there is a big disc in the MRI.
90% of the patients will resolve the symptoms in 1 month.
Smoking, depression, vibration will increase the incidence of low back pain.
Intra-discal pressure will change with position, the lowest pressure is when the patient is supine, the highest pressure is when the patient is sitting leaning forward and holding weight.
If the patient comes with a low back pain and a history of cancer, you need to get an x-ray & MRI, especially if the pain is at rest at night.
In case of renal tumor, you will need to do arteriography and do embolization to the spine lesion.
The spine is a common place for metastatic tumors, the metastasis occur in the vertebral body and goes to the pedicle.
Infection will occur in the disc space, ESR & CRP will be elevated, 50% of the patients will have fever, & less than 50% will have increased WBC count.
Get blood culture, its positive in 24% of the cases.
Get MRI and give antibiotics.
In the case of epidural abscess, we’ll do surgery.
Osteoporotic fracture: start with wrist then spine, then hip.
After 1 year of treatment with medications you decrease the incidence of vertebral fracture by 60%, and after 2 years decrease by 40%.
Get x-rays if there is red flags only: older patient, patient with history of cancer, infection is suspected, trauma, osteoporotic fracture due to steroid use.
Ankylosing spondylitis: it starts at the SI joint, get HLA-B27; you find marginal syndesmophytes with diffuse ossification of the disc space without large osteophyte formation. This is different from the DISH (diffuse idiopathic skeletal hyperostosis) in diabetic patients where you get HbA1c and the syndesmophytes are nonmarginal & they have larger osteophytes.
So you get an MRI of the spine at a certain point, but you need to start with x-rays.
MRI may be a little problem: there are abnormal MRI in asymptomatic patients, false positive:
35% in patients less than 40 years of age.
90% in asymptomatic patients over 60 years of age.
MRI with gadolinium dye:
Gadolinium will differentiate a disc from a scar.
Both granulation tissue and the recurrent disc could look alike on routine MRI.
There will be contrast enhancement when there is granulation tissue because it is vascular.
When there is a disc herniation the dye will not enhance because the disc is dead piece of tissue (avascular).
When you try to differentiate between a recurrent disc and a scar, you will inject the dye and get the MRI.
If there is a vascular enhancement then it is granulation tissue and you will need to sit tight and not do surgery.
If there is no enhancement then it is a recurrent disc and it is avascular which is why it doesn’t enhance.
If the recurrent disc is causing a lot of pain or symptoms to the patient, then you probably need to do surgery.
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[@Assad966]

One of the best explanation on net. Thank you, jazakallah.

[@kalpeshwani8520]

Well spoken.... conceptual and ease of understanding.

[@shelaghbrown4857]

Wow you videos are incredible, I am very grateful for them. Thank you

[@HafizahHoshni]

Very beautifully and clearly explained presentation! Thank you for making me understand better! Thank you so much from Malaysia 🇲🇾 17/8/2019

[@lulugigi5312]

Your videos are very helpful Dr.Nabil, Thank you so much you've helped me in my studies .

[@sumaiyakhan9368]

Thank you very much for sharing information....please share treatment of each condition

[@maboshemunyinda6600]

Indeed, helpful

[@erichammond2466]

Outstanding information - Thank you

[@dibyasattwakarmakar]

Thank You , Sir

[@andrewb2476]

Great video, I am currently waiting for an MRI after rupturing a disc in my back causing Sciatica. Been laid on my back for over a week now, I hope Monday I find out about MRI because no improvements in over a week.

[@supravakaran6604]

Thank you sir for the information

[@andreadluna]

Wonderful! Thank you for your wonderful videos!

[@shir9080]

brilliant! thank you so much

[@geojor]

very clear teaching, thank you ...

[@arijitdhar71]

Thanks Sir very nice videos...kindly present videos of ctev , DDH and other diseases.

[@yaseryam9898]

Thank you for Tutorial .God Bless.

[@DoctorsHub]

Wow! Good one!

[@desgoulding7154]

THANK FOR SHARING PROF VERY GOOD VIDEO, GOD BLESS

[@mioangel1227]

Very good content! TFS Doctor! ❤️🙏

[@custom8888]

thank you very much professor!

[@mylifeinsweden575]

thank you very much

[@ismailhossain1060]

Thank you Very much sir

[@MrUmar62750]

Extremely Nice Videos Sir

[@umashekars1111]

Thank you so much Prof..

[@stevee211]

Hi Doc Nabil. I'm 24 years old and i have lower back pain. My MRI results says I have a small 2mm central disc bulge with posterior annular tear on L5-S1. I've been undergoing Physical Rehabilitation Therapy for over 3 weeks and my condition really improved. Almost 80 to 90% of the pain is gone. I just want to know, will my bulging disc heal permanently and back to normal?

[@karthikkeyan964]

I am also have the same doubt

[@janaabouhamdan7]

You're greaaaatttt ❤️

[@physiotherapypointmaithilp5538]

Thanks 😊☺️☺️☺️ you Soo much sir

[@KNGTTO]

thank you. Good one

[@badalbaloch]

Very good and informative as usuale

[@ismailbuiya9096]

Patients with spinal cord and spinal cord injuries are advised to recover

[@naasirabdi4044]

Doctor nabil. Thank you so much I want ask I have l5. S1 disc herniation now m feeling. Pain in my left leg when I stand long hours. Or. When I sit more then 10 minutes I visit several doctors ND they give. Medcin. Plus. Exercise to stretch my back ND my belvis still m feeling pain ND I finish Medcin what can I do doctor what is your advice plz any one can help me

[@shrees9022]

Sir...What is meant by sacralization of vertebrate? pls explain sir

[@takhellambamibungo9015]

,spinal cord very important. Spinal cord injury what madicine?any part 2nd.

[@alibasha2362]

so what is the treatment of l5/s1 disc herniation

[@shamimwani4407]

Sir' I have a MRI report But how may u see. I have a pain.

[@clarabartha1737]

Some of the topics could have been fleshed out more.

[@weldaytekle8020]

how to de selution

[@edunjacobs3040]

I only get pain went I stand and walk too long sitting make it better

[@tonysorice5142]

i have L4 L5 S1 how can i get better with out surgey

[@mioangel1227]

Professional therapy. ❤️🙏

[@Skoolboydev]

I have problem in L4 L5 C4C5

[@childofgodlove2875]

What type of syntoms are u feeling?

[@alb9982]

nobody have no idea what is this only injury people

[@azzamalmnaseer6160]

ترجمة للعربي

[@akonain1984]

0:01

[@skythunder2601]

🌷👋👌🌷👋👌🌷👋👌