Diagnosis and differential diagnosis of lumbar disc herniation (two)

1.2 cutaneous nerve entrapment syndrome of superior Clunial Nerve originated from L1 - 3 of the posterior rami of lateral branch, descending

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1.2 cutaneous nerve entrapment syndrome of superior Clunial Nerve originated from L1 - 3 of the posterior rami of lateral branch, descending over the iliac crest in the hips, after the lumbodorsal fascia in the iliac crest bone formed at the edge of attached fiber tube piercing into the subcutaneous, distributed in the lateral skin of hip and femoral. A series of symptoms may be produced by the stimulation or compression of the superior gluteal nerve through the deep fascia. The clinical manifestations of low back pain and hip pain, can spread to the thigh and popliteal fossa, but rarely involved in the leg; the posterior superior iliac spine there was tenderness point above the iliac crest margin, sometimes palpable cord nodules or small lipoma; with gluteal muscle spasm. Local closure can immediately eliminate pain. No signs of the waist, straight leg raising and strengthening test negative, except for lumbar disc herniation. 1.3 lumbar transverse process syndrome of the third lumbar transverse process syndrome misdiagnosed as lumbar disc herniation is not uncommon in the third. Located in the third lumbar transverse process of lumbar central, the longest, backward curvature, muscle and fascia multiple back abdomen attached to it, the formation of lumbar motion and stress center hub. Therefore, it is vulnerable to the tensile injury of muscle fascia. The third lumbar vertebrae transverse tip close to the rear second posterior branch of lumbar nerve root, middle and lateral bending flexion to, it is easy to stretch and wear due to its dominant area of pain, numbness and other symptoms; and may refer to the anterior branch caused radioactive pain, affected hips and thighs, a handful of radiation to the perineum. The third lumbar transverse process in front of the lumbar plexus of the lateral femoral cutaneous nerve stem through the thigh and knee, distributed to the outside, the lesions can produce lateral femoral cutaneous nerve pain. Third lumbar transverse process syndrome onset can be slow and urgent, can have a history of trauma. Clinical manifestations in addition to the above symptoms, examination can be found at the tip of the third lumbar transverse process tenderness significantly, local muscle spasm or muscle tension. In patients with multiple palpable and slender three lumbar transverse process is too long. Local closure, when the tip to reach the lesion area, can lead to the recurrence of the original symptoms; local closure can immediately relieve pain. 1.4 gluteal muscle strain of gluteus maximus is shallow muscles of the fascia covering thick, the beginning part is susceptible to distraction injury. Gluteus maximus muscle innervation from L5 ~ S2, pain may involve the lower limb and produce similar symptoms of lumbar disc herniation. Acute gluteal muscle injury can cause muscle spasm, but its tenderness in the posterior superior iliac spine lateral, 5 can immediately eliminate the symptoms. 1.5 interspinous ligament strain is one of the common causes of low back pain, sore waist bent nowadays generally showed weakness, after bending straight difficulties and local pain etc.. Zhao Detian in 13 cases of interspinous ligament injury surgery, in which there were 8 cases of nerve root symptoms and signs. The authors found that 2 cases, no symptoms of nerve root, can only be attributed to the first diagnosed blindly believe CT diagnosis. After the diagnosis by 2 5 symptoms disappeared, no recurrence were followed up in June. 1.6 spinal nerve syndrome of posterior ramus of spinal nerve by spinal nerve from about O.5 to 1cm, in the lower edge of the vertebral transverse process, lateral facet backward walking, divided into medial and lateral branches, the angle of approximately 60 degrees. The medial branch of the lower part of the vertebral body through the transverse process of the root of the root and the superior articular process of the lateral downward through the bone fiber tube down 3 vertebral body, in the middle of the line through the deep fascia to the skin. The small joints, ligaments, and ligaments that are divided into one or two segments. The lateral outward walking out, muscle innervated paraspinal muscle, down to cutaneous branches of 3 vertebral body piercing down the lumbodorsal fascia and DAPI: L1 below the lateral branch of Zhiqia ridge; L2, supported by the hip to the outside L4, L3 shares; L5 cross by the hip to the posterior iliac crest. The distal end of the medial branch was distributed between the posterior midline and the facet joint. In. There are anastomotic branches between the lateral branches, and the innervation of the same structure is multi source. Such as L4 - 5 small joints by L2, L3 and L4 spinal nerve posterior branch of the medial branch. Therefore, a spinal nerve can cause irritation to below the distant parts of the pain involved, the nerve trunk closed, all symptoms disappeared. Because the posterior branch of spinal nerve and the bifurcation of the fixed part of the spine, the spine is prone to pull injury. Vertebral fracture. Intervertebral disc degeneration or postoperative changes in the relative position between the vertebrae, can be pulled back to the spinal cord and symptoms. The clinical manifestations of acute or chronic low back pain, with thigh pain, but not knee, without feeling, movement and reflection anomaly; chief pain area above 2 ~ 3 segments with lateral transverse root tenderness. (Continued)

 

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