Lumbosakralt diskbråck, ischias
Senast reviderad:
Sakkunnig:Gita Singh
Definition:
Lumbosakralt diskbråck med rotpåverkan (radikulopati). Cauda equina syndrom (CES) uppstår när ett diskbråck eder till kraftig förträngning av spinalkanalen och kan ge irreversibla nervskador.
Förekomst:
Prevalensen av ischias med nervrotssmärtor beräknas vara cirka 1–5 %.
Symtom:
Smärtor i ett dermatom och eventuell svaghet i muskler, oftast motsvarande nervrötterna L5 eller S1. Vid cauda equina syndrom ses ridbyxanestesi, störning av miktion/defekation, radikulopati och sexuell dysfunktion.
Kliniska fynd:
Enstaka kliniska fynd har begränsad förmåga att påvisa/avfärda diskbråck i ländryggen, men flera fynd kan tala för diskbråck. Test av sensorik, motorik och reflexer ingår.
Diagnostik:
Klinisk diagnos. Vid misstanke om cauda equina syndrom bör akut utredning på akutsjukhus ske.
Behandling:S
märtlindring och icke-kirurgisk behandling initialt. Endast vissa behöver kirurgisk åtgärd. Vid CES behövs akut kirurgisk åtgärd.
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- Gita Singh, specialist i allmänmedicin, medicinsk redaktör, Medibas