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Lumbosakralt diskbråck, ischias

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Definition:
Lumbosakralt diskbråck med rotpåverkan (rizopati). Ischias och ischialgi är utstrålande från ryggen till försörjningsområdet av nervus ischiadicus (L5- och S1-dermatom). Cauda equina-syndrom (CES) är ett diskbråck som trycker på nerver S2–S4 som kan ge irreversibla nervskador. 
Förekomst:
Akut ryggsmärta är vanlig, men lumbosakralt diskbråck är orsak till <5 % av fallen med akut ländryggssmärta.
Symtom:
Smärtor i ett dermatom och eventuellt svaghet i muskler, oftast L4, L5 eller S1. Vid CES ses ridbyxanestesi, störning av miktion/defekation, bilaterala symtom 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. I vissa fall görs MRT preoperativt, tidigast efter 4–8 veckor. Vid misstanke om cauda equina-syndrom bör akut diagnostik på akutsjukhus ske. 
Behandling:
Består av initial anpassad aktivitet, smärtlindring och i subakut skede fysioterapi. Endast vissa behöver kirurgisk åtgärd. Vid CES behövs akut kirurgisk åtgärd. 
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  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Max Tenne, med dr och överläkare, Ortopediska kliniken, Skånes universitetssjukhus