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Lumbosakralt diskbråck, ischias

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Sakkunnig:
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