Lumbosakralt diskbråck, ischias
Senast uppdaterad: Senast reviderad:
Sakkunnig:Remy Waardenburg
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