Spinal disc herniation

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suggests disc herniation when it shows an increased T2-weighted signal at the posterior 10% of the disc. Degenerative disc diseases have shown a correlation with Modic type 1 changes. When evaluating for postoperative lumbar radiculopathies, the recommendation is that the MRI is performed with contrast unless otherwise contraindicated. MRI is more effective than CT in distinguishing inflammatory, malignant, or inflammatory etiologies of LDH. It is indicated relatively early in the course of evaluation (<8 weeks) when the patient presents with relative indications like significant pain, neurological motor deficits, and cauda equina syndrome. Diffusion tensor imaging is a type of MRI sequence used for detecting microstructural changes in the nerve root. It may be beneficial in understanding the changes that occur after herniated lumbar disc compresses a nerve root, and might help in differentiating the patients that need surgical intervention. In patients with a high suspicion of radiculopathy due to lumbar disc herniation, yet the MRI is equivocal or negative, nerve conduction studies are indicated.

695: 763: 1122:. Moderate quality evidence suggests that spinal manipulation is more effective than placebo for the treatment of acute (less than 3 months duration) lumbar disc herniation and acute sciatica. The same study also found "low to very low" evidence for its usefulness in treating chronic lumbar symptoms (more than 3 months) and "the quality of evidence for ... cervical spine-related extremity symptoms of any duration is low or very low". A 2006 review of published research states that spinal manipulation "is likely to be safe when used by appropriately-trained practitioners", and research currently suggests that spinal manipulation is safe for the treatment of disc-related pain. 863:. Because myelography involves the injection of foreign substances, MRI scans are now preferred for most patients. Myelograms still provide excellent outlines of space-occupying lesions, especially when combined with CT scanning (CT myelography). CT myelography is the imaging modality of choice to visualize herniated discs in patients with contraindications for an MRI. However, due to its invasiveness, the assistance of a trained radiologist is required. Myelography is associated with risks like post-spinal headache, meningeal infection, and radiation exposure. Recent advances with a multidetector CT scan have made the diagnostic level of it nearly equal to the MRI. 809: 502: 640: 833: 821: 449: 652: 797: 664: 845: 1212:

disc appears to provide faster relief from the acute attack than non‐surgical management. However, any positive or negative effects on the lifetime natural history of the underlying disc disease are unclear. Microdiscectomy gives broadly comparable results to standard discectomy. There is insufficient evidence on other surgical techniques to draw firm conclusions." Regarding the role of surgery for failed medical therapy in people without a significant neurological deficit, a

1362: 679: 755:(X-ray imaging). Traditional plain X-rays are limited in their ability to image soft tissues such as discs, muscles, and nerves, but they are still used to confirm or exclude other possibilities such as tumors, infections, fractures, etc. In spite of their limitations, X-rays play a relatively inexpensive role in confirming the suspicion of the presence of a herniated disc. If a suspicion is thus strengthened, other methods may be used to provide final confirmation. 58: 303:) on the posterior side (back side) of the disc. The combination of membrane-thinning from stretching and increased internal pressure (14 to 21 bar (200 to 300 psi)) can result in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, which may produce intense and potentially disabling pain and other symptoms. 1057:(FDA) suggested that the "injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death", and that "the effectiveness and safety of epidural administration of corticosteroids have not been established, and FDA has not approved corticosteroids for this use". 443:

postero-lateral herniation of the disc between vertebrae C5 and C6 will impinge on the right C6 spinal nerve. The rest of the spinal cord, however, is oriented differently, so a symptomatic postero-lateral herniation between two vertebrae will impinge on the nerve exiting at the next intervertebral level down.

859:. An X-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces will reveal displacement of the contrast material. It can show the presence of structures that can cause pressure on the spinal cord or nerves, such as herniated discs, tumors, or 492:

can also be affected and cause the patient to experience a numb, tingling feeling throughout one or both legs and even feet or a burning feeling in the hips and legs. A herniation in the lumbar region often compresses the nerve root exiting at the level below the disc. Thus, a herniation of the L4–5

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is the most sensitive imaging modality to examine the bony structures of the spine. CT imaging allows for the evaluation of calcified herniated discs or any pathological process that may result in bone loss or destruction. It is deficient for the visualization of nerve roots, making it unsuitable in

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is relatively thin and is not reinforced by the posterior or anterior longitudinal ligament. In the cervical spine, a symptomatic postero-lateral herniation between two vertebrae will impinge on the nerve which exits the spinal canal between those two vertebrae on that side. So, for example, a right

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is a set of symptoms associated with disc herniation. A study on sciatica showed that about one-third of patients with sciatica recover within two weeks after presentation using conservative measures alone, and about three-quarters of patients recovered after three months of conservative treatment.

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is a misnomer, as the intervertebral discs are tightly sandwiched between two vertebrae to which they are attached, and cannot actually "slip", or even get out of place. The disc is actually grown together with the adjacent vertebrae and can be squeezed, stretched and twisted, all in small degrees.

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When different forms of surgical treatments including (discetomy, microdiscectomy, and chemonucleolysis) were compared evidence was suggestive rather than conclusive. A Cochrane review from 2007 reported: "surgical discectomy for carefully selected patients with sciatica due to a prolapsed lumbar

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are still intact, but can bulge when the disc is under pressure. In contrast to a herniation, none of the central portion escapes beyond the outer layers. Most minor herniations heal within several weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or

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is the gold standard study for confirming a suspected LDH. With a diagnostic accuracy of 97%, it is the most sensitive study to visualize a herniated disc due to its significant ability in soft tissue visualization. MRI also has higher inter-observer reliability than other imaging modalities. It

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Following surgery, rehabilitation programs are often implemented. There is wide variation in what these programs entail. A Cochrane review found low- to very low-quality evidence that patients who participated in high-intensity exercise programs had slightly less short term pain and disability

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Cervical disc herniations occur in the neck, most often between the fifth and sixth (C5–6) and the sixth and seventh (C6–7) cervical vertebral bodies. There is an increased susceptibility amongst older (60+) patients to herniations higher in the neck, especially at C3–4. Symptoms of cervical

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Non-surgical methods of treatment are usually attempted first. Pain medications may be prescribed to alleviate acute pain and allow the patient to begin exercising and stretching. There are a number of non-surgical methods used in attempts to relieve the condition. They are considered

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Rabin A, Gerszten PC, Karausky P, Bunker CH, Potter DM, Welch WC (2007). "The sensitivity of the seated straight-leg raise test compared with the supine straight-leg raise test in patients presenting with magnetic resonance imaging evidence of lumbar nerve root compression".

295:) (lying down) to over 21 bar (300 psi) (lifting with a rounded back). Herniation of the contents of the disc into the spinal canal often occurs when the anterior side (stomach side) of the disc is compressed while sitting or bending forward, and the contents ( 1333:

bracing, and floor bridges. If pain is present in the back, it can mean that the stabilization muscles of the back are weak and a person needs to train the trunk musculature. Other preventative measures are to lose weight and not to work oneself past fatigue. Signs of

1236:. Lumbar disc herniation occurs 15 times more often than cervical (neck) disc herniation, and it is one of the most common causes of low back pain. The cervical discs are affected 8% of the time and the upper-to-mid-back (thoracic) discs only 1–2% of the time. 2613:

Igarashi T, Kikuchi S, Shubayev V, Myers RR (Dec 2000). "2000 Volvo Award winner in basic science studies: Exogenous tumor necrosis factor-alpha mimics nucleus pulposus-induced neuropathology. Molecular, histologic, and behavioral comparisons in rats".

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found shortcomings in most published studies and concluded that there was only "very limited evidence in the scientific literature to support the effectiveness of non-surgical spinal decompression therapy". Its use and marketing have been very

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Anjankar SD, Poornima S, Raju S, Jaleel M, Bhiladvala D, Hasan Q. Degenerated intervertebral disc prolapse and its association of collagen I alpha 1 Spl gene polymorphism: A preliminary case control study of Indian population. Indian J Orthop

925:(EMG/NCS) measure the electrical impulses along nerve roots, peripheral nerves, and muscle tissue. Tests can indicate if there is ongoing nerve damage, if the nerves are in a state of healing from a past injury, or if there is another site of 212:

that radiates into regions served by nerve roots which have been irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as patients present with undefined pains in the thighs, knees, or feet.

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identify the level of the spinal cord where myelopathy is located. This is especially useful in cases where more than two lesions may be responsible for the clinical symptoms and signs, such as in patients with two or more cervical disc

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provide a slight and questionable short-term improvement for those with sciatica, but are of no long-term benefit. Complications occur in up to 17% of cases when injections are performed on the neck, though most are minor. In 2014, the

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of the test. A Cochrane review published in 2010 found that individual diagnostic tests including the straight leg raising test, absence of tendon reflexes, or muscle weakness were not very accurate when conducted in isolation.

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Pinto, RZ; Maher, CG; Ferreira, ML; Hancock, M; Oliveira, VC; McLachlan, AJ; Koes, B; Ferreira, PH (18 December 2012). "Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis".

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Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue involved. They can range from little or no pain, if the disc is the only tissue injured, to severe and unrelenting

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Moore, Keith L. Moore, Anne M.R. Agur; in collaboration with and with content provided by Arthur F. Dalley II; with the expertise of medical illustrator Valerie Oxorn and the developmental assistance of Marion E. (2007).

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van der Windt, Daniëlle AWM; Simons, Emmanuel; Riphagen, Ingrid I; Ammendolia, Carlo; Verhagen, Arianne P; Laslett, Mark; Devillé, Walter; Deyo, Rick A; Bouter, Lex M; de Vet, Henrica CW; Aertgeerts, Bert (2010-02-17).

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Disc herniations can result from general wear and tear, such as weightlifting training, constant sitting or squatting, driving, or a sedentary lifestyle. Herniations can also result from the lifting of heavy loads.

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is harmful, as it leads to an incorrect idea of what has occurred and thus of the likely outcome. However, during growth, one vertebral body can slip relative to an adjacent vertebral body, a deformity called

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When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 1.2

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Intradural disc herniation is a rare form of disc herniation with an incidence of 0.2–2.2%. Pre-operative imaging can be helpful for diagnosis, but intra-operative findings are required for confirmation.

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of the spinal cord or nerve roots, but may also be caused by chemical inflammation. There is evidence that points to a specific inflammatory mediator in back pain: an inflammatory molecule, called

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with a one-inch skin opening has not been shown to result in a significantly different outcome from larger-opening discectomy with respect to pain. It might however have less risk of infection.

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disc protrusions in 50% of participants, suggesting that a considerable part of the population might have focal herniated discs in their cervical region that do not cause noticeable symptoms.

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Earhart, Jeffrey S.; Roberts, David; Roc, Gilbert; Gryzlo, Stephen; Hsu, Wellington (January 2012). "Effects of Lumbar Disk Herniation on the Careers of Professional Baseball Players".

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Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ (Sep 2005). "Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers".

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Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation. The former is the most common, causing

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When a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings, the disc is said to be herniated.

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Kraemer J (March 1995). "Natural course and prognosis of intervertebral disc diseases. International Society for the Study of the Lumbar Spine Seattle, Washington, June 1994".

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A herniated disc in the lumbar spine may cause radiating nerve pain in the lower extremities or groin area and may sometimes be associated with bowel or bladder incontinence.

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is often used as a preliminary test for possible disc herniation in the lumbar region. A variation is to lift the leg while the patient is sitting. However, this reduces the

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Some authors favour degeneration of the intervertebral disc as the major cause of spinal disc herniation and cite trauma as a minor cause. Disc degeneration occurs both in

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Typically, symptoms are experienced only on one side of the body, but if a herniation is very large and presses on the nerves on both sides within the spinal column or the

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Surgery may be useful when a herniated disc is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control.

1207:(in which there is incontinence, weakness, and genital numbness) is considered a medical emergency requiring immediate attention and possibly surgical decompression. 820: 1342:, poor coordination, muscle burning, and loss of the transverse abdominal brace. Heavy lifting should be done with the legs performing the work, and not the back. 808: 3289:

Abbasi A, Malhotra G, Malanga G, Elovic EP, Kahn S (Sep 2007). "Complications of interlaminar cervical epidural steroid injections: a review of the literature".

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McCarron RF, Wimpee MW, Hudkins PG, Laros GS (Oct 1987). "The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain".

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Foreman, A. Croft, S. Whiplash Injuries The Cervical Acceleration/Deceleration Syndrome. Williams and Wilkins. 428 E. Preston Street. Baltimore, MD. 21202 p 469

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Sekiguchi M, Kikuchi S, Myers RR (May 2004). "Experimental spinal stenosis: relationship between degree of cauda equina compression, neuropathology, and pain".

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Séguin CA, Pilliar RM, Roughley PJ, Kandel RA (Sep 2005). "Tumor necrosis factor-alpha modulates matrix production and catabolism in nucleus pulposus tissue".

1873:"Incidence rates and characteristics of abnormal lumbar findings and low back pain in child and adolescent weightlifter: A prospective three-year cohort study" 2684:

Igarashi A, Kikuchi S, Konno S, Olmarker K (Oct 2004). "Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders".

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is a significant, potentially disabling, result that can arise following invasive spine surgery to treat disc herniation. Smaller spine procedures such as

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Al-Ryalat, Nosaiba Tawfik; Saleh, Saif Aldeen; Mahafza, Walid Sulaiman; Samara, Osama Ahmad; Ryalat, Abdee Tawfiq; Al-Hadidy, Azmy Mohammad (March 2017).

1046:(NSAIDs), but long-term use of NSAIDs for people with persistent back pain is complicated by their possible cardiovascular and gastrointestinal toxicity. 418:. Within athletic contexts, herniation is often the result of sudden blunt impacts against, or abrupt bending or torsional movements of, the lower back. 3161:

Chen R, Cros D, Curra A, et al. (March 2008). "The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee".

1568: 714:. During an evaluation, tests may be performed to confirm or rule out other possible causes with similar symptoms – spondylolisthesis, degeneration, 372:– that encode for proteins and enzymes involved in the regulation of the extracellular matrix has been shown to contribute to lumbar disc herniation. 318:– become exposed to altered loads. Specifically, the nucleus becomes fibrous and stiff and less able to bear load. Excess load is transferred to the 271:

can cause permanent nerve damage or paralysis which can result in loss of bowel and bladder control and sexual dysfunction. This disorder is called

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The following locations have no discs and are therefore exempt from the risk of disc herniation: the upper two cervical intervertebral spaces, the

3557: 1932:"The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men - PubMed" 651: 2570:

Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T (Jan 1996). "Inflammatory cytokines in the herniated disc of the lumbar spine".

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In the majority of cases spinal disc herniation can be treated successfully conservatively, without surgical removal of the herniated material.

1616: 1589: 796: 663: 402:, are known to be prone to disc herniations as well as some limited contact sports that require repetitive flexion and compression such as 3845:

Oosterhuis, Teddy; Costa, Leonardo OP; Maher, Christopher G; de Vet, Henrica CW; van Tulder, Maurits W; Ostelo, Raymond WJG (2014-03-14).

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Oliphant, D (2004). "Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations: A Systematic Review and Risk Assessment".

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Lumbar disc herniations occur in the back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the

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Del Grande F, Maus TP, Carrino JA (July 2012). "Imaging the intervertebral disk: age-related changes, herniations, and radicular pain".

832: 3536:

Nordhoff, L. Motor Vehicle Collision Injuries, Mechanisms, Diagnosis and Management. Aspen Publisher, Inc. Gaithersburg, MD 1996 p 94

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material doesn't press on soft tissues or nerves. A small-sample study examining the cervical spine in symptom-free volunteers found

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WHO guidelines on basic training and safety in chiropractic. "2.1 Absolute contraindications to spinal manipulative therapy", p. 21.

2915: 4199: 3578:"Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?" 2070: 2052: 2031: 844: 3356:

Leininger B, Bronfort G, Evans R, Reiter T (2011). "Spinal manipulation or mobilization for radiculopathy: a systematic review".

639: 146: 2403:

Kobayashi, K (October 2014). "Intradural disc herniation: Radiographic findings and surgical results with a literature review".

1824:"A Functional Polymorphism in THBS2 that Affects Alternative Splicing and MMP Binding Is Associated with Lumbar-Disc Herniation" 4469: 2935: 1309:

Education should emphasize not lifting beyond one's capabilities and giving the body a rest after strenuous effort. Over time,

678: 192:, but this term is not accurate as the spinal discs are firmly attached between the vertebrae and cannot "slip" out of place. 3772: 2257: 1554: 1484: 1132:

Spinal manipulation is contraindicated when the etiology of the herniation is the result of a Motor Vehicle Collision (MVC)

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Haldeman, S. Principles and Practice of Chiropractic. Appleton & Lange, 25 Van Zant Str., East Norwalk, CT. 1992 p 565

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Ahn, Yong; Choi, Gun; Lee, Sang-Ho (2016). "History of Lumbar Endoscopic Spinal Surgery and the Intradiskal Therapies".

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Diagnosis of spinal disc herniation is made by a practitioner on the basis of a patient's history and symptoms, and by

2306:"Myelopathy associated with age-related cervical disc herniation: a retrospective review of magnetic resonance images" 2219: 1967: 1285:

Because there are various causes of back injuries, prevention must be comprehensive. Back injuries are predominant in

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Mutations in several genes have been implicated in intervertebral disc degeneration. Probable candidate genes include

3450: 1706: 1166:(the partial removal of a disc that is causing leg pain) can provide pain relief sooner than non-surgical treatments. 871: 2729:"Up-regulation of p55 TNF alpha-receptor in dorsal root ganglia neurons following lumbar facet joint injury in rats" 1220:

compared to low-intensity exercise programs. There was no difference between supervised and home exercise programs.

1349:. The usage of lumbar-sacral support belts may restrict movement at the spine and support the back during lifting. 612:

It can also be torn, ripped, herniated, and degenerated, but it cannot "slip". Some authors consider that the term

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Narrowed space between L5 and S1 vertebrae, indicating probable prolapsed intervertebral disc – a classic picture

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Deftereos SN, et al. (April–June 2009). "Localisation of cervical spinal cord compression by TMS and MRI".

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disc tear are generally effective. Severe herniations may not heal of their own accord and may require surgery.

4464: 159: 20: 4001:"Regeneration of intervertebral disc by mesenchymal stem cells: potentials, limitations, and future direction" 3700:"Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation" 3333:"Epidural Corticosteroid Injection: Drug Safety Communication - Risk of Rare But Serious Neurologic Problems" 1373: 438:

region accounts for only 1–2% of cases. Herniations usually occur postero-laterally, at the points where the

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Hsu, Wellington K. (August 2010). "Lumbar and Cervical Disk Herniations in NFL Players: Return to Action".

1435: 1009: 151: 130:, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by 2200:"[The incidence of disk changes in volleyball players. The magnetic resonance findings] - PubMed" 739: 544: 539:

It is increasingly recognized that back pain resulting from disc herniation is not always due solely to

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Disc herniation is frequently associated with age-related degeneration of the outer ring, known as the

3393:"Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review" 1766: 1138:

is contraindicated for disc herniations when there are progressive neurological deficits such as with

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However the study did not indicate the number of individuals with sciatica that had disc herniations.

4433: 3042:"Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain" 1455: 874:(TMS), a neurophysiological method that measures the time required for a neural impulse to cross the 601: 307: 86: 1672: 1604: 4257: 4111: 2960:

Waddell G, McCulloch JA, Kummel E, Venner RM (1980). "Nonorganic physical signs in low-back pain".

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assess the progression of myelopathy with time, for example before and after cervical spine surgery

752: 150:, but is normally triggered by trauma or straining by lifting or twisting. Tears are almost always 111: 501: 4420: 4185: 2079:"Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations" 1930:

Videman, T.; Sarna, S.; Battié, M. C.; Koskinen, S.; Gill, K.; Paananen, H.; Gibbons, L. (1995).

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Shimozaki, K.; Nakase, J.; Yoshioka, K.; Takata, Y.; Asai, K.; Kitaoka, K.; Tsuchiya, H. (2018).

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concluded that "limited evidence is now available to support some aspects of surgical practice".

241: 4296: 1098: 1094: 1075: 943: 922: 252: 4151: 911:

TMS can also help in the differential diagnosis of different causes of pyramidal tract damage.

789:-weighted images allow for clear visualization of protruded disc material in the spinal canal. 267:, both sides of the body may be affected, often with serious consequences. Compression of the 4443: 3451:"Spinal manipulation in patients with disc herniation: A critical review of risk and benefit" 3259: 2862: 1460: 1201: 1169: 1067: 1004: 292: 272: 2492:

Marshall LL, Trethewie ER (Aug 1973). "Chemical irritation of nerve-root in disc prolapse".

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to address mechanical factors, and may include modalities to temporarily relieve pain (i.e.

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It is possible to have a herniated disc without pain or noticeable symptoms if the extruded

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Bartolozzi, C.; Caramella, D.; Zampa, V.; Dal Pozzo, G.; Tinacci, E.; Balducci, F. (1991).

1884: 1330: 1297:. Prevention must come from multiple sources such as education, proper body mechanics, and 1190: 1177: 1146: 711: 379: 2887: 1267:

4.8% of males and 2.5% of females older than 35 experience sciatica during their lifetime.

322:, which may then develop fissures as a result. If the fissures reach the periphery of the 8: 4085: 2912: 1440: 1255:

changes ("dries out") and the risk of herniation is greatly reduced. After age 50 or 60,

1135: 1119: 883: 774: 559:. In addition to causing pain and inflammation, TNF may contribute to disc degeneration. 99: 3724: 3699: 1888: 1074:, relatively contraindicated, or inconclusive, depending on the safety profile of their 240:, pain from a herniated disc is usually continuous or at least continuous in a specific 4428: 4162: 4025: 4000: 3946: 3921: 3879: 3846: 3822: 3789: 3737: 3698:

Rasouli, MR; Rahimi-Movaghar, V; Shokraneh, F; Moradi-Lakeh, M; Chou, R (Sep 4, 2014).

3606: 3577: 3420: 3314: 3271: 3222: 3205: 3186: 2985: 2844: 2832: 2801: 2753: 2728: 2709: 2697: 2639: 2595: 2552: 2474: 2428: 2338: 2305: 2267: 2105: 2078: 2023: 1959: 1907: 1872: 1848: 1823: 1799: 1774: 1583: 1184: 735: 435: 431: 338: 4094: 4090: 2657:

Sommer C, Schäfers M (2004). "Mechanisms of neuropathic pain: the role of cytokines".

2505: 4344: 4318: 4122: 4030: 3951: 3884: 3866: 3827: 3809: 3768: 3729: 3671: 3611: 3510: 3412: 3373: 3306: 3263: 3227: 3178: 3143: 3106: 3065: 3057: 3021: 2977: 2973: 2836: 2793: 2789: 2758: 2701: 2631: 2627: 2587: 2583: 2544: 2540: 2509: 2466: 2420: 2343: 2325: 2253: 2211: 2180: 2145: 2110: 2005: 2001: 1951: 1947: 1912: 1853: 1804: 1742: 1702: 1654: 1560: 1550: 1522: 1425: 1393: 1346: 1335: 1247:. Most disc herniations occur when a person is in their thirties or forties when the 1023: 969: 726:, for instance – as well as to evaluate the efficacy of potential treatment options. 618: 387: 361: 65: 47:

Slipped disc, bulging disc, ruptured disc, herniated disc, prolapsed disc, herniated

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3424: 3318: 3275: 2989: 2939: 2848: 2805: 2713: 2643: 2599: 2556: 2478: 2432: 4313: 4223: 4020: 4012: 3941: 3933: 3874: 3862: 3858: 3817: 3805: 3801: 3760: 3719: 3715: 3711: 3663: 3601: 3591: 3502: 3464: 3404: 3365: 3298: 3255: 3217: 3190: 3170: 3053: 3049: 3013: 2969: 2828: 2785: 2748: 2740: 2693: 2666: 2623: 2579: 2536: 2501: 2458: 2416: 2412: 2333: 2317: 2172: 2137: 2100: 2090: 1997: 1963: 1943: 1902: 1892: 1843: 1835: 1794: 1786: 1734: 1646: 1549:. A. M. R. Agur, Arthur F., II Dalley (8 ed.). Philadelphia. pp. 98–108. 1298: 1090: 1071: 918: 875: 826:

MRI scan of large herniation (on the right) of the disc between L4 and L5 vertebrae

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can cause the intervertebral disc to tear or become damaged. Striving to maintain

1232:(lumbago) and often leg pain as well, in which case it is commonly referred to as 929:. EMG/NCS studies are typically used to pinpoint the sources of nerve dysfunction 4388: 4356: 4116: 3764: 3639: 3635: 3561: 3408: 3302: 3174: 3041: 2919: 2176: 2141: 1897: 1465: 1260: 1213: 1014: 950: 886:

of the cervical, thoracic, or lumbar spinal cord. This measurement is called the

879: 589: 556: 547:(TNF), is released not only by a herniated disc, but also in cases of disc tear ( 519: 515: 330: 228:. If the herniated disc is in the lumbar region, the patient may also experience 177: 107: 4165: 3468: 2670: 1650: 4361: 4349: 4208: 3628: 3506: 3100: 3017: 2462: 2321: 2287: 2252:(3rd ed.). Baltimore, MD: Lippincott Williams & Wilkins. p. 286. 1839: 1256: 1114: 473: 391: 334: 131: 4127: 4075: 4016: 3937: 3667: 3369: 2744: 2095: 2045: 1738: 236:. Unlike a pulsating pain or pain that comes and goes, which can be caused by 4458: 4410: 4393: 4339: 4276: 3922:"Surgical techniques for sciatica due to herniated disc, a systematic review" 3870: 3813: 3061: 2329: 1564: 1450: 1410: 1329:. Back exercises include the prone push-ups/press-ups, upper back extension, 1314: 1290: 1229: 978: 700:

Illustration showing disc degeneration, prolapse, extrusion and sequestration

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herniations may be felt in the back of the skull, the neck, shoulder girdle,

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disc compresses the L5 nerve root, only if the herniation is posterolateral.

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Disc herniation is normally a further development of a previously existing

163: 135: 74: 2981: 2591: 2548: 2513: 2215: 2009: 1955: 1544: 1270:

Of all individuals, 60% to 80% experience back pain during their lifetime.

4334: 4291: 4262: 4146: 3902: 1326: 1019: 856: 217: 162:. A tear in the disc ring may result in the release of chemicals causing 81: 70: 1361: 4398: 3788:

Gibson, J. N. A.; Waddell, G. (2007-04-18). Gibson, JN Alastair (ed.).

1445: 1430: 1163: 999: 995: 989: 958: 867: 719: 415: 411: 395: 288: 167: 119: 57: 4058: 2449:

Peng B, Wu W, Li Z, Guo J, Wang X (Jan 2007). "Chemical radiculitis".

4383: 4375: 4241: 4157: 3654:

Manusov, EG (September 2012). "Surgical treatment of low back pain".

3629:

Be Wary of Spinal Decompression Therapy with VAX-D or Similar Devices

3038: 2391: 2292: 1775:"Genetic background of degenerative disc disease in the lumbar spine" 1612: 946:

spinal disc herniations from other conditions with similar symptoms.

860: 399: 221: 205: 115: 103: 3759:. Berlin, Heidelberg: Springer Berlin Heidelberg. pp. 783–791. 3244: 4403: 4308: 4236: 4231: 1405: 1233: 1035: 983: 974: 786: 597: 485: 469: 461: 407: 342: 229: 430:

spine (95% at L4–L5 or L5–S1). The second most common site is the

299:) get pressed against the tightly stretched and thinned membrane ( 200:

Typically, symptoms are experienced on one side of the body only.

4177: 2197: 1325:

Exercises that enhance back strength may also be used to prevent

1102: 964: 657:

Normal situation and spinal disc herniation in cervical vertebrae

511: 346: 216:

Symptoms may include sensory changes such as numbness, tingling,

118:, pain or sensation in different parts of the body, and physical 4105: 3920:

Jacobs WC, Arts MP, van Tulder MW, et al. (November 2012).

814:

MRI scan of cervical disc herniation between C6 and C7 vertebrae

802:

MRI scan of cervical disc herniation between C5 and C6 vertebrae

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Generally, males have a slightly higher incidence than females.

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cannot cause failed back syndrome, because no bone is removed.

326:, the nuclear material can pass through as a disc herniation. 1870: 715: 465: 369: 237: 3355: 3206:"Predicting the outcome of sciatica at short-term follow-up" 3087: 2959: 2683: 2612: 2569: 1720: 1718: 1317:

and body alignment will aid in preventing disc degradation.

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Ball, J. R.; Harris, C. B.; Lee, J.; Vives, M. J. (2019).

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is the most commonly affected nerve, causing symptoms of

477: 166:, which can result in severe pain even in the absence of 127: 3203: 850:

Example of a herniated disc at L5–S1 in the lumbar spine

310:

and aging. With degeneration, the disc components – the

154:(on the back sides) owing to relative narrowness of the 16:

Injury to the connective tissue between spinal vertebrae

2913:

FAQ: "...the entire disc does not 'slip' out of place."

2162: 3495:

Journal of Manipulative and Physiological Therapeutics

3099:

Al Qaraghli, MI; De Jesus, O (2021), "article-24453",

2727:

Sakuma Y, Ohtori S, Miyagi M, et al. (Aug 2007).

1696: 1293:

prevention methods have been applied primarily toward

604:, and black disc (a totally degenerated spinal disc). 572:

Terms commonly used to describe the condition include

134:

strength and an awareness of body mechanics including

3757:

Advanced Concepts in Lumbar Degenerative Disk Disease

2775: 1724: 1605:"Frequency of asymptomatic cervical disc protrusions" 1263:

are more likely causes of low back pain or leg pain.

426:

The majority of spinal disc herniations occur in the

4048: 3919: 3649: 3647: 3548: 2024:"Herniated disk: 6 safe exercises and what to avoid" 588:. Other conditions that are closely related include 3098: 232:due to irritation of one of the nerve roots of the 26:"Slipped disc" redirects here. For other uses, see 3204:Vroomen PC, de Krom MC, Knottnerus JA (Feb 2002). 2726: 2076: 3790:"Surgical interventions for lumbar disc prolapse" 3644: 3390: 2863:"Slipped discs: "they do not actually 'slip'..."" 2491: 669:Illustration depicting herniated disc and spinal 4456: 3748: 3006:Archives of Physical Medicine and Rehabilitation 1251:is still a gelatin-like substance. With age the 460:. Here, symptoms can be felt in the lower back, 3998: 3105:, Treasure Island (FL): StatPearls Publishing, 1697:Simeone, F.A.; Herkowitz, H.N.; Garfin (2006). 220:, and motor changes such as muscular weakness, 122:. The most conclusive diagnostic tool for disc 2656: 4193: 3787: 3456:International Journal of Osteopathic Medicine 3160: 2053:"What is the physical toll of playing rugby?" 1515:"Backache from Occiput to Coccyx | Home Page" 525: 3197: 2996: 2272:: CS1 maint: multiple names: authors list ( 1758: 1756: 838:A rather severe herniation of the L4–L5 disc 624:Spinal disc herniation is known in Latin as 3794:The Cochrane Database of Systematic Reviews 3704:The Cochrane Database of Systematic Reviews 2953: 2448: 2444: 2442: 2242: 2240: 2238: 2236: 1630: 1195:endoscopic transforaminal lumbar discectomy 496: 4200: 4186: 3847:"Rehabilitation after lumbar disc surgery" 3754: 3238: 1822:Hirose, Yuichiro; et al. (May 2008). 1588:: CS1 maint: location missing publisher ( 56: 4024: 3945: 3878: 3821: 3723: 3605: 3595: 3349: 3221: 3133: 2752: 2402: 2337: 2104: 2094: 1987: 1906: 1896: 1847: 1798: 1772: 1753: 1596: 1078:and on whether they may or may not help: 1060: 937: 3999:Leung VY, Chan D, Cheung KM (Aug 2006). 3492: 3486: 3448: 3442: 3260:10.7326/0003-4819-157-12-201212180-00564 2929: 2927: 2659:Drug Discovery Today: Disease Mechanisms 2439: 2233: 500: 476:), and may radiate into the foot and/or 447: 3983: 3968: 3851:Cochrane Database of Systematic Reviews 3653: 3391:Hahne AJ, Ford JJ, McMeeken JM (2010). 3046:Cochrane Database of Systematic Reviews 1602: 1273:In 14%, pain lasts more than two weeks. 705: 180:, in which the outermost layers of the 4457: 3575: 3569: 2938:. MacDonald Publishing. Archived from 1821: 1690: 1042:Initial treatment usually consists of 188:The condition may be referred to as a 4181: 2924: 2362:"Symptoms of Herniated Cervical Disc" 2246: 1542: 1176:) is non-invasive and does not cause 729: 195: 3622: 1356: 1109:Nonsteroidal anti-inflammatory drugs 1044:nonsteroidal anti-inflammatory drugs 514:, arm, and hand. The nerves of the 3325: 2405:Clinical Neurology and Neurosurgery 2127: 1495:from the original on 8 October 2017 684:Nucleus herniating through tear in 645:Lumbar disc lesions, classification 632:Click images to see larger versions 600:, disc disease, disc degeneration, 13: 4207: 2936:"Backache: From Occiput to Coccyx" 2833:10.1097/01.brs.0000176188.40263.f9 2698:10.1097/01.brs.0000141265.55411.30 1828:American Journal of Human Genetics 1779:Spine Surgery and Related Research 1345:Swimming is a common tool used in 1126: 1087:Education on proper body mechanics 1050:Epidural corticosteroid injections 421: 14: 4481: 4044: 2933: 872:transcranial magnetic stimulation 746: 2974:10.1097/00007632-198003000-00005 2790:10.1097/00007632-200405150-00011 2628:10.1097/00007632-200012010-00003 2584:10.1097/00007632-199601150-00011 2541:10.1097/00007632-198710000-00009 2002:10.1097/00007632-199503150-00001 1948:10.1097/00007632-199503150-00011 1360: 843: 831: 819: 807: 795: 761: 693: 677: 662: 650: 638: 626:prolapsus disci intervertebralis 3992: 3977: 3962: 3913: 3895: 3838: 3781: 3691: 3682: 3539: 3530: 3521: 3475:from the original on 2014-03-18 3431:from the original on 2023-05-31 3282: 3154: 3127: 3117:from the original on 2022-02-21 3076:from the original on 2022-02-21 3032: 2905: 2894:from the original on 2012-01-02 2880: 2869:from the original on 2012-03-06 2855: 2812: 2769: 2720: 2677: 2650: 2606: 2563: 2520: 2485: 2396: 2379: 2354: 2297: 2280: 2222:from the original on 2022-02-21 2156: 2121: 2059:from the original on 2021-02-27 2034:from the original on 2019-12-24 2016: 1981: 1970:from the original on 2021-05-25 1815: 1679:from the original on 2015-02-12 1619:from the original on 2009-01-08 1571:from the original on 2021-03-01 1223: 1055:US Food and Drug Administration 778:the diagnoses of radiculopathy. 534: 156:posterior longitudinal ligament 3863:10.1002/14651858.cd003007.pub3 3806:10.1002/14651858.CD001350.pub4 3716:10.1002/14651858.CD010328.pub2 3054:10.1002/14651858.cd007431.pub2 2417:10.1016/j.clineuro.2014.06.033 1665: 1536: 1507: 1477: 1392:Future treatments may include 1259:degeneration (spondylosis) or 901:determine if myelopathy exists 567: 364:. Mutation in genes – such as 275:. Other complications include 160:anterior longitudinal ligament 106:, usually caused by excessive 21:vertebral compression fracture 1: 4470:Bones of the vertebral column 3986:Overcoming Back and Neck Pain 3971:Overcoming Back and Neck Pain 3583:Chiropractic & Osteopathy 2506:10.1016/S0140-6736(73)90818-0 1673:"Prolapsed Disc Arizona Pain" 1471: 1280: 894:). TMS can aid physicians to: 870:can be evaluated by means of 866:The presence and severity of 505:Herniated disc at C6–C7 level 28:Slipped disc (disambiguation) 4421:Intervertebral disc disorder 3988:. Harvest House. p. 31. 3973:. Harvest House. p. 37. 3765:10.1007/978-3-662-47756-4_53 3409:10.1097/BRS.0b013e3181cc3f56 3303:10.1097/BRS.0b013e318145a360 3175:10.1016/j.clinph.2007.10.014 2177:10.3928/01477447-20111122-40 2142:10.3928/01477447-20100625-18 1898:10.1371/journal.pone.0206125 1436:Failed back surgery syndrome 1304: 1081: 1029: 1010:Sacroiliac joint dysfunction 562: 7: 3469:10.1016/j.ijosm.2006.08.001 3248:Annals of Internal Medicine 2671:10.1016/j.ddmec.2004.11.018 1651:10.1016/j.ejrad.2004.11.003 1546:Clinically oriented anatomy 1519:www.macdonaldpublishing.com 1399: 1352: 1320: 1170:Small endoscopic discectomy 545:tumor necrosis factor alpha 434:region (C5–C6, C6–C7). The 382:, especially those playing 10: 4486: 3908:Herniated nucleus pulposus 3507:10.1016/j.jmpt.2003.12.023 3358:Phys Med Rehabil Clin N Am 3018:10.1016/j.apmr.2007.04.016 2463:10.1016/j.pain.2006.06.034 2322:10.5144/0256-4947.2017.130 2250:Essential clinical anatomy 1840:10.1016/j.ajhg.2008.03.013 1699:Rothman-Simeone, The Spine 1603:Windsor, Robert E (2006). 1416:Nerve compression syndrome 1174:nano-endoscopic discectomy 1154: 782:Magnetic resonance imaging 526:Intradural disc herniation 25: 18: 4434:Degenerative disc disease 4419: 4374: 4327: 4284: 4275: 4250: 4222: 4215: 4137: 4052: 4017:10.1007/s00586-006-0183-z 3938:10.1007/s00586-012-2422-9 3668:10.1016/j.pop.2012.06.010 3370:10.1016/j.pmr.2010.11.002 2745:10.1007/s00586-007-0365-3 2096:10.1186/s40798-019-0199-7 1739:10.1016/j.rcl.2012.04.014 1456:Degenerative disc disease 1145:A review of non-surgical 942:Tests may be required to 602:degenerative disc disease 308:degenerative disc disease 87:Connective tissue disease 80: 64: 55: 43: 38: 3903:MedlinePlus Encyclopedia 3576:Daniel, Dwain M (2007). 2310:Annals of Saudi Medicine 1543:Moore, Keith L. (2018). 923:nerve conduction studies 753:Projectional radiography 497:Cervical disc herniation 282: 51:, lumbar disc herniation 19:Not to be confused with 2865:. Emedicinehealth.com. 1791:10.22603/ssrr.2017-0007 888:central conduction time 775:Computed tomographyscan 4439:Spinal disc herniation 4297:Ankylosing spondylitis 3984:Marrone, Lisa (2008). 3969:Marrone, Lisa (2008). 3597:10.1186/1746-1340-15-7 3341:. 2014. Archived from 3102:Lumbar Disc Herniation 2083:Sports Medicine - Open 1773:Kawaguchi, Y. (2018). 1727:Radiol. Clin. North Am 1609:Cervical Disc Injuries 1099:electrical stimulation 1061:Lumbar disc herniation 938:Differential diagnosis 506: 453: 96:spinal disc herniation 39:Spinal disc herniation 4465:Spinal cord disorders 4444:Facet joint arthrosis 4258:Scheuermann's disease 1461:Cauda equina syndrome 1289:, so the majority of 1005:Myocardial infarction 504: 452:Herniated lumbar disc 451: 380:Professional athletes 273:cauda equina syndrome 4011:(Suppl 3): S406–13. 2204:La Radiologia Medica 1331:transverse abdominis 1191:Failed back syndrome 1178:failed back syndrome 1147:spinal decompression 878:, starting from the 722:and space-occupying 712:physical examination 706:Physical examination 242:position of the body 98:is an injury to the 3449:Snelling N (2006). 2387:Cervical herniation 2030:. 28 January 2019. 1889:2018PLoSO..1306125S 1675:. arizonapain.com. 1136:Spinal manipulation 1120:Spinal manipulation 884:anterior horn cells 470:anal/genital region 224:, and affection of 114:. It may result in 102:between two spinal 100:intervertebral disc 4138:External resources 3634:2019-06-20 at the 3560:2020-04-29 at the 2918:2010-01-06 at the 2055:. September 2015. 2028:Medical News Today 1441:Intervetebral disc 1372:. You can help by 1076:risk–benefit ratio 994:Benign tumor like 882:and ending at the 736:straight leg raise 730:Straight leg raise 507: 454: 339:vitamin D receptor 196:Signs and symptoms 4452: 4451: 4370: 4369: 4345:Spondylolisthesis 4271: 4270: 4175: 4174: 3774:978-3-662-47755-7 3345:on April 6, 2017. 3163:Clin Neurophysiol 2934:Burke, Gerald L. 2890:. Spine-inc.com. 2288:Lumbar herniation 2259:978-0-7817-6274-8 1556:978-1-4963-4721-3 1426:Neuroinflammation 1394:stem cell therapy 1390: 1389: 1347:strength training 1024:spondylolisthesis 970:Aortic dissection 927:nerve compression 671:nerve compression 619:spondylolisthesis 607:The popular term 596:(pinched nerve), 541:nerve compression 522:can be affected. 388:American football 110:or trauma to the 92: 91: 33:Medical condition 4477: 4328:non inflammatory 4314:Spondylodiscitis 4282: 4281: 4224:Spinal curvature 4220: 4219: 4202: 4195: 4188: 4179: 4178: 4050: 4049: 4039: 4038: 4028: 3996: 3990: 3989: 3981: 3975: 3974: 3966: 3960: 3959: 3949: 3917: 3911: 3899: 3893: 3892: 3882: 3842: 3836: 3835: 3825: 3785: 3779: 3778: 3752: 3746: 3745: 3727: 3695: 3689: 3686: 3680: 3679: 3651: 3642: 3626: 3620: 3619: 3609: 3599: 3573: 3567: 3552: 3546: 3543: 3537: 3534: 3528: 3525: 3519: 3518: 3490: 3484: 3483: 3481: 3480: 3446: 3440: 3439: 3437: 3436: 3403:(11): E488–504. 3388: 3382: 3381: 3353: 3347: 3346: 3329: 3323: 3322: 3286: 3280: 3279: 3242: 3236: 3235: 3225: 3201: 3195: 3194: 3158: 3152: 3151: 3131: 3125: 3124: 3123: 3122: 3096: 3085: 3084: 3082: 3081: 3036: 3030: 3029: 3000: 2994: 2993: 2957: 2951: 2950: 2948: 2947: 2931: 2922: 2909: 2903: 2902: 2900: 2899: 2888:"Prolapsed disc" 2884: 2878: 2877: 2875: 2874: 2859: 2853: 2852: 2816: 2810: 2809: 2773: 2767: 2766: 2756: 2724: 2718: 2717: 2681: 2675: 2674: 2654: 2648: 2647: 2610: 2604: 2603: 2567: 2561: 2560: 2524: 2518: 2517: 2489: 2483: 2482: 2446: 2437: 2436: 2400: 2394: 2383: 2377: 2376: 2374: 2373: 2364:. Archived from 2358: 2352: 2351: 2341: 2301: 2295: 2284: 2278: 2277: 2271: 2263: 2244: 2231: 2230: 2228: 2227: 2195: 2189: 2188: 2160: 2154: 2153: 2125: 2119: 2118: 2108: 2098: 2074: 2068: 2067: 2065: 2064: 2049: 2043: 2042: 2040: 2039: 2020: 2014: 2013: 1985: 1979: 1978: 1976: 1975: 1927: 1921: 1920: 1910: 1900: 1883:(10): e0206125. 1868: 1862: 1861: 1851: 1834:(5): 1122–1129. 1819: 1813: 1812: 1802: 1770: 1764: 1760: 1751: 1750: 1722: 1713: 1712: 1694: 1688: 1687: 1685: 1684: 1669: 1663: 1662: 1634: 1628: 1627: 1625: 1624: 1600: 1594: 1593: 1587: 1579: 1577: 1576: 1540: 1534: 1533: 1531: 1530: 1521:. Archived from 1511: 1505: 1504: 1502: 1500: 1485:"Herniated disk" 1481: 1385: 1382: 1364: 1357: 1299:physical fitness 1253:nucleus pulposus 1249:nucleus pulposus 1200:The presence of 1091:Physical therapy 919:Electromyography 876:pyramidal tracts 847: 835: 823: 811: 799: 765: 697: 681: 666: 654: 642: 440:annulus fibrosus 335:type IX collagen 316:annulus fibrosus 312:nucleus pulposus 301:annulus fibrosus 297:nucleus pulposus 249:nucleus pulposus 182:annulus fibrosus 158:relative to the 147:annulus fibrosus 60: 49:nucleus pulposus 36: 35: 4485: 4484: 4480: 4479: 4478: 4476: 4475: 4474: 4455: 4454: 4453: 4448: 4429:Schmorl's nodes 4415: 4389:Upper back pain 4366: 4357:Spinal stenosis 4323: 4267: 4246: 4211: 4206: 4176: 4171: 4170: 4133: 4132: 4061: 4047: 4042: 3997: 3993: 3982: 3978: 3967: 3963: 3932:(11): 2232–51. 3918: 3914: 3900: 3896: 3857:(3): CD003007. 3843: 3839: 3800:(2): CD001350. 3786: 3782: 3775: 3753: 3749: 3710:(9): CD010328. 3696: 3692: 3687: 3683: 3652: 3645: 3640:Stephen Barrett 3636:Wayback Machine 3627: 3623: 3574: 3570: 3562:Wayback Machine 3553: 3549: 3544: 3540: 3535: 3531: 3526: 3522: 3491: 3487: 3478: 3476: 3447: 3443: 3434: 3432: 3389: 3385: 3354: 3350: 3331: 3330: 3326: 3297:(19): 2144–51. 3287: 3283: 3243: 3239: 3216:(475): 119–23. 3202: 3198: 3159: 3155: 3132: 3128: 3120: 3118: 3097: 3088: 3079: 3077: 3048:(2): CD007431. 3037: 3033: 3001: 2997: 2958: 2954: 2945: 2943: 2932: 2925: 2920:Wayback Machine 2910: 2906: 2897: 2895: 2886: 2885: 2881: 2872: 2870: 2861: 2860: 2856: 2817: 2813: 2784:(10): 1105–11. 2774: 2770: 2725: 2721: 2682: 2678: 2655: 2651: 2622:(23): 2975–80. 2611: 2607: 2568: 2564: 2525: 2521: 2490: 2486: 2447: 2440: 2401: 2397: 2384: 2380: 2371: 2369: 2360: 2359: 2355: 2302: 2298: 2285: 2281: 2265: 2264: 2260: 2245: 2234: 2225: 2223: 2196: 2192: 2161: 2157: 2126: 2122: 2075: 2071: 2062: 2060: 2051: 2050: 2046: 2037: 2035: 2022: 2021: 2017: 1986: 1982: 1973: 1971: 1928: 1924: 1869: 1865: 1820: 1816: 1771: 1767: 1761: 1754: 1723: 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4386: 4380: 4378: 4372: 4371: 4368: 4367: 4365: 4364: 4362:Facet syndrome 4359: 4354: 4353: 4352: 4350:Retrolisthesis 4342: 4337: 4331: 4329: 4325: 4324: 4322: 4321: 4319:Pott's disease 4316: 4311: 4306: 4301: 4300: 4299: 4288: 4286: 4279: 4273: 4272: 4269: 4268: 4266: 4265: 4260: 4254: 4252: 4248: 4247: 4245: 4244: 4239: 4234: 4228: 4226: 4217: 4213: 4212: 4209:Spinal disease 4205: 4204: 4197: 4190: 4182: 4173: 4172: 4169: 4168: 4154: 4142: 4141: 4139: 4135: 4134: 4131: 4130: 4119: 4108: 4097: 4078: 4062: 4057: 4056: 4054: 4053:Classification 4046: 4045:External links 4043: 4041: 4040: 3991: 3976: 3961: 3912: 3894: 3837: 3780: 3773: 3747: 3690: 3681: 3643: 3621: 3568: 3547: 3538: 3529: 3520: 3501:(3): 197–210. 3485: 3441: 3383: 3348: 3324: 3281: 3254:(12): 865–77. 3237: 3210:Br J Gen Pract 3196: 3153: 3126: 3086: 3031: 2995: 2952: 2923: 2911:Ehealthmd.com 2904: 2879: 2854: 2827:(17): 1940–8. 2811: 2768: 2719: 2692:(19): 2091–5. 2676: 2649: 2605: 2562: 2519: 2484: 2438: 2395: 2378: 2353: 2316:(2): 130–137. 2296: 2279: 2258: 2232: 2190: 2155: 2136:(8): 566–568. 2120: 2069: 2044: 2015: 1980: 1942:(6): 699–709. 1922: 1863: 1814: 1765: 1763:2015;49:589-94 1752: 1714: 1707: 1689: 1664: 1629: 1595: 1555: 1535: 1506: 1475: 1473: 1470: 1469: 1468: 1463: 1458: 1453: 1448: 1443: 1438: 1433: 1428: 1423: 1418: 1413: 1408: 1401: 1398: 1388: 1387: 1367: 1365: 1354: 1351: 1322: 1319: 1315:proper posture 1306: 1303: 1282: 1279: 1278: 1277: 1274: 1271: 1268: 1257:osteoarthritic 1225: 1222: 1209: 1208: 1198: 1188: 1181: 1167: 1156: 1153: 1152: 1151: 1150:controversial. 1143: 1133: 1128: 1125: 1124: 1123: 1117: 1115:Weight control 1112: 1106: 1088: 1083: 1080: 1062: 1059: 1031: 1028: 1027: 1026: 1017: 1012: 1007: 1002: 992: 986: 981: 972: 967: 962: 956: 953: 939: 936: 935: 934: 915: 914: 913: 912: 909: 906: 902: 896: 895: 864: 853: 852: 849: 842: 840: 837: 830: 828: 825: 818: 816: 813: 806: 804: 801: 794: 791: 790: 779: 771: 770: 767: 760: 757: 756: 748: 747:Spinal imaging 745: 731: 728: 707: 704: 703: 702: 699: 692: 690: 683: 676: 674: 668: 661: 659: 656: 649: 647: 644: 637: 634: 633: 578:prolapsed disc 574:herniated disc 569: 566: 564: 561: 536: 533: 527: 524: 498: 495: 474:perineal nerve 423: 420: 384:contact sports 284: 281: 197: 194: 152:posterolateral 90: 89: 84: 78: 77: 68: 62: 61: 53: 52: 45: 41: 40: 32: 15: 9: 6: 4: 3: 2: 4482: 4471: 4468: 4466: 4463: 4462: 4460: 4445: 4442: 4440: 4437: 4435: 4432: 4430: 4427: 4426: 4424: 4422: 4418: 4412: 4411:Radiculopathy 4409: 4405: 4402: 4400: 4397: 4396: 4395: 4394:Low back pain 4392: 4390: 4387: 4385: 4382: 4381: 4379: 4377: 4373: 4363: 4360: 4358: 4355: 4351: 4348: 4347: 4346: 4343: 4341: 4340:Spondylolysis 4338: 4336: 4333: 4332: 4330: 4326: 4320: 4317: 4315: 4312: 4310: 4307: 4305: 4302: 4298: 4295: 4294: 4293: 4290: 4289: 4287: 4283: 4280: 4278: 4277:Spondylopathy 4274: 4264: 4261: 4259: 4256: 4255: 4253: 4249: 4243: 4240: 4238: 4235: 4233: 4230: 4229: 4227: 4225: 4221: 4218: 4214: 4210: 4203: 4198: 4196: 4191: 4189: 4184: 4183: 4180: 4167: 4164: 4160: 4159: 4155: 4153: 4149: 4148: 4144: 4143: 4140: 4136: 4129: 4125: 4124: 4120: 4118: 4114: 4113: 4109: 4107: 4103: 4102: 4098: 4096: 4092: 4088: 4087: 4083: 4079: 4077: 4073: 4072: 4068: 4064: 4063: 4060: 4055: 4051: 4036: 4032: 4027: 4022: 4018: 4014: 4010: 4006: 4002: 3995: 3987: 3980: 3972: 3965: 3957: 3953: 3948: 3943: 3939: 3935: 3931: 3927: 3923: 3916: 3909: 3905: 3904: 3898: 3890: 3886: 3881: 3876: 3872: 3868: 3864: 3860: 3856: 3852: 3848: 3841: 3833: 3829: 3824: 3819: 3815: 3811: 3807: 3803: 3799: 3795: 3791: 3784: 3776: 3770: 3766: 3762: 3758: 3751: 3743: 3739: 3735: 3731: 3726: 3721: 3717: 3713: 3709: 3705: 3701: 3694: 3685: 3677: 3673: 3669: 3665: 3662:(3): 525–31. 3661: 3657: 3650: 3648: 3641: 3637: 3633: 3630: 3625: 3617: 3613: 3608: 3603: 3598: 3593: 3589: 3585: 3584: 3579: 3572: 3566: 3563: 3559: 3556: 3551: 3542: 3533: 3524: 3516: 3512: 3508: 3504: 3500: 3496: 3489: 3474: 3470: 3466: 3462: 3458: 3457: 3452: 3445: 3430: 3426: 3422: 3418: 3414: 3410: 3406: 3402: 3398: 3394: 3387: 3379: 3375: 3371: 3367: 3364:(1): 105–25. 3363: 3359: 3352: 3344: 3340: 3339: 3334: 3328: 3320: 3316: 3312: 3308: 3304: 3300: 3296: 3292: 3285: 3277: 3273: 3269: 3265: 3261: 3257: 3253: 3249: 3241: 3233: 3229: 3224: 3219: 3215: 3211: 3207: 3200: 3192: 3188: 3184: 3180: 3176: 3172: 3169:(3): 504–32. 3168: 3164: 3157: 3149: 3145: 3142:(2): 99–105. 3141: 3137: 3130: 3116: 3112: 3108: 3104: 3103: 3095: 3093: 3091: 3075: 3071: 3067: 3063: 3059: 3055: 3051: 3047: 3043: 3035: 3027: 3023: 3019: 3015: 3011: 3007: 2999: 2991: 2987: 2983: 2979: 2975: 2971: 2968:(2): 117–25. 2967: 2963: 2956: 2942:on 2014-08-08 2941: 2937: 2930: 2928: 2921: 2917: 2914: 2908: 2893: 2889: 2883: 2868: 2864: 2858: 2850: 2846: 2842: 2838: 2834: 2830: 2826: 2822: 2815: 2807: 2803: 2799: 2795: 2791: 2787: 2783: 2779: 2772: 2764: 2760: 2755: 2750: 2746: 2742: 2739:(8): 1273–8. 2738: 2734: 2730: 2723: 2715: 2711: 2707: 2703: 2699: 2695: 2691: 2687: 2680: 2672: 2668: 2664: 2660: 2653: 2645: 2641: 2637: 2633: 2629: 2625: 2621: 2617: 2609: 2601: 2597: 2593: 2589: 2585: 2581: 2578:(2): 218–24. 2577: 2573: 2566: 2558: 2554: 2550: 2546: 2542: 2538: 2534: 2530: 2523: 2515: 2511: 2507: 2503: 2500:(7824): 320. 2499: 2495: 2488: 2480: 2476: 2472: 2468: 2464: 2460: 2457:(1–2): 11–6. 2456: 2452: 2445: 2443: 2434: 2430: 2426: 2422: 2418: 2414: 2410: 2406: 2399: 2393: 2389: 2388: 2382: 2368:on 2016-05-16 2367: 2363: 2357: 2349: 2345: 2340: 2335: 2331: 2327: 2323: 2319: 2315: 2311: 2307: 2300: 2294: 2290: 2289: 2283: 2275: 2269: 2261: 2255: 2251: 2243: 2241: 2239: 2237: 2221: 2217: 2213: 2210:(6): 757–60. 2209: 2205: 2201: 2194: 2186: 2182: 2178: 2174: 2170: 2166: 2159: 2151: 2147: 2143: 2139: 2135: 2131: 2124: 2116: 2112: 2107: 2102: 2097: 2092: 2088: 2084: 2080: 2073: 2058: 2054: 2048: 2033: 2029: 2025: 2019: 2011: 2007: 2003: 1999: 1995: 1991: 1984: 1969: 1965: 1961: 1957: 1953: 1949: 1945: 1941: 1937: 1933: 1926: 1918: 1914: 1909: 1904: 1899: 1894: 1890: 1886: 1882: 1878: 1874: 1867: 1859: 1855: 1850: 1845: 1841: 1837: 1833: 1829: 1825: 1818: 1810: 1806: 1801: 1796: 1792: 1788: 1785:(2): 98–112. 1784: 1780: 1776: 1769: 1759: 1757: 1748: 1744: 1740: 1736: 1733:(4): 629–49. 1732: 1728: 1721: 1719: 1710: 1708:9780721647777 1704: 1700: 1693: 1678: 1674: 1668: 1660: 1656: 1652: 1648: 1645:(3): 409–14. 1644: 1640: 1633: 1618: 1614: 1610: 1606: 1599: 1591: 1585: 1570: 1566: 1562: 1558: 1552: 1548: 1547: 1539: 1525:on 2019-03-16 1524: 1520: 1516: 1510: 1494: 1490: 1486: 1480: 1476: 1467: 1464: 1462: 1459: 1457: 1454: 1452: 1451:Low back pain 1449: 1447: 1444: 1442: 1439: 1437: 1434: 1432: 1429: 1427: 1424: 1422: 1419: 1417: 1414: 1412: 1411:Radiculopathy 1409: 1407: 1404: 1403: 1397: 1395: 1384: 1375: 1371: 1368:This section 1366: 1363: 1359: 1358: 1350: 1348: 1343: 1341: 1337: 1332: 1328: 1327:back injuries 1318: 1316: 1312: 1302: 1300: 1296: 1292: 1291:low back pain 1288: 1275: 1272: 1269: 1266: 1265: 1264: 1262: 1258: 1254: 1250: 1246: 1242: 1237: 1235: 1231: 1230:low back pain 1221: 1217: 1215: 1206: 1204: 1199: 1196: 1192: 1189: 1186: 1182: 1179: 1175: 1171: 1168: 1165: 1162: 1161: 1160: 1148: 1144: 1141: 1137: 1134: 1131: 1130: 1121: 1118: 1116: 1113: 1110: 1107: 1104: 1100: 1096: 1092: 1089: 1086: 1085: 1079: 1077: 1073: 1069: 1058: 1056: 1051: 1047: 1045: 1040: 1037: 1025: 1021: 1018: 1016: 1013: 1011: 1008: 1006: 1003: 1001: 997: 993: 991: 987: 985: 982: 980: 979:osteomyelitis 976: 973: 971: 968: 966: 963: 960: 957: 954: 952: 949: 948: 947: 945: 933:to the spine. 932: 928: 924: 920: 917: 916: 910: 907: 903: 900: 899: 898: 897: 893: 889: 885: 881: 877: 873: 869: 865: 862: 858: 855: 854: 846: 841: 834: 829: 822: 817: 810: 805: 798: 793: 792: 788: 783: 780: 776: 773: 772: 764: 759: 758: 754: 751: 750: 744: 741: 737: 727: 725: 721: 717: 713: 696: 691: 687: 680: 675: 672: 665: 660: 653: 648: 641: 636: 635: 631: 630: 629: 627: 622: 620: 615: 610: 605: 603: 599: 595: 594:radiculopathy 591: 587: 583: 582:ruptured disc 579: 575: 560: 558: 554: 550: 546: 542: 532: 523: 521: 517: 513: 503: 494: 491: 490:femoral nerve 487: 483: 482:sciatic nerve 479: 475: 471: 467: 463: 459: 450: 446: 444: 441: 437: 433: 429: 419: 417: 413: 409: 405: 401: 397: 393: 389: 385: 381: 377: 373: 371: 367: 363: 362:polymorphisms 360: 359:interleukin-6 356: 355:interleukin-1 352: 348: 344: 340: 336: 332: 327: 325: 321: 317: 313: 309: 304: 302: 298: 294: 290: 280: 278: 274: 270: 266: 265: 259: 256: 254: 250: 245: 243: 239: 235: 234:sciatic nerve 231: 227: 223: 219: 214: 211: 210:low back pain 207: 201: 193: 191: 186: 183: 179: 174: 172: 169: 165: 161: 157: 153: 149: 148: 142: 139: 137: 133: 129: 125: 121: 117: 113: 109: 105: 101: 97: 88: 85: 83: 79: 76: 72: 69: 67: 63: 59: 54: 50: 46: 42: 37: 29: 22: 4438: 4304:Sacroiliitis 4285:inflammatory 4163:orthoped/138 4156: 4145: 4121: 4110: 4099: 4080: 4065: 4008: 4004: 3994: 3985: 3979: 3970: 3964: 3929: 3925: 3915: 3901: 3897: 3854: 3850: 3840: 3797: 3793: 3783: 3756: 3750: 3707: 3703: 3693: 3684: 3659: 3656:Primary Care 3655: 3624: 3587: 3581: 3571: 3550: 3541: 3532: 3523: 3498: 3494: 3488: 3477:. Retrieved 3463:(3): 77–84. 3460: 3454: 3444: 3433:. Retrieved 3400: 3396: 3386: 3361: 3357: 3351: 3343:the original 3336: 3327: 3294: 3290: 3284: 3251: 3247: 3240: 3213: 3209: 3199: 3166: 3162: 3156: 3139: 3136:Funct Neurol 3135: 3129: 3119:, retrieved 3101: 3078:. Retrieved 3045: 3034: 3012:(7): 840–3. 3009: 3005: 2998: 2965: 2961: 2955: 2944:. Retrieved 2940:the original 2907: 2896:. Retrieved 2882: 2871:. Retrieved 2857: 2824: 2820: 2814: 2781: 2777: 2771: 2736: 2732: 2722: 2689: 2685: 2679: 2665:(4): 441–8. 2662: 2658: 2652: 2619: 2615: 2608: 2575: 2571: 2565: 2535:(8): 760–4. 2532: 2528: 2522: 2497: 2493: 2487: 2454: 2450: 2408: 2404: 2398: 2385: 2381: 2370:. Retrieved 2366:the original 2356: 2313: 2309: 2299: 2286: 2282: 2249: 2224:. Retrieved 2207: 2203: 2193: 2171:(1): 43–49. 2168: 2164: 2158: 2133: 2129: 2123: 2086: 2082: 2072: 2061:. Retrieved 2047: 2036:. Retrieved 2027: 2018: 1996:(6): 635–9. 1993: 1989: 1983: 1972:. Retrieved 1939: 1935: 1925: 1880: 1876: 1866: 1831: 1827: 1817: 1782: 1778: 1768: 1730: 1726: 1698: 1692: 1681:. Retrieved 1667: 1642: 1639:Eur J Radiol 1638: 1632: 1621:. Retrieved 1608: 1598: 1573:. Retrieved 1545: 1538: 1527:. Retrieved 1523:the original 1518: 1509: 1497:. Retrieved 1488: 1479: 1421:Inflammation 1391: 1378: 1374:adding to it 1369: 1344: 1324: 1311:poor posture 1308: 1295:biomechanics 1287:manual labor 1284: 1252: 1248: 1238: 1227: 1224:Epidemiology 1218: 1210: 1203:cauda equina 1202: 1194: 1173: 1158: 1140:cauda equina 1139: 1064: 1048: 1041: 1033: 941: 891: 887: 733: 709: 685: 625: 623: 614:slipped disc 613: 609:slipped disc 608: 606: 586:slipped disc 585: 581: 577: 573: 571: 553:facet joints 548: 538: 535:Inflammation 529: 508: 455: 445: 439: 425: 378: 374: 333:(sp1 site), 328: 323: 319: 315: 311: 305: 300: 296: 286: 277:chronic pain 269:cauda equina 268: 264:cauda equina 262: 260: 257: 248: 246: 238:muscle spasm 215: 202: 199: 190:slipped disc 189: 187: 181: 175: 164:inflammation 145: 143: 140: 136:good posture 95: 93: 82:Risk factors 75:neurosurgery 48: 4335:Spondylosis 4292:Spondylitis 4263:Torticollis 4147:MedlinePlus 4005:Eur Spine J 3926:Eur Spine J 2733:Eur Spine J 2165:Orthopedics 2130:Orthopedics 1499:16 December 1489:Mayo Clinic 1020:Spondylosis 944:distinguish 857:Myelography 740:sensitivity 568:Terminology 218:paresthesia 171:compression 71:Orthopedics 44:Other names 4459:Categories 4399:Coccydynia 4123:DiseasesDB 3479:2010-02-19 3435:2023-03-02 3121:2021-09-09 3080:2020-01-31 2946:2008-03-14 2898:2011-12-19 2873:2011-12-19 2372:2015-11-12 2226:2020-09-18 2063:2020-12-21 2038:2019-12-24 1974:2020-09-18 1683:2015-02-10 1623:2008-02-27 1575:2021-02-23 1529:2021-02-23 1472:References 1446:Herniation 1431:Discectomy 1281:Prevention 1243:, and the 1164:Discectomy 1000:meningeoma 990:malignancy 959:Myofascial 868:myelopathy 861:bone spurs 720:metastases 688:(with MRI) 416:volleyball 412:basketball 396:ice hockey 386:, such as 168:nerve root 124:herniation 120:disability 4384:Neck pain 4376:Back pain 4242:Scoliosis 4216:Deforming 4166:radio/219 4158:eMedicine 3910:Frequency 3871:1465-1858 3814:1469-493X 3062:1465-1858 2411:: 47–51. 2392:eMedicine 2330:0975-4466 2293:eMedicine 2268:cite book 2089:(1): 26. 1613:eMedicine 1584:cite book 1565:978362025 1305:Education 1183:Invasive 1142:syndrome. 1082:Indicated 1068:indicated 1030:Treatment 996:neurinoma 563:Diagnosis 555:, and in 551:tear) by 472:(via the 400:wrestling 291:(17 222:paralysis 206:neck pain 116:back pain 104:vertebrae 66:Specialty 4404:Sciatica 4309:Discitis 4237:Lordosis 4232:Kyphosis 4035:16845553 3956:22814567 3889:24627325 3832:17443505 3742:25838265 3734:25184502 3725:10961733 3676:22958562 3632:Archived 3616:17511872 3590:(1): 7. 3558:Archived 3515:15129202 3473:Archived 3429:Archived 3425:19121111 3417:20421859 3378:21292148 3319:23087393 3311:17762818 3276:21203011 3268:23362516 3232:11887877 3183:18063409 3148:19775538 3115:archived 3111:32809713 3074:Archived 3070:20166095 3026:17601462 2990:29441806 2916:Archived 2892:Archived 2867:Archived 2849:42449538 2841:16135983 2806:41308365 2798:15131438 2763:17468886 2714:46717050 2706:15454697 2644:45206575 2636:11145807 2600:10909087 2557:22589442 2479:45814193 2471:16963186 2433:32978237 2425:25086430 2348:28377542 2220:Archived 2185:22229920 2150:20704153 2115:31236714 2057:Archived 2032:Archived 1968:Archived 1917:30372456 1877:PLOS ONE 1858:18455130 1809:31440655 1747:22643389 1677:Archived 1659:16129249 1617:Archived 1569:Archived 1493:Archived 1406:Sciatica 1400:See also 1381:May 2022 1353:Research 1338:include 1321:Exercise 1234:sciatica 1205:syndrome 1172:(called 1111:(NSAIDs) 1095:traction 1036:Sciatica 984:Hematoma 975:Discitis 598:sciatica 486:sciatica 462:buttocks 436:thoracic 432:cervical 408:baseball 343:aggrecan 230:sciatica 226:reflexes 4117:D007405 4026:2335386 3947:3481105 3880:7138272 3823:7028003 3607:1887522 3223:1314232 3191:8345397 2982:6446157 2754:2200776 2592:8720407 2549:2961088 2514:4124797 2339:6150546 2216:1788427 2106:6591346 2010:7604337 1964:5983201 1956:7604346 1908:6205614 1885:Bibcode 1849:2427305 1800:6698496 1340:shaking 1336:fatigue 1155:Surgery 1103:massage 965:Abscess 905:hernias 724:lesions 686:annulus 549:annulus 512:scapula 347:asporin 324:annulus 320:annulus 4152:000442 4106:603932 4033: 4023: 3954: 3944: 3887: 3877: 3869: 3830: 3820: 3812: 3771: 3740: 3732: 3722: 3674: 3614: 3604: 3513: 3423: 3415: 3376: 3317: 3309: 3274: 3266: 3230: 3220: 3189: 3181: 3146: 3109: 3068: 3060: 3024: 2988: 2980: 2847: 2839: 2804: 2796: 2761: 2751: 2712: 2704: 2642: 2634: 2598: 2590: 2555: 2547: 2512: 2494:Lancet 2477: 2469: 2431: 2423: 2346: 2336: 2328: 2256: 2214: 2183: 2148: 2113: 2103: 2008: 1962: 1954: 1915: 1905: 1856: 1846: 1807: 1797: 1745: 1705: 1657: 1563: 1553: 1245:coccyx 1241:sacrum 931:distal 716:tumors 584:, and 488:. 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