Possible answer (3)

6,1,3 imaging features
(1), X-ray film. The following changes as a reference.
<1> disc changes.
<2> sequence is lateral interbody / curve of change. Lumbar spinal lesions (lumbar disc herniation) can happen lumbar scoliosis and lumbar kyphosis, in the waist, hips or severe soft tissue in cases of damage can also occur, clinical manifestations are often severe lumbar spinal canal for the mixed internal and external lesions.
(2), CT scan or MRI examination. Determination of the size of the spinal canal, or whether stenosis (central canal, lateral canal, the intervertebral foramen) and the contents of the structure changes in the pattern can be served as a reminder. On the disc shape, size, location, scope and segments with the dural sac and nerve root relations can be made more precise diagnosis. On the spinal tumor detection rate is also high, with an important reference value.
6,1,4 EMG. Can be divided into neurogenic damage and muscle-derived damage, show that from the spinal disease.
(1). Nerve root involvement. If the anterior tibial muscle (L.4, 5), peroneus longus muscle (L.5, S.1) found a large number of defibrillators potential and are of potential, action potentials at the same time reduce, and amplitude, wave-wide no significant change, show that L.5, spinal nerve may be involved. If the L.5 dominated by the sacral spine also check muscle innervation potential gains and losses can be identified L.5 segmental nerve roots involvement. If L.5 domination of the sacral spine found no abnormal muscle potential, should consider the peripheral lesions. Most of the limb nerve root pain positioning can be determined accordingly. Such as muscle atrophy in a large number of investigations in the denervated spontaneous potential, but also reduce motor units, and the normal conduction velocity, action potential amplitude, width, that the possibility of spinal cord lesions.
(2). Myogenic damage. No action potential to reduce volatility and lower, narrower width, normal nerve conduction velocity, are mostly myopathy. Pure action potential to shorten the average time that muscle tissue for nerve root irritation aseptic inflammation arising from the impact of dysfunction.


6,2 determine location


6,2,1 lumbar spinal lesions
(1). Lumbar flexion extension functional activities. Lumbar flexion of the first activities from hip flexion to complete 50 per cent, followed by the lumbar spine truly itself to complete 50 per cent. Lumbar flexion activities about 75% to rely largely on the L.5-S.1 between functions (functions of the remaining 25 per cent by the L2-5 completed). When L.5 or lumbosacral intervertebral disc-S.1, the sacral spine muscle damage flexion activities will be significantly restricted. And waist extension activities, mainly by segmental spinal 2-5 after the completion of extension activities. Above the L.5-S.1 segments less affected, which limited the waist and extension activities have neurological symptoms, consideration should be given L.3-4/L.4-5 segmental lesions. Similarly, the impact of the work of the movement sitting segments should be L.5-S.1 site.
(2). Lumbar spine center site or adjacent to the spinous process tenderness, tips segmental spinal damage. Spinous process of tenderness at the same time next to the spinous process of tenderness and lower extremities laminectomy Fangshetong said that the central disc of highlights unilateral if only spinous process of tenderness or adjacent to the spinous process laminectomy Fangshetong between tenderness and lower extremities should be considered for the central disc - or side-adjacent to highlight. Of course, tenderness on the part of the distinction between different segments of spinal damage is an important value, especially spinous process hitting pain in the spinal space-occupying lesion detection meaningful, can be used as CT scan / MRI examination before the screening method.

(3). Positioning of signs. A high diagnostic value, but the clinical manifestations late.
<1> feeling diminish or disappear. Back of the sensory nerve distribution, mainly dorsal-dominated; sensory fibers in the spinal canal is the distribution issued by the posterior branch of vertebral sinus denervation, spinal nerve limb while former branch of the nerve plexus with a sense of dominance. So dominant nerve root involvement corresponding Skin sensory dysfunction can be used as lumbar spinal canal, in the diagnosis and positioning information. But the premise is the first to distinguish between the two diseases both inside and outside the spinal canal after. Because of the sciatic nerve trunk and its branches by the waist hip lesions of the soft tissue degeneration or spastic contracture of oppression, but also have a basic body with waist nerve compression by the same sense of regional domination of the skin feeling diminish or disappear. Clinical findings of sciatica and the lateral leg hyperalgesia or diminishes, the spinal damage both inside and outside of all common signs.

① lateral thigh skin. From the lumbar plexus (L.2, 3) nerve branches.
② before medial calf skin. From the lumbar plexus (L.4) nerve branches.
③ after the lateral thigh and leg lateral skin, foot lateral malleolus, and the medial dorsal foot toe three skin. From the sacral plexus (S.1-L.5) nerve branches.
④ posterior thigh, posterior leg, foot or foot and lateral margin of two lateral toes Skin. From the sacral plexus (L.5-S.1, 2) nerve branches.
<2> muscle weakening. Different parts of the weakened muscle involvement of the ganglion. If quadriceps muscle weakened reflect L.2, 3,4 segmental involvement (Shenxi ↓); weakening of the anterior tibial muscle reflect L.4 segmental involvement (foot bend↓); extensor pollicis longus muscle L.5 reflected strength weakened segments involvement (thumb bend↓); foot flexor and toe flexor muscles weakened segmental involvement reflects S.1 (toe plantar flexion ↓), but should pay attention to muscle atrophy or weaken spinal lesions is shared by the internal and external signs. On the full support of single-body movements (Caragana standing) suggested that S.1 ganglion of the involvement or not.
<3> reflection obstacles. Leg tendon reflexes of a more accurate positioning significance. In spinal lesions to determine the involvement of the ganglion. Knee tendon reflexes disappear or decrease to reflect L.3, four of the lesions. Achilles tendon reflex reflects the reduction or disappearance of the lesion S.1 segment. If there Babinski reflex levy such as pathological lesions in the spinal canal will have to be taken into account parts of cervical thoracic vertebrae beam signs, and most of the lesions caused by spinal cord damage.
<4>. Prone knees hip extension trial. L.4-5 disc herniation L.5 stimulate nerve root compression, this test may be positive. However, as L.5-S.1 disc stimulate nerve root compression S.1, the trial will not lead Fangshetong lower extremities, can identify L.4-5 segment and L.5-S1 nerve segment damage.


6,2,2 lumbar spinal soft tissue damage,
(1), point tenderness and pain involved
<1> waist hip tenderness point. Gluteal nerve epithelial tenderness; exit of the sciatic nerve Piriformis under tenderness; Tunshang Piriformis on exports of tenderness; inferior gluteal nerve Piriformis exported tenderness; tibial nerve slapped Wochu tenderness; patella fat pad tenderness; tenderness points below the medial anterior malleolus (posterior tibial tendon and tendon sheath); tenderness points below the lateral malleolus (peroneus longus and brevis tendon and tendon sheath).
<2> pain involved. Vertebral sinus nerve or spinal nerve posterior branch of the regional distribution of disposable soft tissue damage can produce similar spinal nerve root involvement in the emission of lower limb pain. Bleeding pain pathway usually ambiguous, and not necessarily very far, a few cases can be arrived at the end of limbs.
(2), the function test. Can be carried out to confirm tenderness, pain contribute to the positioning.
<1> straight leg raising test: sciatic nerve tense <2> knees hip-flexor legs test: the resumption muscles;
<3> hip outreach test: small and medium-sized hip muscle; <4> iliotibial tract tension test; <5> hip internal rotation test: Piriformis; <6> sacroiliac joint test: "4" character test, Okashi Lin test, Ai-li test; <7> patella fat pad squeeze sign; <8> McNamara test: meniscus; <9> drawer test: knee cruciate ligament; <10> Unit nervous test.


6,3 The difference between nature. Based on the clinical features of imaging examinations and laboratory diagnosis of lesions can be clear.


6,3,1 spinal disorders
(1), tumor-specific disease or
<1> Tumor: neurofibroma, schwannoma, nerve root cyst, dermoid cyst, ependymoma, metastatic carcinoma (liver, kidney, prostate, ovary), the glial cells of the spinal cord, neuroblastoma, moving Venous aneurysm.
<2> malformation (sacral, lumbar, spina bifida).
<3> syringomyelia disease, multiple sclerosis.
(2), common disorder.
<1> lumbar disc herniation (central, lateral-side, lateral, a lateral, anterior type).
<2> thoracolumbar spinal canal stenosis (congenital, developmental, degenerative, trauma and iatrogenic, mixed).
<3> slip of the lumbar spine (causing secondary spinal canal stenosis).
<4> soft tissue damage (the ligamentum flavum hypertrophy, the posterior longitudinal ligament calcification, fatty degeneration of connective tissue contracture, etc.).


6,3,2, spinal lesions.
(1), tumor-specific disease or
<1> spinal tumors, tuberculosis, eosinophilic granuloma.
<2> spinal injury sequelae: extrusion fracture, splitting fractures, fractures and dislocations.
(2), rheumatoid joint disease category. Rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, Li UNSCOM's syndrome, systemic lupus erythematosus, gouty arthritis, reactive arthritis and dermatomyositis, sacroiliac joint disease, femoral head ischemic necrosis.
(3), and systemic diseases organ disorders. Hepatobiliary digestive, urinary and reproductive system disorders, gynecological disorders, endocrine disorders (thyroid function reduction, diabetes, Hyperaldosteronism).
(4), vascular disorders. Thromboangiitis obliterans, deep vein thrombosis and inflammation, the common iliac artery or external iliac artery thrombosis.
(5), soft tissue damage (including myofascial pain syndrome, fibromyalgia syndrome). Roughly divided into waist muscles, buttocks muscles, or muscles Unit, the ventral muscle, slapping rope muscle, the gastrocnemius muscle and outside Cetou, patella fat pad, fibula length of muscle, the posterior tibial muscle, tarsal sinus bone tissue and plantar aponeurosis of the damage sites, such as aseptic inflammatory response.
(6), infection. Herpes Zoster, lymphangitis.



6,4 spinal soft tissue damage, point of tenderness detailed inspection methods



6,4,1 What is the point of tenderness and pain conduction

6,4,2 head, neck, back, scapula, Bitong conduction of pain and tenderness point

(1) of the Department of tenderness pillow point inspection

(2) back tenderness point inspection

(3) shoulder tenderness point inspection

(4) arm tenderness point inspection

(5) forearm and hand tenderness point inspection

6,4,3 waist lumbosacral, sacral Sacrococcygeal conduction of pain and tenderness point

(1) waist and lumbosacral tenderness point inspection

(2) hip, hip, thigh roots, joint tenderness point inspection suprapubic

(3) check point thigh tenderness

(4) knee tenderness point inspection

(5) leg and foot tenderness point inspection