Liyew Worku Abie
Biomedical Science Department, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
Int J Rheumatol. 2020 Aug 29;2020:2919625. doi: 10.1155/2020/2919625. eCollection 2020.
Lumbar disc degeneration is defined as the wear and tear of lumbar intervertebral disc, and it is mainly occurring at L3-L4 and L4-S1 vertebrae. Lumbar disc degeneration may lead to disc bulging, osteophytes, loss of disc space, and compression and irritation of the adjacent nerve root. Clinical presentations associated with lumbar disc degeneration and lumbosacral nerve lesion are discogenic pain, radical pain, muscular weakness, and cutaneous. Discogenic pain is usually felt in the lumbar region, or sometimes, it may feel in the buttocks, down to the upper thighs, and it is typically presented with sudden forced flexion and/or rotational moment. Radical pain, muscular weakness, and sensory defects associated with lumbosacral nerve lesions are distributed on lower extremities, the buttock, lower abdomen, and groin region. A lumbosacral plexus lesion presents different symptoms in the territories of the lumbar and sacral nerves. Patients with lumbar plexus lesion clinically present with weakness of hip flexion, knee extension, thigh adduction, and sensory loss in the lower abdomen, inguinal region, and over the entire medial, lateral, and anterior surfaces of the thigh and the medial lower leg, while sacral plexus lesion presents clinical symptoms at nerve fibers destined for the sciatic nerve, common peroneal nerve, and pudendal nerve. Weakness of ankle inversion, plantar flexion, and foot drop are the main clinical manifestations of the sacral plexus lesion area. Numbness and decreased sensation are also present along the anterolateral calf and dorsum of the foot. On examination, foot eversion is usually stronger than foot dorsiflexion. The patients may also present with pain and difficulty of bowel movements, sexual dysfunction assessments, and loss of cutaneous sensation in the areas of the anal canal, anus, labia major, labia minor, clitoris, penis, and scrotum.
腰椎间盘退变被定义为腰椎间盘的磨损，主要发生在L3 - L4和L4 - S1椎体。腰椎间盘退变可能导致椎间盘突出、骨赘形成、椎间隙变窄以及对相邻神经根的压迫和刺激。与腰椎间盘退变和腰骶神经损伤相关的临床表现有椎间盘源性疼痛、根性疼痛、肌肉无力和皮肤感觉异常。椎间盘源性疼痛通常在腰部感觉到，有时也可能在臀部、直至大腿上部感觉到，典型表现为突然的强迫性屈曲和/或旋转动作。与腰骶神经损伤相关的根性疼痛、肌肉无力和感觉缺陷分布在下肢、臀部、下腹部和腹股沟区。腰骶丛损伤在腰神经和骶神经支配区域表现出不同症状。腰丛损伤患者临床上表现为髋关节屈曲、膝关节伸展、大腿内收无力，以及下腹部、腹股沟区和大腿内、外侧及前表面和小腿内侧的感觉丧失，而骶丛损伤在坐骨神经、腓总神经和阴部神经支配的神经纤维处出现临床症状。踝关节内翻、跖屈无力和足下垂是骶丛损伤区域的主要临床表现。小腿前外侧和足背也会出现麻木和感觉减退。检查时，足外翻通常比足背屈更强。患者还可能出现排便疼痛和困难、性功能评估异常，以及肛管、肛门、大阴唇、小阴唇、阴蒂、阴茎和阴囊区域的皮肤感觉丧失。
