Syndromes douloureux et anesthésie caudale thérapeutique

Summary

The sedentary habits of our population are one cause of the increase in the frequency of occurrence of lumbar pains The lumbosacral region is often required to make a considerable effort for which it is not prepared

Sixty to seventy per cent of adults suffer, have suffered, or will suffer from chronic lumbar pain or acute lumbar pain with or without root neuralgia

The anaesthetist should be able to render a service m the treatment of simple lumbar pains, but he is most often consulted for the treatment of patients suffering from acute lumbar pain accompanied by root neuralgia, usually due to a hemiated intervertebral disk

Anatomically, it should be recalled that the normal disk is composed of two parts the nucleus pulposus and the annulus fibrosis The nucleus pulposus has the consistency of a homogeneous jelly in the lumbar region it is situated in the lower and posterior part of the disk The lamellar ring or annulus fibrosis is composed of a series of fibrous lamelli disposed around the nucleus

During movements of the spine this nucleus is easily displaced and deformed During flexion the nucleus is displaced posteriorly and takes an ovoid form with the large end posteriorly In extension the opposite occurs, the nucleus being displaced forward

In the event of trauma, a sudden movement or an effort to lift a weight, the nucleus pulposus is able to infiltrate through a gap m the lamellar ring which is more or less altered Nerve root compression and intense pain may result The roots of L5 and SI are most often involved, with pain in the distribution of the sciatic nerve