Surgery Godfather

Chapter 463: Chapter 423: Orthopedics Doctor Performs Ultrasound Part 2 Chapter 463: Chapter 423: Orthopedics Doctor Performs Ultrasound Part 2 Upon hearing that 301 has already taken action, Xiehe would also bear the responsibility without fear. In contrast to 301’s strong stance, Xiehe is more moderate.

In terms of academic atmosphere, Director Hu has more confidence in Xiehe, and talents like Yang Ping would prefer Xiehe.

Returning to the doctor’s office, Song Zimo pulled up the imaging pictures again, and Yang Ping took the opportunity to explain lumbar disc herniation to the young doctors.

“This is not lumbar disc herniation, but lumbar discogenic pain and lateral femoral cutaneous nerve inflammation on the right side. Lateral femoral cutaneous nerve inflammation is often misdiagnosed as lumbar disc herniation, fooling many doctors. Add to this lumbar discogenic pain, and most doctors would fall into the trap.” Yang Ping spoke without constraint only after returning to the office.

Lumbar disc herniation is a syndrome caused by degeneration of the intervertebral disc, rupture of the fibrous ring, and protrusion of the nucleus pulposus, irritating or pressing on the nerve roots or the cauda equina.

As can be seen, without symptoms of nerve roots or the cauda equina, one cannot be diagnosed with lumbar disc herniation.

That is, having only lower back pain does not justify a diagnosis of lumbar disc herniation.

Lumbar disc herniation must have symptoms of nerve root or cauda equina compression and irritation.

But often, a large number of patients who only have lower back pain are easily diagnosed with lumbar disc herniation.

The manifestations of radicular pain are mostly symptoms of sciatica, but sciatica can result from many other causes. The two are not synonymous.

Therefore, even if there are manifestations of sciatica, it doesn’t necessarily mean it’s lumbar disc herniation.

This patient is such an example.

If we compare the spinal cord to the main electrical switch, the spinal nerves are the wires emitted from the main switch, while the sciatic nerves are the wires that have left the main switch and are spread out in the room.

The pain caused by lumbar disc disease can be of several types. There is discogenic pain, which is caused by stimulation of the nerve in the disc itself – the sinuvertebral nerve – resulting in lower back pain.

Radicular pain is when there is a problem with the main line where the wire leaves the main switch, resulting from compression or irritation by the lumbar disc, leading to pain in the area innervated by this nerve.

Furthermore, there is referred pain, wherein the location of the pain is different from the site of the disease, but because their sensory nerves transmit to the spinal cord at the same segment. This can be understood as having two locations under the same central control and monitoring. When a nerve in one location is stimulated, the signal is transmitted to the spinal cord and upward to the brain. The brain tends to make mistakes, unable to determine exactly where the problem is. As a result, it sends out pain signals to both locations, resulting in pain at the location that has no issue.

The pain caused by a lumbar disc can be broadly divided into these three types, with the first one being what we call lumbar discogenic pain, and the second is lumbar disc herniation.

As for sciatica, it can be caused by lumbar disc herniation or problems related to the nerve itself. If problems arise after the nerve has left the main switch, unrelated to a protruding disc, it’s not diagnosed as lumbar disc herniation.

Take piriformis syndrome as an example. Teacher Yan is one such case, causing distress for both the doctors and patients for two years.

While speaking, Yang Ping sketched an anatomical diagram of the lumbar spine on the whiteboard. With the aid of the diagram, everyone could understand more clearly.

Drawn on-the-go, it was even more accurate and beautiful than the anatomical atlas.

Even if a herniated disc compresses and stimulates the nerves, there are patterns that can be followed. Look, the most common lateral herniation of the lumbar disc affects the traversing roots.

The traversing roots are those that pass below the intervertebral disc and exit from the intervertebral foramen of the next vertebra.

The extreme lateral disc herniation affects the exiting root; the nerve root exiting directly from the corresponding intervertebral foramen.

Central disc herniation compresses the cauda equina and is the most troublesome type.

“Men are most afraid of this type!” Director Hu humorously pointed out.

“Does lumbar disc herniation affect sexual function?” A quick-thinking student asked.

That’s correct, but men often find it hard to bring up this issue. Even when asked, many are unwilling to admit it and beat around the bush, so people don’t pay attention to it.

“No wonder when the back is good, she’s also good,” Zhang Lin joked.

Xu Zhiliang gave him a stern look. Zhang Lin immediately withdrew his smile and did not dare to say more, grumbling in his heart: “Just trying to liven up the atmosphere, this guy is so serious.”

Yang Ping’s organization of the back pain symptoms was as clear and straightforward as a mind map created by an elementary school student.

“Why do we need to perform discography during surgery on this patient?” Li Guodong, who was eager to learn, asked.

“If it’s discogenic back pain, the pain can be induced by the contrast medium used in discography, or be eliminated by anesthetics. It confirms that the pain comes from between discs in the lumbar spine, pinpointing the culprit of the back pain. We then perform radiofrequency ablation to kill the sinuvertebral nerve, thereby naturally eliminating the pain,” Song Yun explained.

Song Yun admired Yang Ping’s meticulous thinking ability. Given the patient’s back pain and radiating leg pain, it seemed obvious to diagnose him with lumbar disc herniation.

This was the root cause of the misdiagnosis.

“Dr. Song, share with us your knowledge about lumbago caused by lumbar disc herniation,” Yang Ping encouraged everyone to discuss. As in academia, the more debates, the clearer the information.

With Yang Ping’s guidance, Song Yun lit up with insight: “Diagnoses like lumbar disc herniation and lumbar muscle strain are becoming abused, causing both patients and doctors to feel helpless.”

“As the advancements in diagnostic techniques become consolidated, it’s held that the most common cause of chronic back pain is discogenic. This clarifies the diagnosis of back pain.”

“As Dr. Yang mentioned earlier, the most accurate diagnosis for this patient should be: first, discogenic lumbago, and second, right-sided meralgia paraesthetica.”

“Through diskography, discogenic lumbago can be divided into nucleus pulposus-associated and annulus fibrosus-associated types. The term ‘source’ refers to the origin of the pain.”

Song Yun’s professional knowledge was excellent, however when it came to verifying it with MRI imaging, his lack of experience showed and he sought help from Yang Ping.

Yang Ping encouraged everyone to come closer to look at the images displayed on the screen: “See this cross-sectional image, where high-intensity zones (HIZ) appear in the lumbar disc. MRI scans with both T1-weighted and T2-weighted images must be examined. Can’t just look at one angle. If there’s localized low or equal signal on T1, and localized high signal on T2, it indicates the annulus fibrosus of the disc has ruptured with granulation tissue growing into its interior. This signal from the granulation tissue is a definitive imaging marker.”

“Indeed, I see it now.” Song Yun had an epiphany.

The things he had been reading about and researching for a long time, but never fully comprehended, suddenly became clear to him through Dr. Yang’s explanation.

Yang Ping then explained to Song Yun the pathology of granulation tissue, the principle of MRI imaging, the theory of image artifacts, the signal presentation of granulation tissue on MRI, the reasoning behind the specific signal types, how to determine the disease’s onset time from the signal, how to differentiate image artifacts, and more.

Especially when explaining the principle of MRI imaging, he was so profound that probably even those who invented MRI couldn’t understand it as deeply. And he used such accessible language to explain it.

Coming here for further study was the right decision!

Song Yun noticed Song Zimo was constantly taking notes, so she quickly pulled out her notebook and wrote vigorously.

As the lecture was in progress, the operating room upstairs had been prepared. Li Guodong took the patient to the operating room.

Song Zimo performed the surgery under the guidance of Yang Ping with others observing.

The surgery was completed in just over ten minutes and it worked wonders. The patient was no longer in pain and was able to get out of the operating bed and walk back to the ward all by himself.

And so a dispute had been effortlessly resolved by Yang Ping.

Upon receiving the news, Director Qin of the Spinal Surgery department breathed a sigh of relief and immediately called Yang Ping to express his gratitude. He reminded himself to be extra cautious with such trivial patient issues in the future.

The patient offered a banner as a token of gratitude to Director Qin. He was about to retreat from the scene. It’s a good thing Yang Ping helped defuse the situation. If things had escalated, where would he have hidden his face in shame?

Director Gao from the Sports Medicine Center rushed over to practice arthroscopic sculpting.

Upon hearing the news about the patient from the Spinal Surgery Department, he shook his head disapprovingly.

Old Qin, how could you send over such a patient and wash your hands of it? You should have come and followed the case from start to finish, listened to Dr. Yang’s lecture, and helped out during the operation. Only in this way you can learn from the situation and avoid falling into the same pitfalls in the future.

Having heard that Dr. Yang employed a new surgical procedure for pediatric anterior cruciate ligament (ACL) reconstruction while in the United States, Director Gao saw it as an opportunity to learn ACL reconstruction techniques using curved drilling from Yang Ping.

He carried a notebook and a USB drive around with him at all times in anticipation.