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Degenerative Disc Disease I: Introduction01:27

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Degenerative disc disease is a chronic condition in which intervertebral discs gradually lose structure and function. It is not infectious or autoimmune; rather, it results from age-related biochemical and mechanical changes, influenced by genetic, metabolic, and environmental factors.Structure and Function of DiscsThe spine contains 23 intervertebral discs that absorb load, distribute forces, maintain spacing, and allow flexibility. Each disc consists of a nucleus pulposus, a gel-like core...
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Degenerative Disc Disease ll: Pathophysiology01:23

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The symptoms of degenerative disc disease arise from a combination of mechanical compression, vascular compromise, and biochemical inflammation, which together disrupt nerve function and produce pain.Mechanical CompressionDisc degeneration reduces height and elasticity, predisposing to herniation of the nucleus pulposus, a major cause of radicular pain. Herniations may be protrusion (bulging with intact annulus), extrusion (nucleus extends beyond disc but remains connected), or sequestration...
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Herniated Intervertebral Disc l: Introduction01:29

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Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...
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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Related Experiment Video

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Transtubular Endoscopic Posterolateral Decompression for L5-S1 Lumbar Lateral Disc Herniation
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TMJ Disc Displacement without Reduction Management: A Systematic Review.

M Al-Baghdadi1, J Durham2, V Araujo-Soares3

  • 1Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, UK Institute of Health and Society, Newcastle University, UK m.k.s.al-baghdadi@ncl.ac.uk dr.mk79@yahoo.com.

Journal of Dental Research
|March 25, 2014
PubMed
Summary

This systematic review found no significant differences between various treatments for temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Patients with symptomatic DDwoR should start with the least invasive interventions due to comparable effects and limited high-quality evidence.

Keywords:
TMDclosed lockdisc disorderinternal derangementmeta-analysistemporomandibular joint surgery

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Area of Science:

  • Dentistry
  • Oral and Maxillofacial Surgery
  • Evidence-Based Medicine

Background:

  • Temporomandibular joint (TMJ) disc displacement without reduction (DDwoR) management lacks clear clinical effectiveness data for various interventions.
  • A systematic review is needed to evaluate the efficacy of conservative and surgical treatments for DDwoR.

Purpose of the Study:

  • To systematically review and synthesize evidence on the clinical effectiveness of interventions for TMJ disc displacement without reduction (DDwoR).
  • To compare the outcomes of different conservative and surgical interventions for DDwoR.

Main Methods:

  • Systematic review adhering to PRISMA guidelines, including randomized clinical trials.
  • Searched English-language, peer-reviewed publications up to November 2013.
  • Extracted data on TMJ pain intensity and maximum mouth opening; assessed risk of bias.
  • Performed meta-analysis on homogenous groups where applicable.

Main Results:

  • Twenty studies with 1,305 patients were included, involving 21 comparisons.
  • Most interventions showed no statistically significant differences in primary outcomes (pain, mouth opening) compared to controls or other interventions.
  • A majority of interventions demonstrated significant improvement from baseline levels over time.
  • Included studies exhibited high heterogeneity and unclear to high risk of bias, limiting definitive conclusions.

Conclusions:

  • Current evidence is insufficient to definitively conclude the superiority of any specific intervention for DDwoR.
  • Given comparable therapeutic effects and risks, initial treatment for symptomatic DDwoR should prioritize the simplest, least invasive interventions.
  • Further high-quality research is needed to guide optimal management strategies for TMJ disc displacement without reduction.