Lɛ wi lan bɔt yu lɔwa bak (Lumbar Spine) Wetin na dis ɛksaktɔli?

Sɔntɛnde yu kin gɛt pen na yu bak? We yu sidɔm na wan ples fɔ lɔng tɛm, ɔ we yu es ebi ebi lod, na di ɔda pat we de dɔŋ na yu bak na di pat we de mek yu strɛs pas ɔl. So, tide wi go tɔk bɔt di lɔwa bak, we na wan rili impɔtant pat na wi bɔdi, ɔ as dɔktɔ dɛn kin kɔl am , di lumbar spine . Lɛ wi jɔs ɔndastand wetin i bi, us savis i de gi wi bɔdi, us prɔblɛm i kin kam wit, ɛn wetin na di sɔlv fɔ dɛn.

Wetin na di Lumbar Spine?

Fɔ tɔk am simpul wan, di lכmba spayna na fayv bon dεm (dεn kin kכl dεm bak vεrbra) na di bכtכm pat na yu bak. Dɔktɔ dɛn kɔl dɛn fayv bon ya L1, L2, L3, L4, ɛn L5. (di L tinap fכ lכmba.) dεn lכmba vεrbra dεm ya big sכm εn tik pas di כda vεrbra dεm na yu כl spayna, lεk skwea ston.

imajin, di lכmba spayna de dכn di 12 vεrbra dεm na yu chεst (dεn kכl dεn tכraks vεrbra dεm) εn oba di bon we shep triangul we dεn kכl sakrum, we ivin lכs.

biכs dεn lכmba vεrbra dεm ya big, dεn de gi gud stεbiliti to wi spayna. Dɔn bak, bɔku mɔsul ɛn ligamɛnt dɛn kin kam ɛn kɔnɛkt to dis pat. di mכst imכtant na dis lכmba spayna de bia di mכst wet na yu bכdi. Nɔto dat nɔmɔ, i de ɛp yu bak fɔ mek yu balans. di mכsul dεm εn ligament dεm we de atak dis lכmba spayna de εp yu fכ waka, rכn, sidon, es tin dεm, bεnd εn twist yu bכdi na כl di say dεm.

yu lכmba spayna gεt sכm inward kכv. Dɛn kɔl am lordotic curve .

Wetin kin apin to di lumbar spine?

Lɛ wi tek tɛm luk sɔm pan di tin dɛn we kin apin na wi bɔdi we de dɔŋ:

• i de sכpכt yu כp bכdi εn de sheb yu wet: na di lכmba spayna we de sכpכt di wet na yu ed, εn di sεvin vεrbra dεm na yu nεk (dεn kכl dεm di sεvikal spayna) εn di tεlv vεrbra dεm na yu chεst (di tכraks spayna). I kin kɔnɛkt bak to yu bɛlɛ, we kin bia di mɔs wet na yu bɔdi ɛn we kin bia di prɛshɔn we yu es ɔ kɛr sɔntin. Na di pat we de transfa di wet na yu ɔpa bɔdi to yu leg dɛn.
• I de ɛp yu fɔ muv yu bɔdi: di mɔsul dɛm na yu lכw bak εn di fleksibiliti na yu lכmba spayna de alaw yu fכ bεnd yu torso na כl di say dεm (fכwכd, bak), bεnd to di sayd, fulכp rotate, εn twist. di las tu lכmba vεrbra dεm (L4, L5) in patikyula de εp wit dεn muvmεnt dεm ya mכst.
• I de protεkt yu spεnal kכd εn Cauda Equina: di spεnal kכd we de rכn tru yu spayna, lεk wan men nεv kεbul we de kכmכt na yu bren. i de stat na di bכs pat pan yu sכkul εn i de εnd na di fכs lכmba vεrbra (L1). afta dat, wan bכndכl nεv dεm de we de rכn dכn frכm di εnd pan di spεnal kכd. I tan lɛk ɔs in tel bikɔsDɛn kɔl am di cauda equina (we min ɔs in tel). dis spεnal kכd, di cauda equina, de protεkt bay wan kכva we dεn mek wit dεn vεrbra dεm ya.
• i de kכntro di muvmεnt dεm na di leg dεm: di nεv dεm we de kכmכt na yu lכw spεnal kכd εn di cauda equina de kכntro di sens dεm (filin) ​​εn di muvmεnt dεm na yu leg dεm.

Us mכsul dεm εn כda sכft tisu dεm de na di lכmba spayna?

Mɔsul dɛn na di lumbar spayna

yu lכw bak mכsul dεm, wit yu bכdi mכsul dεm de muv yu torso εn lכw bכk. Dɛn mɔsul ɛn ligamɛnt ya de gi yu trɛnk ɛn stebul na yu bɔdi we de dɔŋ, ɛn dis de ɛp yu fɔ bɛn bifo, bak, ɛn rɔta. dis na sכm pan di men mכsul dεm we de kכnekt to di lכmba spayna:

• Latissimus Dorsi: Dis na big, flat, triangul mɔsul. I de rɔn along yu mid ɛn lɔwa bak. I de ɛp yu fɔ es wet wit yu an, es yu chɛst we yu de blo, ɛn bɛn yu bak to di sayd.
• Iliopsoas: Dis na grup we gɛt tri mɔsul dɛn. I de muv yu hip jɔyn. Dis mכsul de εp fכ mek yu hip εn lכw bכk stebul we yu de waka, rכn, εn grap na chia.
• Paraspinals: dis tri grup dεm fכ mכsul dεm de along yu spayna. Dɛn kin ɛp yu fɔ tinap stret, bɛn na di sayd, ɛn rɔta. Dɛn impɔtant bak fɔ mek yu kɔntinyu fɔ tinap.

Disk dεm na di lumbar spayna

di intavεrbral disk dεm na di pat dεm na di spayna we de wok lεk "shכk abzכba kushכn" bitwin tu vεrbra dεm. Fayv pan dεn disk dεm de bitwin yu lכmba vεrbra dεm. apat frכm we dεn de abzכp shכk, dεn disk dεm ya de εp bak fכ sכpכt di wet we de travul dכn yu spayna εn alaw fכ muv bitwin di vεrbra dεm.

Impɔtant: Dis disk we de na yu lכw bכk na di wan we kin bכku כ hεnia. Dis na wae yu kin bigin fil pen na yu lכw bak, כ dכn yu leg, sכmtεm insay yu fut.

Ligament dεm na di lumbar spayna

Ligament na di tisu dεm we de kכnekt wan bon to כda wan. di ligament dεm na di lכmba spayna de εp fכ kip di spayna stebul, alaw fכ muv fayn fayn wan, εn εp fכ abzכp di impak if aksidεnt apin. Sɔm pan di men ligamɛnt dɛn na:

• Anterior Longitudinal Ligament: dis de rכn dכn di fכnt pan di lכmba vεrbra. i de stεbyul di lכmba jכint dεm εn i de limited bakwכd flekshכn (εkstenshכn).
• di posita lכnjitudinal Ligament: dis de rכn along di bak pat pan di lכmba vεrbra. I de stɔp fɔ fleks fɔ go bifo.
• Supraspino ligament/Interspino ligament:Dis binding de ɛp bak fɔ limited fɔdɔm bɛnd.
• Ligamentum Flavum: dεn ya de kכba di insay pat pan di spεnal kanal εn de protεkt di spεnal kכd frכm biεn.
• di intatransvas ligament dεm: dεn ya de kכnekt di transvas prכsεs dεm na di vεrbral dεm. Dɛn kin ɛp fɔ mek yu bɔdi nɔ bɛn di say we yu bɔdi de.
• Iliolumbar ligament: dis de kכmכt frכm di L5 vεrbra to di pεlvik bon. i de εp fכ mek di lumbosacral spayna stebul.

Spinal Kɔd ɛn Nɛv dɛn

as wi bin dכn tכk bכt, di spεnal kכ d na wan bכndεl fכ nεv tisu we de kכmכt frכm di bren to di L1 vεrbra. Dis na wetin de kɛr mɛsej frɔm di bren to di mɔsul dɛm. di nεv rכt dεm we de go dכn afta L1 dεn kכ l dεm di cauda equina .

fayv pe nεv dεm de kכmכt na yu lכmba spayna (L1 to L5, wan na εvri say). dis nεv dεm de travul dכn yu spayna εn jכyn wit כda nεv dεm fכ mek wan nεtwכk fכ nεv dεm we de kכntro di pen, sεns, εn muvmεnt na yu lכw pat dεm.

• L1 nerve: I de gi sens to yu groin eria εn genitals, εn i de εp fכ muv yu hip mכsul dεm.
• L2, L3, L4 nεv dεm: Gi sεns to di fכnt pat pan yu thigh εn insay yu lכw leg. Dɛn kin kɔntrol bak di hip ɛn ni mɔsul dɛn we de muv.
• L5 nerve: I de gi sens to di bak pat pan yu lכw leg, di tכp pat pan yu fut, εn di εria bitwin yu big fut εn sεkכn fut. I de kɔntrol bak aw yu hip, yu ni, yu fut, ɛn yu fut finga dɛn de muv.
• Sciatic Nerve: Dis na di L4, L5, εn כda sakral nεv dεm de fכm am. I kin bigin na yu bɔdi, i kin rɔn dɔŋ yu leg, ɛn i kin dɔn na yu fut. Sciatica pen kin apin we dis nerve dɔn pwɛl ɔr kɔmprɛs.

Blɔd Vesel dɛn

di vεrbra, mכsul dεm, εn ligament dεm na di lכmba rijyכn de gεt bכdi εn nyutriεnt frכm di branch dεm we de k כmכt frכm di bכdi aorta, di men at we de na yu bכdi.

Us sik ɛn dizayd kin afɛkt di lumbar spayna?

Bɔt i sɔri fɔ no se dis pat we de dɔŋ na wi spayna kin gɛt difrɛn prɔblɛm dɛn. Dɛn prɔblɛm ya kin mek yu bak ɔ yu hip nɔ ebul fɔ muv fayn fayn wan, ɛn yu kin mek yu bak, yu hip, yu hip, ɔ yu leg dɛn nɔ gɛt pen, wik, ɛn swɛ.

Sɔm pan di sik ɛn kɔndishɔn dɛm wae kin afɛkt di lumbar spayna na:

• Lɔwa bak pen: Dis na prɔblɛm we bɔku pipul dɛn kin gɛt. I kin kam bikɔs ɔf difrɛn kayn injury ɛn kɔndishɔn dɛn. Dijenεraytiv sik dεm (e.g. Osteoarthritis , Ankylosing Spondylitis ), Spinal Stenosis , Hεniεt DiskBak pen kin bi bay tin dεm lεk di nεv dεm we dεn pinch, spεn, spεnal fraktכs, tכmכro, sist, bon spכr, εn spondylolisthesis (slip fכ wan vεrbra).
• Lumbar Stenosis: Dis na we di spεs we de rawnd yu spεnal kכd de sכmtεm sכmtεm. dis de ridyus di spes fכ di nεv dεm we de kכmכt na di spεnal kכd. Dis kin mek di nerve kompreshɔn, pen, swɛt, wik na di leg, groin, hip, bɔt, ɛn di ɔda pat na di bak. Dɛn sayn ya kin wɔs wae yu de waka ɔr tinap, ɛn yu kin fil fayn wae yu de ledɔm, sidɔm, ɔr bɛn fɔ go bifo smɔl.
• Spondylolisthesis: Dis na we wan lכmba vεrbra de slip fכ go bifo we yu rilitiv to di vεrbra dεm we de dכn am. Dis kin kɔmprɛs wan nerv ɛn mek yu bak ɔ yu leg pen.
• Vεrbral Kכmpreshכn Frakshכn: Pɔsin we gεt kכndyushכn lεk כstioporosis kin sכfa wit vεrbral kכmpreshכn frakshכn frכm ivin sכm sכm aksidεnt. Bɔrku fraktrɔs kin apin bak frɔm tin dɛm lɛk motoka aksidɛnt ɛn fɔdɔm frɔm ayt.
• Sciatica: Dɛn kin kɔl am bak lumbar radiculopathy , dis na pen na di nerve we kin kam bikɔs di sciatic nerve dɔn pwɛl ɔ i kin mek i vɛks. I kin kam wit tin dɛm lɛk hεnia disk, spondylolisthesis, ɔr ɔstiɔ-arayt.
• Herniated Disk: Dis kin apin we di disk bitwin di vεrbra dεm bulge, tear, כ lik di tin dεm we de insay. I kin mek yu bak pen, yu leg dɛn kin swɛla, ɛn yu mɔsul dɛn kin wik.
• Lumbar Lordosis (dεn kin kכl am bak "Swayback"): Dis na we di lכw bכdi kכva pasmak. dis de put prεshכn we nכ nid pan di lכmba vεrbra dεm. Dis kin kam bikɔs yu gɛt sik, yu nɔ de tinap fayn, ɛn yu spayna de bɛn pasmak.
• Mכsul Spasm: Big mכsul dεm de we de sכpכt di lכmba rijyכn. Dɛn mɔsul dɛn ya kin tɛns ɔ twist. Dis na tin bak we kin mek pɔsin gɛt bak pen.
• Dijeneretiv Disk Disease: Dis kכndyushכn kin apin we di disk dεm na di lכmba spayna de west. di spεs bitwin di vεrbra dεm de dכn, we kin mek di nεv kכmpreshכn εn bak pen.
• Adult Scoliosis: Skoliosis na wan sayd we di spayna de kɔba. dis kכndyushכn kin apin na di lכmba spayna as wi de ol כ as di spayna de west.
• Cauda Equina Syndrome: Dis kכndyushכn de kכmכt we di nεv bכndεl we dεn kכl cauda equina de kכmכt. Dis na mɛdikal imejensi . Di sayn dɛm na pen, wik, ɛn nɔr kin ebul fɔ kɔntrol yu bɔdi ɛn blad.

Aw dɛn kin no di sik ɛn kɔndishɔn dɛn na di lumbar spayna?

Fɔs, yu dɔktɔ go aks yu bɔt yu mɛrɛsin istri, di mɛrɛsin dɛn we yu de tek, ɛn di sayn dɛn we yu gɛt. Dɔn, dɛn go du fizik ɛgzam ɛn ɔda tɛst ɛn skan if nid de.

Yu kin du tɛst dɛn lɛk dis:

• CT Scan (Computed Tomography - CT Scan): Dis de yuz X-ray εn kכmpyuta fכ tek rili tint "slais" pikchכ dεm fכ di εria we dεn de egzamin. i kin luk tin dεm lεk di shep εn saiz fכ di spεnal kanal, εn di kכndishכn fכ di bon dεm (bon spur, bon fכs, bon dεstrכkshכn bikoz fכ infεkshכn כ tכmכro).
• Magnetic Resonance Imaging (MRI): Dis kin yuz big magnet, redio wev, ɛn kɔmpyuta fɔ tek ditayli pikchɔ dɛn. I kin ɛp fɔ no di prɔblɛm dɛn we de wit di spaynal kɔd ɛn di nɛv dɛn we de kɔmɔt na di spayna, lɛk di disk dɛn we gɛt hεnia, infεkshɔn, ɛn tכmכro. MRI de gi klia pikchɔ bɔt di nerv dɛn pas CT skan.
• X-ray: I de yuz smɔl raytin fɔ tek pikchɔ fɔ di bon dɛn ɛn di sɔft tisu dɛn. Dɛn kin luk fɔ tin dɛm lɛk fraktrɔs, disk prɔblɛm, spɛshal stenɔsis, ɛn at at sik.
• ilektromayogram (EMG) εn Nεv Kכndukshכn Stɔdi dεm: EMG de chεk di hεlth εn di wok we di nεv εn mכsul dεm de du. Wan stכdi we dεn du fכ kכndukshכn na di nεv de mכsu aw kwik wan ilektrikal impuls de travul along wan nεv. Dɛn tɛst ya kin ɛp fɔ no di nerve we dɔn pwɛl ɛn usay di nerve dɔn kɔmprɛs.
• Maylogram: Dis tεst de luk di kכnεkshכn bitwin di vεrbra εn disk dεm, di spεnal kכd, εn di nεv rכt dεm. I kin chɛk fɔ si if yu gɛt tumbu, bon spur, ɔ hεnia disk we de prɛs pan di spaynal kɔd ɔ di nerv dɛm, we de mek yu fil pen, yu nɔ de fil fayn, ɔ yu wik.

Aw dɛn kin trit di lɔmbar spayna wɛl bɔdi prɔblɛm?

Tritmεnt dεm de we nכ de du כspitul εn כspitul fכ plεnti kכndyushכn dεm we de afekt di lכmba spayna. Di tritmɛnt we yu go pik go dipen pan wetin mek di prɔblɛm ɛn aw i siriɔs.

Wetin na tritmɛnt dɛn we nɔto ɔpreshɔn?

If yu lɔwa bak pen nɔto aksidɛnt ɔ tumbu, yu dɔktɔ kin tɛl yu fɔs fɔ tek tritmɛnt dɛn we nɔ go mek yu nɔ gɛt bɔku prɔblɛm. Sɔm kɔmɔn tritmɛnt dɛn we nɔ gɛt ɔpreshɔn na:

• Rɛst.
• Ays ɔ ɔt kɔmprɛs.
• Fɔ avɔyd wok we de mek yu taya ɔ we de mek yu fil pen mɔ.
• Fizik Tɛrapi.
• Mεdikeshכn dεm: mכsul rilaksεnt, pen kil (e.g. paracetamol), εn anti-inflammatory mεdikeshכn (e.g. ibuprofen, naproxen).
• Stɛroyd Injɛkshɔn: Tri kayn stɛroyd injɛkshɔn de we dɛn kin tink bɔt fɔ mek yu gɛt pen na yu bɔdi. Lumbar Epidural Block na injεkshכn fכ stεroyd insay di epidural spεs, we na di spεs we de ausayd di spεnal kכd.lכmbar fεs jכyn blכk na stεroyd injεkshכn insay di fεs jכyn layn bitwin di vεrbra dεm. intalaminar injεksh כn כ transforaminal injεksh כn na stεroyd injεkshכn insay di spεs bitwin di spεnal kכd εn di spεnal kכlכm.
• Mɛdikal Branch Blɔk ɛn Rediofrikyuɛnsi Ablashɔn: Dɛn kin tink bɔt dis tritmɛnt fɔ sɔm pen we nɔ de dɔn. Fɔs, dɛn kin injɛkt wan lokal anestetik insay di nɛv we de kɔnɛkt to di fes jɔyn na di spayna. If di pen dɔn go dɔŋ, di nɛks tin we yu fɔ du na fɔ tray fɔ pul di pen sote go. Dɛn kin du dis bay we dɛn de pwɛl di nɛv wit wan we we dɛn kɔl rediofrikyuɛnsi ablashɔn . Di pen dɔn ridyus fɔ sɔm mɔnt. Bɔt if di nerve gro bak, di pen kin kam bak.

Aw a go no if a nid fɔ du ɔpreshɔn pan mi lɔmba spayna?

Yu kin nid fɔ du ɔpreshɔn pan yu lumbar spayna if:

• If ɔda tritmɛnt dɛn nɔ ɛp.
• If yu lɔwa bak, hip ɛn/ɔ yu leg simptom dɛn de wɔs (dɛn kin du ɔpreshɔn fɔ yu leg pen pas fɔ mek yu bak pen).
• If yu gɛt wɛlbɔdi fɔ mek dɛn du ɔpreshɔn pan yu.

If yu gɛt injury na di lumbar rijyɔn frɔm aksidɛnt (lɛk motoka aksidɛnt), kansa, epidural abscess (infɛkshɔn bitwin di spaynal kɔd ɛn di kɔva fɔ di spaynal kɔd), ɔstiomyelitis (infɛkshɔn na di bon), cauda equina syndrome, ɔ conus medullaris syndrome (wan kayn spaynal kɔd disɔda), ɔpreshɔn na di fɔs layn fɔ tritmɛnt.

Us ɔpreshɔn dɛn de fɔ di lɔmba spayna kɔndishɔn?

Na sɔm ɔpreshɔn dɛn we dɛn kin du:

Lumbar Spinal Dikɔmpreshɔn Ɔpreshɔn

Dis na wan jenɛral wɔd. i de tכk bכt difrεn כpεrayshכn dεm we dεn kin du fכ rεliv di simptom dεm bay we dεn de rεdכks prεshכn כ kכmpreshכn pan di spεnal kכd כ nεv rכt dεm. Di we dɛn we dɛn kin yuz fɔ du ɔpreshɔn na:

• Lumbar Diskectomy: Insay dis prosidur, di ɔspitul kin pul pat pan wan disk fɔ mek i nɔ gɛt prɛshɔn pan di nerve rut dɛn we de nia am.
• Lumbar Laminotomy ɔ Laminectomy: Insay dis prosidur, di ɔspitul kin pul wan smɔl pat pan di bɔdi arch (lamina) na di spaynal kanal. insay laminotomy, na sכm sכm pat pan di lamina nכmכ dεn kin pul. insay laminectomy, dεn kin pul di כl lamina, wit eni bon spur, disk fragmεnt, εn tik ligament, if nid de. we dεn pul di lamina, di spεnal kanal de big εn di prεshכn de rεliv.
• Lumbar Foraminotomy ɔ Fɔraminektomi: .dεn kin du dεn tu כpεrayshכn ya fכ mek di opin (foramen) we di nεv rכt dεm de kכmכt na di spεnal kכd, big, bay we dεn de pul sכm pan di bon we de na da εria de. Insay fɔraminektomi, dɛn kin pul bɔku bɔku bon.
• Lumbar Corpectomy: Insay dis ɔpreshɔn, di ɔspitul kin pul di men pat pan di vɛrbra (vɛrbral bɔdi) ɛn di disk fɔ mek i nɔ gɛt prɛshɔn pan di spaynal kɔd. sכmtεm, dεn kin fכs di vεrbra dεm togeda ( spinal fusion ) fכ mek di lכmba spayna stebul.

Lumbar Disk Riplesmɛnt Ɔpreshɔn

insay dis, dεn kin pul wan lכmba disk we sik εn put wan atifishal disk insay. Bɔku tɛm dɛn kin du dis fɔ riples di lumbar disk. Bɔt insay di las ia dɛn, dis ɔpreshɔn nɔ kin bɔku, bikɔs ɔf di prɔblɛm dɛn we kin apin afta di ɔpreshɔn.

Lumbar Spinal Fusion we de na di bɔdi

dis na כpεrayshכn we de fכs wan כ mכr lכmba vεrbra dεm tכgeda fכ כltεm, we de mek i nכ de muv bitwin di vεrbra dεm.

Fכnshכnal Ilektrikal Stimulεshכn fכ Spinal Kכd Injuri

insay dis mכtכd, dεn de yuz sכm sכm ilektrikal impuls dεm fכ mek di mכsul dεm εn nεv dεm na di lכw bכdi we di lכmba nεv dεm de kכntro, fכ tray fכ mek dεn wok bak.

A kin gɛt ɔpreshɔn fɔ di lɔmba spayna we nɔ kin ambɔg mi?

Tɔk to yu dɔktɔ we de du ɔpreshɔn bɔt dis. Bɔku tɛm, di ɔpreshɔn we dɛn kin du na di spayna we nɔ kin tek bɔku mɔni dɔn tek di ples fɔ di tradishɔnal ɔpreshɔn we dɛn kin du fɔ opin. Bifo dɛn kɔt wan big say na di skin, dɛn kin du ɔpreshɔn we nɔ go ambɔg di skin bay wan ɔ mɔ smɔl smɔl say dɛn. Bikɔs di say dɛn we dɛn kɔt smɔl, di mɔsul dɛn ɛn di sɔft tisu dɛn nɔ kin pwɛl bɛtɛ pas we dɛn kɔt am big.

Di tin dɛn we impɔtant pas ɔl fɔ mɛmba (Take-Home Message) .

Yu lכmba spayna na di lכw pat pan yu bak. i gεt fayv vεrbra dεm (L1-L5). i gεt bak di intavεrbral disk dεm, di spεnal kכd, εn di nεv dεm, mכsul dεm, tεndon dεm, εn ligament dεm. na di lכmba spayna we de sכpכt yu bכdi in wet εn de alaw fכ bכku pan yu bכdi fכ muv.

Di tin we impɔtant pas ɔl na, if yu gɛt pen na yu bak ɔltɛm, yu leg dɛn de swɛ, ɔ yu wik, nɔ ignore am. Fɔ tru, yu go si dɔktɔ ɛn gɛt advays.

Tritmɛnt dɛn de we nɔto ɔspitul ɛn ɔspitul fɔ bɔku sik dɛn. So natin nɔ de fɔ wɔri bɔt. Yu kin ɛp bak fɔ mek yu lumbar spayna gɛt wɛlbɔdi bay we yu de tinap fayn, es yu wet kɔrɛkt wan, ɛn du ɛksɛsayz.

` Bak pen, lumbar spayna, vεrbra, disk prכblεm, sciatica, spεnal kכd, nεv pen