Adult Medical-Surgical Adult Medical-Surgical NursingNursing

Neurology Module: Neurology Module:

Spinal Disc LesionSpinal Disc Lesion

Disc Lesion: DescriptionDisc Lesion: Description

A protrusion or herniation of the A protrusion or herniation of the cartilaginous intervertebral disc putting cartilaginous intervertebral disc putting pressure on nerve roots of the spinal cordpressure on nerve roots of the spinal cord

Most common sites are the cervical or Most common sites are the cervical or lumbar spinelumbar spine

Disc Lesion: AetiologyDisc Lesion: Aetiology

““Wear and tear”Wear and tear”

Injury: major or minorInjury: major or minor

Lifting, coughing, sneezing increasing Lifting, coughing, sneezing increasing localised pressure causing herniation localised pressure causing herniation

Disc Lesion: Disc Lesion: Clinical ManifestationsClinical Manifestations

A shooting pain down the nerve. Most A shooting pain down the nerve. Most commonly:commonly:

From the back down the leg (Sciatica)From the back down the leg (Sciatica)

From the neck down one or both armsFrom the neck down one or both arms

Numbness and tingling of the extremitiesNumbness and tingling of the extremities

Limping, difficulty and pain on stretching Limping, difficulty and pain on stretching and straightening limband straightening limb

Disc Lesion: DiagnosisDisc Lesion: Diagnosis

Patient history and clinical picturePatient history and clinical picture

MRI (main diagnostic tool)MRI (main diagnostic tool)

CT scan CT scan

Myelogram (invasive and less used now)Myelogram (invasive and less used now)

Disc Lesion: ManagementDisc Lesion: Management

Surgery (micro-surgery):Surgery (micro-surgery):

Discectomy: removal of the herniating discDiscectomy: removal of the herniating disc

Laminectomy: removal of the lamina of the Laminectomy: removal of the lamina of the vertebra to remove pressure on the nerve vertebra to remove pressure on the nerve rootroot

Disc Lesion: Disc Lesion: Nursing ConsiderationsNursing Considerations

(Demonstrate pre-op): Breathing exercises(Demonstrate pre-op): Breathing exercises

Post-op alignment of the patient: “log-Post-op alignment of the patient: “log-rolling” technique for position changerolling” technique for position change

How to get in and out of bed once mobileHow to get in and out of bed once mobile

Collar or corset to immobilise the areaCollar or corset to immobilise the area

Anti-embolism stockingsAnti-embolism stockings

Usually up to toilet 1Usually up to toilet 1stst day post-op but no day post-op but no sitting in a chair (raised toilet seat)sitting in a chair (raised toilet seat)