Intervertebral Disk Herniation

8/7/2019 Intervertebral Disk Herniation

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IntervertebralIntervertebral Disk Disk HerniationHerniation

-- A disorder involving impingement of aA disorder involving impingement of avertebral disk¶s nucleusvertebral disk¶s nucleus pulposus pulposus on spinalon spinal

nerve roots, causing pain and possiblenerve roots, causing pain and possibleneuromuscular deficit.neuromuscular deficit.



E tiology and Incidence:E tiology and Incidence:

a.a. AgingAging b. b. Gender Gender c.c. DDegenerative disordersegenerative disordersd.d. Congenital predisposing (Congenital predisposing ( hyperlordosishyperlordosis) )e.e. TraumaTrauma-- SponclylolysisSponclylolysisf.f. PregnancyPregnancyg.g. High risk occupationHigh risk occupation



P athophysiologyP athophysiology: :R upture of theR upture of the annulusannulus

pulposus pulposus allows part of theallows part of thenucleusnucleus pulposus pulposus to protrudeto protrude

and stress against spinal nerveand stress against spinal nerveroots, producing symptomsroots, producing symptoms

HerniationHerniation occur anywhereoccur anywherealong the vertebral column butalong the vertebral column butis most common in the lumbar is most common in the lumbar

areaarea

Low back /

neck pain

Numbness



Pressure on the sciatic nervePressure on the sciatic nerve

d ebilitating d ebilitating pain if pain if

chronicchronic

Possiblemotor and

sensorychanges



C linical manifestationC linical manifestation

a.a. Low back /neck pain can vary widelyLow back /neck pain can vary widely b. b. Mild tingling, dull ache / a burning pulsatingMild tingling, dull ache / a burning pulsating

sensationsensationc.c. Numbness Numbness

The pain most often occurs on one side of theThe pain most often occurs on one side of the body body



Lu mbar herniated disk Lu mbar herniated disk

-- sharp pain in one part of the leg,sharp pain in one part of the leg,hip/buttocks, numbness in other parts.hip/buttocks, numbness in other parts.Sensations felt on the back of the calf/ sole of Sensations felt on the back of the calf/ sole of thethe footfoot..

C ervical disk C ervical disk h herniationerniation

-- pain when moving the neck pain when moving the neck, deep, deep pain painnear/over the shoulder bladenear/over the shoulder blade,/ ,/ pain that pain thatradiates to the upper arm,radiates to the upper arm, forearm,/ rarelyforearm,/ rarelyfingers.fingers.



Diagnostic testsDiagnostic tests

I maging techniquesI maging techniquesXX--rayray

CT scanCT scanMRI of theMRI of the spinespine

ElectrodiagnosticElectrodiagnostic testtestnerve conduction studiesnerve conduction studieselectromyographyelectromyography

DiskographyDiskography



M edical and S u rgical Interventions:M edical and S u rgical Interventions:

Medications:Medications:

NSA I DS NSA I DS ± ±aspirin,ibuprofenaspirin,ibuprofen((Advil,NuprinAdvil,Nuprin),),diclofenacdiclofenac ketoprufenketoprufen ((ActronActron))

TramadolTramadol ((ultramultram))

OpioidOpioid

Epidural steroid I njectionsEpidural steroid I njections ± ± used to treat low back used to treat low back pain caused by nerve impingement pain caused by nerve impingement



AntidepressantsAntidepressants- - amitriptylineamitriptyline((ElavilElavil),),desipraminedesipramine ( (Norpramine Norpramine, , DoxepinDoxepin ((SinequanSinequan),), imipramineimipramine ( (TofranilTofranil))

Muscle relaxantsMuscle relaxants- - cyclobenzaprinecyclobenzaprine ( (FlexerilFlexeril),),diazepam (Valium),diazepam (Valium), carisoprodolcarisoprodol (Soma)(Soma)



Su rgery and InvasiveSu rgery and Invasive P roced u res:P roced u res:

DisketomyDisketomy-- Surgical removal of the diseased disk.Surgical removal of the diseased disk.

LaminectomyLaminectomy-- surgery used to move either the lamina,surgery used to move either the lamina,

two small bones that make up a vertebra/two small bones that make up a vertebra/ bone spurs in your back. bone spurs in your back.



Spinal FusionSpinal Fusion-- is a surgery usedis a surgery used toto fusefuse spinebonesspinebones(vertebrae) that cause you to have back (vertebrae) that cause you to have back

problems. problems.

PercutaneousPercutaneous VertebroplastyVertebroplasty-- involves an injection of involves an injection of a cementa cement--likelike bone bone

substitute into vertebrae w/ compressionsubstitute into vertebrae w/ compressionfractures.fractures.



PercutaneousPercutaneous KyphoplastyKyphoplasty

-- the health care provider injects bone cementthe health care provider injects bone cementinto the space surrounding a fractured vertebra.into the space surrounding a fractured vertebra.



N u rsingN u rsing P riorities:P riorities:

1 .1 . I mpaired physical mobilityI mpaired physical mobilityI nterventions:I nterventions:

a.a. Support affected body parts usingSupport affected body parts using pillows/rolls, air mattress pillows/rolls, air mattress, water , water bed bed ..

b. Provide conservative management b. Provide conservative management, if , if indicated, includingindicated, including: :



-- instructing in appropriate exercisesinstructing in appropriate exercises

-- Teach the patient to avoid slipperyTeach the patient to avoid slipperysurfaces andsurfaces and activitiesactivities

-- assess strength, sensation and movementassess strength, sensation and movement

of extremities.of extremities.-- consult w/ physical/occupationalconsult w/ physical/occupational

therapist astherapist as indicated.indicated.

-- teach patient about proper bodyteach patient about proper bodymechanisms.mechanisms.



2 .2 . A cu te painA cu te paina.a. Assess the location, nature, course andAssess the location, nature, course and

progression of back pain progression of back pain b. b. Provide comfort measuresProvide comfort measures

-- BackrubBackrub-- Keep the patient in proper body alignmentKeep the patient in proper body alignment

when inwhen in bed bed andand whenwhen turning turning

-- Positioning in Williams positionPositioning in Williams position-- application of heatapplication of heat



3. A nxiety3. A nxiety

a.a. Provide accurate information about theProvide accurate information about the

problem problem

a.a. Provide calm environment, soft music, warmProvide calm environment, soft music, warm

bath, back rub. bath, back rub.



Thank you!!!Thank you!!!PercyPercy CrisiaCrisia SazonSazonChristineChristine SimundoSimundo

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Intervertebral Disk Herniation