Lumbar Disc HerniationLumbar Disc Herniation

Dr. Walaa NasrDr. Walaa NasrLecturer of Adult NursingLecturer of Adult Nursing

Second yearSecond year

Lumbar disc herniationLumbar disc herniation

OutlinesOutlines Introduction Introduction Definition Definition Causes Causes Types of disc herniationTypes of disc herniation Typical locations of disc herniationTypical locations of disc herniation Clinical manifestationsClinical manifestations Diagnostic studiesDiagnostic studies Management Management Nursing interventionNursing intervention

Lumbar disc herniationLumbar disc herniationIntroductionIntroduction

Definition of disc Definition of disc herniationherniation

Abnormal rupture of the soft Abnormal rupture of the soft gelatinous central portion of gelatinous central portion of

the disc the disc (nucleus pulposus)(nucleus pulposus) through the surrounding outer through the surrounding outer

ring ring (annulus fibrosus).(annulus fibrosus). In In about about 9595% of all disc % of all disc

herniation cases, the L4-L5 or herniation cases, the L4-L5 or L5-S1 disc levels are involved.L5-S1 disc levels are involved.

Causes of lumbar disc Causes of lumbar disc herniationherniation

1.1. Trauma or injury to the Trauma or injury to the discdisc

2.2. Disc degenerationDisc degeneration3.3. Congenital Congenital

predispositionpredisposition

Types of disc herniationTypes of disc herniationThere are three types of disc There are three types of disc

herniationherniation1.1. Protrusion / bulgeProtrusion / bulge 2.2. Disc herniationDisc herniation 3.3. Sequestration (disc rupture)Sequestration (disc rupture)

Typical locations of disc Typical locations of disc herniationherniation

Central Central It is rare condition, it will affect It is rare condition, it will affect

multiple nerve roots, patient will multiple nerve roots, patient will have back pain more than leg have back pain more than leg pain and it may cause pain and it may cause incontinenceincontinence of the bladder and of the bladder and bowel. bowel. UrgentUrgent surgical treatment surgical treatment is necessary if patient presents is necessary if patient presents with neurological deficits.with neurological deficits.

Typical locations of disc Typical locations of disc herniationherniation

PosterolateralPosterolateral Usually it is the most common Usually it is the most common

location, it involve one nerve root location, it involve one nerve root (the lower one).(the lower one).

Foraminal Foraminal It occurs in about 8-10% of all It occurs in about 8-10% of all

cases. It involves the exiting cases. It involves the exiting nerve.nerve.

If the herniated disc is:If the herniated disc is: NotNot pressing on a nerve, you may pressing on a nerve, you may

have an ache in the low back or no have an ache in the low back or no symptoms at all.symptoms at all.

PressingPressing on a nerve, you may have on a nerve, you may have pain, numbness, or weakness in pain, numbness, or weakness in the area of your body to which the the area of your body to which the nerve travels.nerve travels.

Clinical manifestations of Clinical manifestations of disc herniationdisc herniation

With herniation in the lower (lumbar) back, sciatica may develop. sciatica is pain that travels through the buttock and down a leg to the ankle or foot because of pressure on the sciatic nerve. Low back pain may accompany the leg pain.

Clinical manifestations of disc Clinical manifestations of disc herniationherniation

Clinical manifestations of disc Clinical manifestations of disc herniationherniation

Leg pain caused by a Leg pain caused by a herniated discherniated disc

Usually occurs in only one leg.Usually occurs in only one leg.

May start suddenly or gradually.May start suddenly or gradually.

May be constant or may come May be constant or may come and go (intermittent).and go (intermittent).

May get worse ("shooting pain") May get worse ("shooting pain") when sneezing, coughing, or when sneezing, coughing, or straining to pass stools.straining to pass stools.

Leg pain caused by a herniated Leg pain caused by a herniated discdisc

(cont…)(cont…) May be May be aggravatedaggravated by sitting, by sitting,

prolonged standing, and prolonged standing, and bending or twisting movements.bending or twisting movements.

May be May be relievedrelieved by walking, by walking, lying down, and other positions lying down, and other positions that relax the spine and that relax the spine and decrease pressure on the decrease pressure on the damaged disc.damaged disc.

Clinical manifestations of disc Clinical manifestations of disc herniationherniation

Nerve-related symptoms caused by Nerve-related symptoms caused by a herniated disc include:a herniated disc include:

TinglingTingling ("pins-and-needles" sensation) ("pins-and-needles" sensation) or numbness in one leg that can begin or numbness in one leg that can begin in the buttock or behind the knee and in the buttock or behind the knee and extend to the thigh, ankle, or foot. extend to the thigh, ankle, or foot.

WeaknessWeakness in certain muscles in one or in certain muscles in one or both legs.both legs.

PainPain in the front of the thigh. in the front of the thigh. caudacauda equina syndrome equina syndrome

Diagnostic studiesDiagnostic studies MRI is the test of choice for MRI is the test of choice for

evaluation of disc disease. evaluation of disc disease. Its Its multiplanarmultiplanar capabilities capabilities make it suitable for make it suitable for visualizing far lateral disc visualizing far lateral disc herniationherniation as well as the as well as the paravertebralparavertebral structures. structures.

Management of disc Management of disc herniationherniation The medical management traditionally The medical management traditionally

involves:involves: BedBed rest and analgesics and anti- rest and analgesics and anti-

inflammatory drugs.inflammatory drugs. MuscleMuscle relaxants help in some. relaxants help in some.

Transcutaneous electrical nerve Transcutaneous electrical nerve stimulation (TENS) helps in about 20% of stimulation (TENS) helps in about 20% of patients.patients.

PhysicalPhysical therapy such as (exercise, therapy such as (exercise, relaxation, massage, and hot relaxation, massage, and hot compressors).compressors).

Management of disc Management of disc herniationherniation

Surgical management:Surgical management:Indications for surgery include Indications for surgery include

failure of acceptable pain control failure of acceptable pain control by nonoperative measures, by nonoperative measures, progressive neurological deficit. progressive neurological deficit. The traditional approach to The traditional approach to lumbar discectomy lumbar discectomy ((laminectomylaminectomy) usually under ) usually under general anesthesia. general anesthesia.

Nursing interventionNursing interventionReducing painReducing pain Bed restBed rest Comfortable position such as semi-Comfortable position such as semi-

fowler's with moderate hip and knee fowler's with moderate hip and knee flexion or side lying position.flexion or side lying position.

Progressive ambulationProgressive ambulationPatient's educationPatient's education ExerciseExercise Proper positionProper position Avoid liftingAvoid lifting