Herniation of intervertbal disk

1. HERNIATION OF A
INTERVERTEBRAL DISC
Mr. ANILKUMAR BR . Ms.c Nursing
Lecturer (Medical-surgical Nursing )

2. INTRODUCTION
• THE CERVICAL SPINE IS SUBJECTED TO STRESSES THAT
RESULT FROM DISK DEGENERATION (FROM AGING,
OCCUPATIONAL STRESSES) AND SPONDYLOSIS
(DEGENERATIVE CHANGES OCCURRING IN DISK AND
ADJACENT VERTEBRAL BODIES).
• CERVICAL DISK DEGENERATION MAY LEAD TO LESIONS
THAT CAN CAUSE DAMAGE TO THE SPINAL CORD AND
ITS ROOTS.

3. DEFINITION
• Herniation of the intervertebral disk is a protrusion of
the nucleus of the disk into the annulus. ( Fibrous ring
around the disk) with subsequent nerve compression.
• The herniation may occur in any proton of the
vertebral column. The pressure on spinal nerve roots
or the spinal cord causes severe , chronic, or recurrent
back and leg pain.

4. HERNIATION OF A
INTERVERTEBRAL DISC

5. HERNIATION OF A
INTERVERTEBRAL DISC

6. ETIOPATHOPHYSILOGY
a) About 90 % of herniated disks involve the lumber and
lumbosacral spine. The most common site is the L4
& L5 disk space.
a) The cause of a herniated lumber disk is usually a
flexion injury, but many patients do not recall
experiencing a traumatic event.

7. RISK FACTORS FOR HERNIATION INCLUDE:
1. Degeneration (ageing) , TRAUMA, & CONGENITAL
PREDISPOSTION
2. Biochemical factors, such as twisting and repetitive motions
in occupational settings.
3. Sedentary occupations
4. Obesity
5. Smoking
C) The herniation compress the spinal nerve root, usually restricted
to one side and, with further degeneration of the disk, may
eventually produce pressure on the spinal cord.
D) This sequence may take months to years , producing acute and
chronic symptoms.

8. CLINICAL MANIFESTATIONS
• GENERAL CONSIDERATIONS:
1. An intervertebral disk may herniate without causing
symptoms.
2. Symptoms depend on location, size, rate of
development and effect of surrounding structure.
3. Most of symptomatic disk herniations result in pain ,
sensory changes, loss of reflex, and muscle
weakness that resolve without surgery.

9. CERVICAL MANIFESTATIONS
1. Pain and stiffness in the neck. Top of shoulders, and
region of scapula.
2. Pain in upper extremities and head.
3. Paresthesias ((tingling or a “pins and needles”
sensation) and numbness of upper extremities.
4. Weakness of upper extremities.

10. LUMBER MANIFESTATIONS
1. Lower back pain with varying degree of sensory and motor
dysfunction.
2. Pain radiating the lower back into the buttocks and down the
leg, referred to as sciatica.
3. A stiff or unnatural posture
4. Some combination of paresthesias, weakness, and reflux
impairment.

11. DIAGNOSTIC EVALUATIONS
1. CERVICAL CT AND MRI USUALLY CONFIRMS THE
DIAGNOSIS.
2. ELECTROMYOGRAPHY
3. MYELOGRAM

12. MEDICAL MANAGEMENT
• THE GOALS OF TREATMENT ARE:
(1) to rest and immobilize the cervical spine to give the
soft tissues time to heal and
(2) to reduce inflammation in the supporting tissues and
the affected nerve roots in the cervical spine.

13. NON PHARMACOLOGICAL TREATMENT
1. Bed rest on firm mattress ( 2 days usually sufficient )
usually results improvement in 80% of clients.
2. Heat or ice massage to affected area.
3. Cervical collar or possibly cervical traction are widely
used although efficacy is not proven.
4. Physical therapy
5. Epidural steroid injection may be administered.

14. PHARMACOTHERAPY
1. Anti inflammatory drugs such as ibuprofen or
prednisone
2. Muscle relaxants such as diazepam or
cyclobenzaprine.
3. Analgesics,opioids may be necessary for several
days during acute phase.

15. SURGICAL MANAGEMENT
• Surgical excision of the herniated disk may be
necessary when there is a significant neurologic deficit,
progression of the deficit, evidence of cord
compression, or pain that either worsens or fails to
improve.

16. 1. Discectomy ( decompresssion of nerve root)
2. Laminectomy
3. Spinal fusion
4. Microdiscectomy
5. Percutaneous Discectomy
SURGICAL MANAGEMENT

17. ALTERNATIVE AND COMPLIMENTARY TRETMENTS
1. Acupuncture
2. Manipulative therapy
3. Massage therapy for adjunct pain relief
4. Homeopathic remedies
5. Various nutritional supplements

18. COMPLICATIONS
1. Permanent neurologic dysfunction ( weakness &
numbness)
2. Chronic pain with associated psychosocial issue
3. Cauda equina Syndrome (cauda equina syndrome is a
rare disorder that usually is a surgical emergency. In
patients with cauda equina syndrome, something
compresses on the spinal nerve roots. You may need fast
treatment to prevent lasting damage leading to
incontinence and possibly permanent paralysis of the
legs.

19. Nursing assessment client with Herniation of a
intervertebral disc
1. The patient is asked about past injuries to the neck (whiplash)
because unresolved trauma may cause persistent discomfort, and
tenderness, and symptoms of arthritis in the injured joint o the
cervical spine.
2. Perform repeated assessment of motor function, sensation,
weakness, reflex to determine severity of the condition.
3. Assess pain level includes determining the onset location, an
radiation of pain, paresthesias, limited movement and diminished
function of the neck, shoulders, and upper extremities with the help
of pain scale 0 to 10.

20. NURSING DIAGNOSIS
1. Acute pain related to area of compression.
2. Impaired physical mobility related to pain and
disease physiology.
3. Deficient knowledge related to impeding surgery.
4. Risk for injury related to surgical procedure.

21. CLIENT EDUCATION AND HEALTH MAINTENANCE
1. Educate the client regarding lifestyle changes – smoking
cessation, increase activity and weight loss.
2. Provide instructions regarding back anatomy and physiology.
3. Teach the patient about importance of cervical collar use
and other methods.
4. Teach about proper body mechanics
5. Tell the client to avoid the prone position, long car rides and
sitting in a soft chair.
6. Encourage good nutrition's avoidance of obesity and proper
rest to reduce risk of recurrence.