Herniated Nucleus Pulposus

I.

Definition
It is a slipped disk along the spinal cord. The condition occurs when all or part of the center of a spinal disk is forced through a weakened part of the disk.

II.

Anatomy & Physiology

The normal anatomy of the spine is divided into the cervical, thoracic, and lumbar spine. Each of these sections are divided into individuals bones called vertebrae. The cervical spine consist of 7, thoracic of 12, and lumbar of 5. The intervertebral discs are fibrocartilaginous cushions that serve the shock absorbing system of the spine, protecting the vertebrae, brain, and others. The discs allow for extension and flexion. The body of the vertebrae is the primary area of weight bearing and provides a resting place for the fibrous discs, separating each of the vertebrae. The spinous process is the bone felt when running the hands down the spine. The transverse process are oriented 90 degrees to the spinous process and provides for attachment for the back muscles. The annulus is a strong radial tire-like structure that is made up of lamellae; concentric sheets of collagen fibers connected to the vertebral end plates. They enclose the nucleus pulposus. The nucleus pulposus contains a hydrated gel-like matter that resist compression.

III.

Causative Organisim / Causes

The disks herniate due to a trauma or strain. Brought about by a car accident or lifting a very heavy object.

IV.

Other Name
Herniated disk Lumbar radiculopathy Cervical radiculopathy Herniated intervertebral disk Prolapsed intervertebral disk Slipped disk Ruptured disk

V.

Predisposing factors
Middle to older-aged men Involved in strenuous physical activity Congenital conditions that affect the size of the lumbar spinal cord

Congenital Injury/trauma

VI.

Signs and symptoms Does not result any signs/symptoms. Only when nearby nerve/spinal cord is ampinged. Is there an arousal. It is very much possible that one more herniated disc is present, but there is no nerve compression when nerve compression occurs the symptoms include the following: Chronic pain Pain Traveling length of nerve Numbness Weakness Tingling Loss of reflex

VII.

Any direct, forceful vertical pressure on lumbar disc can result in fluid contents being pushed on lumbar disc can result in fluid contents being pushed vertebral body. And may occur suddenly from lifting, twisting, or direct injury or gradually because of degenerative changes, as an individual ages intervertebral disc change shape volume. Chemical and mechanical changes the occur to disc as well The annulus may become weak overtime, resulting stretching/tearing thus leading herniation Depending on location of herniation, the herniated material can also press directly on nerve roots on the spinal cord, causing a shock-like pain, sciatica, down the legs, weakness, numbness, problems with bowels, bladder, or sexual function Muscle spasms Muscle weakness (Atrophy ) Spasms or neck muscles Pain radiating buttocks leg, feet Pain that worsens when coughing, straining, or laughing Severe low back pain Diagnostic Procedure Nerve conducting test Straight-leg raising test

 VIII.

If (+) pain back of leg it may suggest lumbar nerve root problems Crossed straight leg raising test; suggest more localized less severe pain X-ray shows structural changes lumbar spine Computed tomography Reveals details of pathology Magnetic resonance imaging Detect early stages disc aging degeneration Myelography Special x-ray which dye/air is injected into spinal canal Medical Management
Conservative management

Rest, ice, massage Position of neck comfort essential for pain relief Changes in work area to prevent fatigue Cervical Traction Traction on the head can reduce pressure on affected nerve root Head halter traction Cervical collar Shuntz collar brace Philadelphia collar brace Pelvic girdle traction

IX.

Surgical Management Disectomy with/without fusion Anterior approach Orthopedic surgeons Best for central or peri-herniation Posterior approach Shorter, smaller approach, hemilaminectomy No bone graft necessary Indicated for far lateral disk heniation

X. Nursing Management 1) Reduce back stress, muscle spasms, and stress

2) 3) 4) 5)

Promote optimal functioning Support patient in rehabilitation process Provide information concerning condition/prognosis treatment needs Discharge plan projected length in patient stay 49-65days. May require assistance with transport, self-care, and homecare

Prepared by:
Don Dexter C. Camiloza Danna Lynn P. Carreon
BSN III-1, Group 1