TORRES, Joana Marie R.

BSN 208 – Group 32

ZAMORAS, Stephany M. Christopher Evangelista

Herniated Nucleus Pulposus

- A herniated nucleus pulposus is a slipped disk along the spinal cord. The condition occurs
when all or part of the soft center of a spinal disk is forced through a weakened part of the disk.
- Nucleus pulposus of an intervertebral disc protruded through the surrounding fibro-cartilage or
annulus fibrosus.
- Alternative Name: Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk;
Prolapsed intervertebral disk; Slipped disk; Ruptured disk

Causes:
- Repetitive Stress
- Trauma
- Falls
- Work Related
- Increase pressure in disc like in lifting activities, coughing, sneezing, bending/twisting activities

- Most herniation takes place in the lower back (lumbar area) of the spine. Lumbar disk
herniation occurs 15 times more often than cervical (neck) disk herniation, and it is one of the
most common causes of lower back pain. The cervical disks are affected 8% of the time and the
upper-to-mid-back (thoracic) disks only 1 - 2% of the time.
- L4 – L5, L5 – S1 and C5 – C6, C6 – C7 (most common levels of disc herniation)

Types
1. Bulging (Bulge) - Annulus is intact and disc convexity is beyond the vertebral margins.
2. Protrusion (Prolapse) - Nucleus pulposus protrudes thru the annulus defect.
3. Extrusion - Nucleus pulposus extends to PLL (posterior longitudinal ligament)
4. Sequestration - Nucleus pulposus is free in the spinal canal.
- Detach fragment of herniated material.

Clinical Manifestations
1. Cervical Disc
- Pain and stiffness in neck, top of shoulder and in region of scapula.
- Pain in upper extremities and head.
- Paresthesia (Abnormal skin sensations (as tingling, tickling, itching or burning) usually
associated with peripheral nerve damage) and numbness of upper extremities.

2. Lumbar Disc
- Low back pain accompanied by varying degrees of sensory and motor impairement.
- Pain radiating from the low back into the buttock and down the leg (Sciatica).
- Postural deformity of lumbar spine.
- Weakness and asymmetric reflexes.
- Sensory Loss
The pain often starts slowly. It may get worse:
 After standing or sitting
 At night
 When sneezing, coughing, or laughing
 When bending backwards or walking more than a few yards, especially if it is caused by
spinal stenosis

* Positive Straight-Leg Raising Test

a. Patient in supine position
b. Raise leg with knee extended
c. Test is positive
c.1. If pain occurs in leg below and knee or
c.2. If radicular (spinal nerve root pain ensues)

Diagnostic Exam
1. Spine x-ray may be done to rule out other causes of back or neck pain. However, it is not
possible to diagnose a herniated disk by spinal x-ray alone.
2. Spine MRI or Spine CT will show spinal canal compression by the herniated disk.
3. Electromyography may be done to determine the exact nerve root that is involved.
4. Nerve conduction velocity test may also be done.
5. Myelogram may be done to determine the size and location of disk herniation; demonstrate
area of pressure and localizes herniation of disc.

Nursing Intervention
Cervical Disc Herniations
 Immobilize and Rest the Cervical Spine
a. Bed Rest – To reduce inflammation and edema in soft tissues around disc, relieving
pressure on nerve roots, relieves cervical spine of supporting weight of head.
b. Cervical Collar – Allows maximum opening of intervertebral foramina.
c. Cervical Traction – Accomplished by Head Halter Traction, increases vertebral
separation and thus relieves pressure on the nerve roots.
d. Brace – For proper body alignment and to prevent fatigue.

 Reduce Inflammation
a. Anti-inflammatory medications
b. Muscle Relaxant
c. Analgesics and Sedatives
d. Apply moist hot compress (10-20 min several times daily) to back of neck, to increase
blood flow to muscle and promote relaxation of the patient and spastic muscles.
Lumbar Disc Herniations
- Encourage to continually take prescribed muscle relaxant muscle.

 Reducing Pain
o Bed Rest
o Assume comfortable and proper position
o Ambulate when inflammatory reaction and edema have subsided.
o Heat compress and massage to relax muscle spasm.

 Self-monitoring for Neurologic Deficit

o Diminishing or loss of neurologic function below level of disc, including loss of
bladder/bowel control.
o Unrelieved, acute pain.
o Muscle weakness and atrophy.

 Patient Education
o Exercises after acute symptoms subside.
o Sleep on side with knee and hips flexed.
o Avoid lifting until healing has taken place.
o Proper posture while standing, sitting and working.
o Carry out a weight control program.

Possible Complications
o Long-term back pain
o Loss of movement or sensation in the legs or feet
o Loss of bowel and bladder function
o Permanent spinal cord injury (very rare)