Herniation of intervertebral disk

Introduction; intervertebral discs are fibrous pads between

vertebrae ,during which a nucleus pulposus is displaced from
intervertebral space and acts as a shock absorbers .These discs are
made up of jelly like substance and acts cushions for spine A
herniated discs occurs part of disc is forced through a weakened
part of the spine. The lower back is most commonly affected by
herniated discs.
Definition;
An abnormal condition or process in which an organ or
other tissue protrudes through an opening as in the organs
surrounding walls or some other narrow space.
Stages of disc herniation
There are 4 stages of disc herniation are there as follows
1) Disc degeneration; chemical changes associated with aging
causes discs to weaken but without herniation.
2) Prolapse; the form or position of the discs changes with some
slight impingement into the spinal canala so called a bulg or
protrusion.
3) Extrusion; the gel like nucleus pulposes breaks through the
annulus fibrosis but remains with in the disc.
 4) Sequestration or sequestered disc ; the nucleus pulpusus breaks
through the annulus fibrosus and lies outside the disc in spinal
canal.
Causes /etiology
1) Congenital spinal stenosis (congenital degenerative
trauma 75% of cases occur in the low back pain)
2) Infection; TB, abscess
3) Trauma ; vertebral body fracture or facet joint dislocation
4) Inflammatory disorders Rheumatoid arthritis
5) Disc and vertebral lesion
6) Vascular ; epidural and subdural hemorrhage
7) Tumors
Others causes
1) aging process (most common cause)
2)bone and joint enlargement
3) spondylolisthesis
4) bone spurs
5) prolapsed disc may sometimes caused by a sudden
strenuous action
6) smoking
7) A disc prolapse is slightly more common in men than in
women
Symptoms;
1) Pain where the nerve is compressed
2) Pain will begin radiating along the path of the
compressed nerve down the buttocks and hips into the legs
3) whatever the nerve compressed will begin to malfunction
numbness and tingling in the feet or loss of strength in the
legs and hands.
4) In rare cases pressure is exerted on the spinal cord it self
sometimes leading to paralysis of the legs and loss of bladder
or bowel control.
Diagnostic evaluation;
1)complete history and detailed physical examination
2) X-ray of neck and back
3) MRI
4) CT scan 5) Nerve studies Management/ Treatment
In most cases symptoms are relived by bed rest specially
(lying down position of most comfort on a firm mattress for
several days) and NSAIDS analgesics (aspirin) .Recovery
occurs as the protruding material dies and wether away
while the ruptured annulus fibsrosis heals over a period of 6-
8 weeks.
2) The physical thearapy also helpful and may include
-Heat ,Traction, massage, mobilization(small
rhythmic oscillation) special exercises.
3) Also prescription of a supportive brace or neck collar
which is helpful for disc prolapses in the neck.
4) An epidural injection of local anaesthetic (with or
without cortisone) may be recommened to relive sciatica
allow earlier physical therapy and help prevent adhesions of
the nerves.
5) It is useful in about 70% of cases allowing earlier
recovery and return to work.
6) The injection may need to be repeated once or twice. If
unsuccessful another type of epidural may be performed
undernx-ray control called a transforaminal epidural
injection.
7) Occasionally if the sciatic pain is persistent and severe or
if there is muscle weakness and reflex changes or if the
bladder or bowel function is impaired surgery may be needed
8) The long term outcome of surgery versus conservative
treatment is about the same.
9) In principle the smaller the operation the better.
Surgical Management;
1) Chymopapain injection ; an injection of enzyme material
into the disc nucleus to shrink the disc.
2) Discectomy ; when just the prolapsed portion of disc is
removed either by laser or open operation.
3) Laminectomy ; disectomy plus part of the posterior bony
part of the spinal canal is removed to allow extra room or
space for the compressed nerve.
Nurses responsibilites
1) Assess the general condition of client
2) Check the vital signs
3) Assess the level and characterstics of pain
4) Provide proper back care and skin care to the client
5) Advice client to do proper exercise
6) Provide adequate nutrion
Nursing diagnosis
1) Acute pain r/t compression of nerve as evidenced by
visual analogue scale
2) Risk for trauma r/t weakness of vertebral column.
3) Anxiety r/t situational crisis
4) Disturbed body image r/t postural deformity
5) Deficent knowledge r/t impending surgery.