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1. TOPIC-HE R NI A TION OF A INTE R VE R TEBRAL DISC PRSENTED BY- SHREYA YADAV NURSING TUTOR

2.  Is a hydrostatic, load bearing structure between the vertebral bodies from C2-3 to L5-S1 . Nucleus pulposus + annulus fibrosus Is relatively avascular. L4-5, largest avascular structure in the body.

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6. Vital Functions of the IVD Restricted intervertebral joint motion Contribution to stability Resistance to axial, rotational, and bending load Preservation of anatomic relationship

7. Is a medical condition affecting the spine in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out beyond the damaged outer rings.

8. posterolateral disc herniation – protrusion is usually posterolateral into vertebral canal, compress the roots of a spinal nerve. protruded disc usually compresses next lower nerve as that nerve crosses level of disc in its path to its foramen. (eg.protrusion of fifth lumbar disc usually affects S1 instead. central (posterior) herniation: less frequently, a protruded disc above second lumbar vertebra may compress spinal cord itself lateral disc herniation: may compress the nerve root above the level of the herniation L4 nerve root is most often involved & patient typically have intense radicular pain. TYPES OF HERNIATION

9. Repetitive mechanical activities – Frequent bending, twisting, lifting, and other similar activities without breaks and proper stretching can leave the discs damaged. Living a sedentary lifestyle – Individuals who rarely if ever engage in physical activity are more prone to herniated discs because the muscles that support the back and neck weaken, which increases strain on the spine. Traumatic injury to lumbar discs- commonly occurs when lifting while bent at the waist, rather than lifting with the legs while the back is straight. C A U S E S

10. Obesity – Spinal degeneration can be quickened as a result of the burden of supporting excess body fat. Practicing poor posture – Improper spinal alignment while sitting, standing, or lying down strains the back and neck. Tobacco abuse – The chemicals commonly found in cigarettes can interfere with the disc’s ability to absorb nutrients, which results in the weakening of the disc. C A U S E S

11. NORMAL DISC HERNIATED DISC

12. symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. Herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees, or feet Pain Paresthisia

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

14. LUMBER MANIFESTATIONS Lower back pain with varying degree of sensory and motor dysfunction. 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 .

15. Location The majority of spinal disc herniation cases occur in lumbar region (95% in L4-L5 or L5-S1). The second most common site is the cervical region (C5-C6, C6- C7). The thoracic region accounts for only 0.15% to 4.0% of cases.

16. Diagnosis is based on the history, symptoms, and physical examination. D I A G N O S I S

17. X-Ray : lumbo-sacral spine; Narrowed disc spaces. Loss of lumber lordosis. Compensatory scoliosis. CT scan lumber spine; It can show the shape and size of the spinal canal, its contents, and the structures around it, including soft tissues. Bulging out disc. MRI lumber spine; Intervertebral disc protrusion. Compression of nerve root.

18. NARROWED SPACE BETWEEN L5 AND S1 VERTEBRAE, INDICATING PROBABLE PROLAPSED INTERVERTEBRAL DISC - A CLASSIC PICTURE

19. TREATMENT OPTIONS Pain medications. Bed rest Oral steroids . Surgery

20. Indicated treatment . Non-steroidal anti-inflammatory drugs (NSAIDs). Eg- Aspirin, Ibuprofen Oral steroids (e.g. prednisone or methylprednisolone). Benzodiazepines( lowerdose) Epidural cortisone injection.

21. Physical therapy include modalities to temporarily relieve pain (i.e. traction, electrical stimulation massage). Patient education on proper body mechanics. Weight control. Tobacco cessation. Lumbosacral back support. TREATMENT

22. surgery Surgery is generally considered only as a last resort, or if a patient has a significant neurological deficit .

23. INTRADISCAL ELECTROTHERMIC THERAPY (IDET) h e a t s  It is a fairly advanced procedure in which electrothermal catheter is inserted to the intervertebral disc the posterior annulus of the disk, causing contraction of collagen fibers  IDET is a minimally invasive outpatient surgical procedure developed over the last few years to treat patients with chronic low back pain that is caused by tears or small herniations of their lumbar discs.

24. NUCLEOPLASTY  Nucleoplasty is the most advanced form of percutaneous discectomy developed to date.  Tissue removal from the nucleus acts to “decompress” the disc and relieve the pressure exerted by the disc on the nearby nerve root

25. DISCECTOMY/MICRODISCECTOMY -  This procedure is used to remove part of an intervertebral disc that is compressing the spinal cord or a nerve root .

26. DISC ARTHROPLASTY Artificial Disc Replacement (ADR), or Total Disc Replacement (TDR), is a type of arthroplasty. It is a surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial devices in the lumbar (lower) or cervical (upper) spine. Used for cases of cervical disc herniation

27.  Assessment determining the onset, location, and radiation of pain, paresthesias , limited movement, diminished function of the neck, shoulders, and upper extremities NURSING MANAGEMENT

28.  explanations about the surgery and reassurance that surgery will not weaken the back.  Preoperative assessment also includes an evaluation of movement of the extremities as well as bladder and bowel function  To facilitate the postoperative turning procedure, the patient is taught to turn as a unit (called logrolling)  Encouraged to take deep breaths, cough PROVIDING PREOPERATIVE CARE

29.  Vital signs are checked frequently and the wound is inspected for hemorrhage  IV morphine -24-48  Sensation and motor strength of the lower extremities are evaluated at specified intervals, along with the color and temperature of the legs and sensation of the toes.  Assess for CSF leakage ASSESSING THE PATIENT AFTER SURGERY

30.  Assess for paralytic ileus  Assess for urinary retention

31. -Educate the client regarding lifestyle changes – smoking cessation, increase activity and weight loss . - Provide instructions regarding back anatomy and physiology. - Teach the patient about importance of cervical collar use and other methods. - Teach about proper body mechanics - Tell the client to avoid the prone position, long car rides an si tting in a soft chair. CLIEN T EDU C A TION AND HEA L TH MAINTENANCE

32.  Acute pain related to the surgical procedure Nursing Interventions The patient may be kept flat in bed for 12 to 24 hours in cervical surgery Pillow is placed under the head and the knee rest is elevated slightly to relax the back muscles( cervical surgery) Extreme knee flexion must be avoided Administering the prescribed postoperative analgesic agent, positioning for comfort, and reassuring the patient that the pain can be relieved. NURSING DIAGNOSIS

33. Impaired physical mobility related to the postoperative surgical regimen Nursing interventions provide cervical collar cervical collar provide L-S binders  The neck should be kept in a neutral(midline) position  Patients are assisted during position changes(log rolling )

34.  Deficient knowledge about the postoperative course and home care management INTERVENTIONS A cervical collar is usually worn for about 6 weeks. Instructed about strategies for pain management and about signs and symptoms of complications The nurse assesses the patient’s understanding of these management strategies advised to avoid heavy work for 2 to 3 months after surgery. Exercises are prescribed to strengthen the abdominal and erector spinal muscles

35.  Avoid sitting/standing for prolonged periods  Avoid twisting movements  Regular follow up