Prolapsed intervertebral disc ppt slideshare

intervertebral disc prolapse

1. PROLAPSED INTERVERTERBRAL DISC Presented by: sonam

2. . Typical lumbar vertebrae have several features distinct from that of cervical or thoracic vertebrae Presence of a large vertebral body Spinus process is short and thick Articular facets, are markedly vertical Facets also have the unique feature of a curved articular surface. This is one feature that differentiates lumbar vertebrae to from thoracic

3. . L5 has the largest body and transverse process of all vertebrae. The anterior aspect of the body has a greater height compared to the posterior. This creates the lumbo sacral angle between the lumbar region of the vertebrae and the sacrum Due to the size of the intervertebral discs relative to the size of the vertebral body and the size and horizontal direction of the spinous process, the lumbar spine has the greatest degree of extension of the vertebral column

4. INTRODUCTION The spine is subjected to stresses that result from disc degeneration (due to aging, occupational stresses) and spondylosis ( degenerative changes occurring in a disk and adjacent vertebral bodies). disc degeneration may lead to lesions that can cause damage to the spinal cord and its roots.

5. . Lumbar disc herniation is a common low back disorder. A herniated disc is a displacement of disc material beyond the intervertebral disc space. This herniation process begins from failure in the innermost annulus rings and progresses radially outward. Also known as prolapsed disc.

6. EPIDEMIOLOGY The highest prevalence is among people aged 30- 50 years, with a male to female ratio of 2:1. The prevalence of symptomatic herniated lumbar disc is about 1-3% depending on age and gender. In people aged 25-55 years, about 95% of herniated discs occur at the lower lumbar spine (L 4 / L 5 and L 5 /S 1 level) . Herniation above this level is more common in people aged over 55 years. The second most common site is the cervical region (C 5 -C 6 , C 6 –C 7 ) The thoracic region accounts for only 0.15% to 4.0% of cases

7. TYPES OF HERNIATION Posterolateral disc herniation Central (posterior) herniation Lateral disc herniation

8. RISK FACTORS Age: 35 to 50 years Gender

9. . Physically demanding work Pulling, pushing and twisting actions Family history Trauma

10. STAGES OF HERNIATION Bulging Protrusion Extrusion Sequestration

11. PATHOPHYSIOLOGY

12. . With aging, vascular channels start to fail and vascular diffusion of nutrients decrease thus number of viable chondrocytes in the nucleus pulposus diminishes Synthesis rate and concentration of proteoglycans decreases and proportion of collagen increase in nucleus pulposus Water binding capacity of the nucleus decreases Nucleus becomes more fibrous and stiffer Nucleus is less able to bear and disburse load, transforming load to the posterior annulus

13. CLINICAL MANIFESTATION Pain Radiating pain Pain, accompanied by paresthesia (numbness, tingling, or a pins and needles sensation)

14. . Slow, debilitating tip toe walking Atrophy and weakness Loss of bladder and bowel control Muscle spasm

15. . Lhermitte’s syndrome- herniation of the disk centrally onto the spinal cord, an electric like shock sensation in the extremities or spine with neck flexion or straining and bilateral arm and leg weakness (myelopathy)

16. DIAGNOSTIC FINDINGS History collection Physical examination Neurological check: loss of sensation, such as numbness, and weakness in the leg and foot. The patient may be asked to walk normally and on tiptoes to check for a condition called foot drop, in which the muscles used to flex the ankles and toes are weakened. Reflexes may be slower than normal

17. . Vitals signs check Gait monitoring Lumbar spine area exam. If there is inflammation in the lumbar spine , the skin may appear abnormal or sensitive to touch

18. . X ray CT scan MRI Myelogram EMG

19. .

20. Uses of discography To evaluate equivocal abnormality seen on myelography, CT or MRI To isolate a symptomatic disc among multiple level abnormality To diagnose a lateral disc herniation To establish contained discogenic pain To select fusion levels To evaluate the previously operated spine

21. MEDICAL MANAGEMENT Rest and immobilize Proper positioning on a firm mattress The cervical pain may be rested and immobilized by a cervical collar, cervical traction or a brace. A collar allows maximal opening of the intervertebral foramina and holds the head in a neutral or slightly flexed position The patient may have to wear the collar 24 hours a day during the acute phase The skin under the collar is inspected for irritation After the patient is free of pain, cervical isometric exercises are started to strengthen the neck muscles

22. Log roll method

23. Pharmacological therapy Analgesic agent Sedative agent Muscle relaxants : cyclobenzaprine, methocarbamol, metaxalone to interrupt muscle spasm and to promote comfort Occasionally, a corticosteroid is injected into the epidural space for relief of radicular pain (spinal nerve root) Hot, moist compress (for 10 to 20 minutes) applied to the back of the neck several times daily to increase blood flow to the muscles and help relax the patient and reduce muscle spasm

24. Discectomy This procedure is used to remove part of an intervertebral disc that is compressing the spinal cord or a nerve root (1557) Lumbar Discectomy Surgery - YouTube

25. laminectomy Removes the lamina part to relieve spinal stenosis or nerve compression

26. Intradiscal electrothermic therapy (1557) Lumbar IDET (Intradiscal Electrothermal Therapy) Procedure - YouTube

27. 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 (1557) Nucleoplasty Animation – YouTube

28. Lumbar fusion Fusion surgery helps two or more bones grow together into one solid bone. Fusion cages are new devices, essentially hollow screws filled with bone graft, that help the bones of the spine heal together firmly Lumbar fusion is only indicated for recurrent lumbar disc herniations, not primary herniation (1557) Lumbar Fusion of L5 S1 Animation – YouTube

29. CHEMO NUCLEOLYSIS Chemo nucleolysis : chemonucleolysis is the term used to denote chemical destruction of nucleus pulposus (chemo+ nucleo+lysis ) This involves intradiscal injection of chymopapain which causes hydrolysis of the cementing protein of the nucleus pulposus This causes decrease in water binding capacity leading to reduction in size and drying of disc

30. 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 (1557) Disc replacement surgery for the back - YouTube

31. complication Cauda equina syndrome Chronic pain Permanent nerve injury Paralysis

32. NURSING MANAGEMENT Assess the patient for any past injuries to the neck because unresolved trauma can cause persistent discomfort, pain and tenderness and symptoms of arthritis in the injured joint of the cervical spine Assessment includes determining the onset, location, and radiation of pain Assess for paresthesia, limited movement and diminished function of neck, shoulders, and upper extremities It is important to determine whether the symptoms are bilateral, with large herniations, bilateral symptoms may be caused by cord complication Assess muscle tone, tenderness, and range of motion in neck and shoulders Assess mood and stress levels

33. Nursing diagnosis Acute pain related to compression of nerve as evidenced by visual analogue scale Risk for trauma related to temporary weakness of vertebral column, and changes in muscle coordination as evidenced by balancing difficulty and weakness verbalized by the patient

34. . Risk for constipation and urinary retention related to position postoperatively and pain in lower back operated site as evidenced by redness, and swelling in the near side of incision site Impaired physical mobility related to pain and radiculopathy as evidenced by severe pain during standing and walking and inability to move independently Deficient knowledge related to preoperative and postoperative management as evidenced by frequent questioning by patient and family members

35. PROGNOSIS Extruded disc, large herniations, sequestrations have a greater tendency to resolution than small herniations and disc bulges Recurrence of disc prolapse can be prevented by a proper exercise programme and avoidance of stress to the lower part of back

36. BIBLIOGRAPHY Brunner and suddharths . Textbook of medical and surgical nursing. 13th edition vol. I. .New delhi : reed elsevier india pvt. Ltd.; 2014. Pg. No. 580-596 Lewis. Medical surgical nursing. Assessment and management of clinical problems. Vol. I. 2015. New delhi . Elsevier pg. No. 461-493 Joyce M. Black and jane hokanson ; medical surgical nursing; volume 2, 8 th edition, reed elsevier , india pvt. https://www.physio-pedia.com/disc-herniation https://nurseslabscom/8-laminectomy-disc-surgery-nursing-care-plan/

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