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TORRES, Joana Marie R. BSN 208 Group 32ZAMORAS, Stephany M. Christopher Evangelista

Herniated Nucleus Pulposus- A herniated nucleus pulposus is a slipped disk along the spinal cord. The condition occurswhen 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 orannulus 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 diskherniation occurs 15 times more often than cervical (neck) disk herniation, and it is one of themost common causes of lower back pain. The cervical disks are affected 8% of the time and theupper-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)

Types1. 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 Manifestations1. 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) usuallyassociated 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

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The pain often starts slowly. It may get worse:

y After standing or sittingy At nighty When sneezing, coughing, or laughingy When bending backwards or walking more than a few yards, especially if it is caused by

spinal stenosis

* Positive Straight-Leg Raising Testa. Patient in supine positionb. Raise leg with knee extendedc. Test is positive

c.1. If pain occurs in leg below and knee orc.2. If radicular (spinal nerve root pain ensues)

Diagnostic Exam1. 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 InterventionCervical Disc Herniations

Immobilize and Rest the Cervical Spinea. 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 vertebralseparation and thus relieves pressure on the nerve roots.d. Brace For proper body alignment and to prevent fatigue.

Reduce Inflammationa. Anti-inflammatory medicationsb. Muscle Relaxantc. Analgesics and Sedativesd. Apply moist hot compress (10-20 min several times daily) to back of neck, to increaseblood flow to muscle and promote relaxation of the patient and spastic muscles.

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Lumbar Disc Herniations- Encourage to continually take prescribed muscle relaxant muscle.

Reducing Paino Bed Resto Assume comfortable and proper positiono Ambulate when inflammatory reaction and edema have subsided.o Heat compress and massage to relax muscle spasm.

Self-monitoring for Neurologic Deficito 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 Educationo 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 Complicationso Long-term back paino Loss of movement or sensation in the legs or feeto Loss of bowel and bladder functiono Permanent spinal cord injury (very rare)