Scribd Logo
Upload

Welcome to Scribd!

  • 216 views

    Classical Disc Herniation by DR Anupreet Bassi

    Uploaded by

    dr_bassi
    This Presentation highlights a case of lumbar disc herniation causing leg symptoms / radiculopathy comparing it with other signs and symptoms with level of evidence. It later on deals with different diseases progressions and various treatments and success rates.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Classical Disc Herniation by DR Anupreet Bassi

    Uploaded by

    dr_bassi
    216 views17 pages
    This Presentation highlights a case of lumbar disc herniation causing leg symptoms / radiculopathy comparing it with other signs and symptoms with level of evidence. It later on deals with different diseases progressions and various treatments and success rates.

    Original Title

    Classical Disc Herniation by Dr Anupreet Bassi

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This Presentation highlights a case of lumbar disc herniation causing leg symptoms / radiculopathy comparing it with other signs and symptoms with level of evidence. It later on deals with different diseases progressions and various treatments and success rates.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    216 views17 pages

    Classical Disc Herniation by DR Anupreet Bassi

    Uploaded by

    dr_bassi
    This Presentation highlights a case of lumbar disc herniation causing leg symptoms / radiculopathy comparing it with other signs and symptoms with level of evidence. It later on deals with different diseases progressions and various treatments and success rates.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    You are on page 1of 17

    CLASSICAL DISC HERNIATION

    By Dr. Anupreet Bassi


    Director and Spine Consultant
    Dr J L Bassi Hospital and Research Institute
    Definition of Disc Herniation
    Localized displacement of disc
    material beyond the normal margins of
    the intervertebral disc space* resulting
    in pain, weakness, numbness or other
    neurological symptom in a myotomal
    or dermatomal distribution

    *Fardon DF, Milette PC, Combined Task Forces of the North American Spine Society ASoSR, American
    Society of N. Nomenclature and classification of lumbar disc pathology. Recommendations of the
    Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and
    American Society of Neuroradiology. Spine (Phila Pa 1976). Mar 1 2001;26(5):E93-E113
    CAUSES
     Degeneration
     Trauma
     Both minor and major
     Conn tissue
     Short pedicles
    Pathophysiology of acute disc
     Acute Disc Herniation

    Release of PG,Interlukin 6,nitrous oxide


    From NUC.PUL.

    Nerve root compression Chemical inflamation

    Chemical radiculitis

    PAIN
    XX 2750460
     40 Y F C/O Right leg pain (buttock to calf – Post.) with
    numbness in same area since 2.5 months after lifting
    weight
    SYMPTOMS
     Sudden pain when picking up heavy object- initially slight but
    worsens and can impair movement.
     Repeated attacks occur suddenly e.g. sneezing or coughing
     Pain after a prolonged sustained position
     Central or referred symptoms- not always clearly defined
     Proximal worse than distal
     Pain diminishes when lying down with knees supported or
    hanging in a specific position
     May have Cauda equina
    SIGNS
     Young, healthy patient
     Lateral tilt of the pelvis / List
     Increased lumbar lordosis
     Gluteal / calf area sensitive to palpation
     Protective muscle spasm
     Sitting, straining, driving, Valsalva,
    coughing and sneezing painful
     Decreased intervertebral movements
     Walking Limp
     Straight leg painful
    WHAT ARE THE RELEVANT
    QUESTIONS?
    Any Red Flags
    Aggravating / decreasing factors
    Other neurological manifestation
    Any systemic signs
    Comorbidities
    Occupation
    Family & Financial Hx
    Associated risk factors
    Examination
     Ambulation / Gait
     Local tenderness area
     Manual muscle power testing
     Sensory testing – 50 - 60 %
     Supine straight Leg Raise Test / Lasegue Test Level 1 Evidence
     Cross SLR
     Restricted ROM
     Reflex testing
     Cough Impulse
    Insufficient Evidence
     Femoral Nerve Stretch Test
     Gore Sign
     Bell Test
    When to get investigations done?
     X-ray
     MRI
     Myelography
     CT
     Electrodiagnostic study
     Post voidal residual urine volume scan
    Examination – Walking with limp, Power 5/5 SLR right positive 40
    degree (Braggard +ve) Spasm in glutei area, sens thigh, rest normal

    L3

    L4

    Right L5-S1 disc


    herniation
    Treatment
     In the absence of reliable evidence relating to the
    natural history of lumbar disc herniation with
    radiculopathy, it is the work group’s opinion that the
    majority of patients will improve independent of
    treatment. Disc herniations will often
    shrink/regress over time. Many, but not all, papers
    have demonstrated a clinical improvement with
    decreased size of disc herniations.

    North American Spine Society Guidelines 2012


    Multiple Treatments
    Main course of action
     Home Exercises mainly extension based
     Physiotherapy
     Local heat therapy
     Precautions
     NSAIDS – COX 2 vs Non Selec COX inhibitors
     Pregabalin / Gabapentin
     B-Complex
     Calcium / Vitamin E to decrease cramps
     Steroids
     TCAs
     Opioids
     TNF alpha inhibitors
    ADVICE
     Avoid sitting positions (driving or bathing)
     Sit with knees lower than hips and use lumbar cushion
     Avoid sustained positions
     Avoid rotation movements when picking up objects
     Avoid sudden, jerky movements (sporting activities)
     Do not pick up heavy objects
     Swimming is good exercise- strengthens erector spinae
     Wear a brace during activities which aggravate backache
     After significant strengthening exercises normal activities can be
    resumed
    3 Months passed – No Significant pain
    relief

    Block or Surgery
    • Significant pain with • Significant pain with
    conservative failure conservative and block failure
    3-6 months
    • Bowel / Bladder Involvement
    • Neurological deficit especially
    acute and significant

    You might also like