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    Herniated Nucleus Pulposus (HNP)

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    Kaye
    Herniated nucleus pulposus, also known as a slipped disc, occurs when the soft gel-like center of an intervertebral disc ruptures through the surrounding disc wall. It most commonly affects the lower back but can occur in the neck as well. Symptoms depend on the location but may include pain, numbness, weakness and tingling. Diagnosis involves imaging tests like MRI or CT scans. Treatment focuses on reducing inflammation and pressure on nerves through rest, medications, physical therapy and sometimes surgery to remove the protruding disc material.

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    Herniated Nucleus Pulposus (HNP)

    Uploaded by

    Kaye
    93 views21 pages
    Herniated nucleus pulposus, also known as a slipped disc, occurs when the soft gel-like center of an intervertebral disc ruptures through the surrounding disc wall. It most commonly affects the lower back but can occur in the neck as well. Symptoms depend on the location but may include pain, numbness, weakness and tingling. Diagnosis involves imaging tests like MRI or CT scans. Treatment focuses on reducing inflammation and pressure on nerves through rest, medications, physical therapy and sometimes surgery to remove the protruding disc material.

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    Herniated nucleus pulposus, also known as a slipped disc, occurs when the soft gel-like center of an intervertebral disc ruptures through the surrounding disc wall. It most commonly affects the lower back but can occur in the neck as well. Symptoms depend on the location but may include pain, numbness, weakness and tingling. Diagnosis involves imaging tests like MRI or CT scans. Treatment focuses on reducing inflammation and pressure on nerves through rest, medications, physical therapy and sometimes surgery to remove the protruding disc material.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    93 views21 pages

    Herniated Nucleus Pulposus (HNP)

    Uploaded by

    Kaye
    Herniated nucleus pulposus, also known as a slipped disc, occurs when the soft gel-like center of an intervertebral disc ruptures through the surrounding disc wall. It most commonly affects the lower back but can occur in the neck as well. Symptoms depend on the location but may include pain, numbness, weakness and tingling. Diagnosis involves imaging tests like MRI or CT scans. Treatment focuses on reducing inflammation and pressure on nerves through rest, medications, physical therapy and sometimes surgery to remove the protruding disc material.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 21

    Herniated Nucleus

    Pulposus (HNP)

    Kristine Anne Liwanag


    Alternative names

     Lumbar radiculopathy
     Cervical radiculopathy
     Herniated intervertebral disc
     Prolapsed intervertebral disc
     Slipped disc
     Ruptured disc
    Overview
     Intervertebral discs are shock-absorbing pads
    between the bones of the spine.
     may split or rupture which can cause the disk
    to fail
     cause pressure on the spinal cord or on a
    single nerve fiber and cause pain
     low back but any disc can rupture
    Defined
     It is the rupture of the intervertebral disc.
     It involves the portrusion of

    nucleus pulopsus (central part


    of the intervertebral disc) into
    the spine causing compression
    of spinal nerves
     4th and 5th intervertebral disc

    in the lumbar region are most


    commonly affected
     Cross-section
    picture of
    herniated disc
    between L4 and
    L5
    Predisposing factors

     Heavy lifting or pulling and trauma


     Degeneration of intervertebral disc
     Congenital predisposition
    Lumbar area
     Most herniation takes place
     Occurs 15 times more often that cervical
    (neck) disc herniation
     In is the most common causes of lower back
    pain
    Cervical discs
     8% of the time and the upper-to-mid-back
    (thoracic) discs only 1-3% of the time
     Nerve roots may become compressed
    resulting in neurologic symptoms such as
    sensory or motor changes
    pathophysiology

    Rupture of the intervertebral disc

    Protrusion of the nucleus pulosus

    Compression of the spinal nerve


    Clinical Manifestations
     Lumbar Disc
     Back pain radiating
    across the buttocks and
    down the leg (along the
    sciatic nerve)
     Weakness of leg and foot
    on affected leg
     Numbness and tingling in
    toes
     Positive straight leg raise
    test (Lasegue’s sign)
    Clinical manifestation
     Lumbar disc
     Depressed or absent
    Achilles reflex
     tapped while the foot is
    dorsi-flexed. A positive
    result would be the
    jerking of the foot
    towards its plantar
    surface.
     Muscle spasm in lumbar
    region
    Clinical Manifestations
     Cervical region
     Shoulder pain radiating down the arm to hand
     Weakness of affected extremity
     Parasthesias - feeling of "pins and needles"
     Sensory disturbances
    Diagnostics
     Myelogram – determine size and location of
    disc herniation
     CT scan or MRI; MRI has greater sensitivity
     Will show spinal canal herniation
     Spine x-ray – rule out other causes of back or
    neck pain
    Collaborative Management
     Bed rest on firm
    mattress with bed
    board
     Traction (pelvic
    traction)
     Drug therapy
     Anti-inflammatory
     Muscle relaxants
     Analgesics
    Collaborative Management
     Local application of heat and diathermy
     Diathermy - the heating of body tissues due to
    their resistance to the passage of high-frequency
    electromagnetic radiation, electric current, or
    ultrasonic waves
     Use of corset for lumbosacral disc; cervical
    collar for the cervical disc
     Steroids
     Prevent complications of immobility
    Surgical Management
     Chemonucleolysis – less common
    invasive treatment for lumbar disc herniation
     Chymopapain (Chymodiactin) into disc to
    reduce size and pressure on affected nerve
    root.
     Used as alternative to laminectomy in
    selected cases. May cause severe
    complications such as transverse myelitis,
    allergic reactions, persistent muscle spasm.
    chemonucleolysis
     Pre – op care for patient receiving chemonucleolysis
     Cimetidine (Tagamet).
     Diphenhydramine HCI (Benadry) q 6 hrs. to prevent allergic
    reaction
     Corticosteroids before procedure.
     Post – op care for patient receiving
    chemonucleolysis
     Observe for anaphylaxis.
     Observe for less serious allergic reaction.
     Monitor for neurologic deficits (numbness or tingling in
    extremities or inability to void)
    Laminectomy
     Surgical excision of a part of the posterior
    arch of vertebra and removal of portruded
    disc
     relieve compression of spinal nerves
    Laminectomy
     Post-op
     Lower spinal surgery (lumbar) : flat position.
     Cervical spinal surgery: slight elevation of head of bed.
     Maintain proper body alignment.
     For cervical spinal surgery: avoid flexion of neck and apply
    cervical collar.
     Turn patient every 2 hrs.
     Use log rolling technique or Stryker frame.

     Put small pillow under the head and 2 pillows between legs
    while on side. To take pressure off lower back.
    Spinal Fusion
     Fusion of spinous processes with bone graft
    from iliac crest to pro. stabilization of spine.
     Nursing Interventions
     Pre - op care (same as laminectomy).
     Post - op care
     Position: lower spinal fusion - keep bed flat for first 12
    hours, may elevate HOB (head of bed) 20° - 30°; keep
    off back for the first 48 hours.
     Cervical spinal fusion - elevates HOB slightly; assist
    with ambulation.
    Spinal Fusion
     Usually OOB (out of bed) 3 - 4 post - op days; apply
    brace before OOB; apply special cervical collar for
    cervical fusion.
     Promote comfort - the client may have considerable
    pain from graft site.
     Advise client that brace will be needed for 4 months
    and lighter corset for 1 year after surgery.
     It takes 1 year for the graft to become stable.
     No bending, stooping, lifting, or sitting for prolonged
    periods for 4 months.
     Walking without excessive tiring is good; diet modification
    will help prevent weight gain from decreased activity.

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