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DEFINITION
A herniated nucleus pulposus is a slipped disk along the spinal cord. The
condition occurs when all or part of the soft center of a spinal disk is forced through a
weakened part of the disk.
ALTERNATIVE NAMES
INCIDENT RATE
Most herniation takes place in the lower back (lumbar area) of the spine. Lumbar
disk herniation occurs 15 times more often than cervical (neck) disk herniation, and it is
one of the most common causes of lower back pain. The cervical disks are affected 8%
of the time and the upper-to-mid-back (thoracic) disks only 1 - 2% of the time.
Nerve roots (large nerves that branch out from the spinal cord) may become
compressed resulting in neurological symptoms, such as sensory or motor changes.
Disk herniation occurs more frequently in middle aged and older men, especially
those involved in strenuous physical activity. Other risk factors include any congenital
conditions that affect the size of the lumbar spinal canal.
RISK/PREDISPOSING FACTORS
MANIFESTATION
• Muscle spasm
• Muscle weakness or atrophy in later stages
• Pain radiating to the buttocks, legs, and feet
• Pain made worse with coughing, straining, or laughing
• Severe low back pain
• Tingling or numbness in legs or feet
SYMPTOMS OF HERNIATED CERVICAL DISK
TYPE/STAGE/CLASSIFICATION
Person who has sustained one disc herniation is statistically at increased risk for
experiencing another. There is an approximate 5% rate of recurrent disc herniation at
the same level, and a lesser incidence of new disc herniation at another level. Factors
involved may be weight related level of physical conditioning, work or behavioral habits.
Since these factors are typically the same after surgery, there is an increased risk of
herniated disc in this group, over the general population.
However, the good news is that the majority of disc herniations (90%) do not
require surgery, and will resolve with conservative, nonoperative treatment, without
significant long-term sequelae. Unfortunately, approximately 5% of patients with
herniated, degenerated discs will go on to experience symptomatic or severe and
incapacitating low back pain which significantly affects their life activities and work. This
unfortunate result is not always specifically the result of surgery. The causes of this
unremitting pain are not always clear or agreed on, and my be from several sources.
When this occurs, the prognosis is poor for returning to normal life activities regardless
of age.
• EMG may be done to determine the exact nerve root that is involved.
• Spine MRI or spine CT will show spinal canal compression by the herniated disk.
• Spine x-ray may be done to rule out other causes of back or neck pain. However,
it is not possible to diagnosis herniated disk by spinal x-ray alone
MANAGEMENT
The main treatment for a herniated disk is a short period of rest with pain and
anti-inflammatory medications, followed by physical therapy. Most people who follow
these treatments will recover and return to their normal activities. A small number of
people need to have further treatment, which may include steroid injections or surgery.
MEDICATIONS
SURGERY
NURSING DIAGNOSIS
ILLUSTRATIONS
Skeletal Spine
Sciatic Nerve
The main nerve traveling down the leg is the sciatic nerve. Pain
associated with the sciatic nerve usually originates higher along the spinal
cord when nerve roots become compressed or damaged from narrowing
of the vertebral column or from a slipped disk. Symptoms can include
tingling, numbness, or pain, which radiates to the buttocks legs and feet.
The bone that curves around and covers the spinal cord (lamina) is
removed (laminectomy) and the tissue that is causing pressure on the
nerve or spinal cord is removed. The hole through which the nerve passes
can be enlarged to prevent further pressure on the nerve. Sometimes, a
piece of bone (bone graft), interbody cages, or pedicle screws may be
used to strengthen the area of surgery.
Lumbar spinal surgery - series: Aftercare
Reference:
http://www.nlm.nih.gov/medlineplus/ http://www.medhelp.org/
http://adam.about.com/ http://healthline.com/
http://google.com/