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HERNIATED NUCLEUS

PULPOSUS

Preceptor : dr. Martin Firman Suryo, Sp.S, FIPM


Clinical Clerkship Neurology Rotation
Royal Taruma Hospital
Period of 26 November – 30 December 2018
HERNIATED NUCLEUS PULPOSUS

• An occurrence of protrusion from the nucleus intervertebral disc


• Most common causes for neural root pain
PATHOPHYSIOLOGY
SIGNS & SYMPTOMS

• Ipsilateral pain in the neck (dull or sharp)


• Pain radiating down the ipsilateral arm to
the fingers (dull or sharp)
• Numbness or tingling
Cervical • Neck flexion and arm abduction over the
top of the head
• Decreased sensation to pain, touch, or
vibration may be present in the ipsilateral
arm
SIGNS & SYMPTOMS

• Radiating pain may be perceived to


be in the chest or belly
• Upper back pain
Thoracic • Sensory disturbances (such as
numbness) below the level of
compression
• Pain may be exacerbated when
coughing or sneezing
SIGNS & SYMPTOMS

• Pain in the leg (searing, sharp, electric, radiating, or piercing pain)


• Numbness, a pins-and-needles feeling, weakness, and/or tingling
may be experienced in the leg, foot, and/or toes
• Foot drop
• Lower Back Pain  dull or throbbing, and may be accompanied

LUMBAR
by stiffness
• Pain that worsens with movement (prolonged standing or sitting,
or after walking even a short distance)
• A laugh, sneeze, or other sudden action may also intensify the
pain
• Pain that worsens from hunching forward (positions such as
slouching or hunching forward in a chair, or bending forward at
the waist)
IMAGING MODALITIES
IMAGING MODALITIES
IMAGING MODALITIES
MANAGEMENT

CONSERVATIVE
• To reduce inflammation
• NSAIDs and physical therapy are the first-line treatment modalities
• Only a very short period of rest is appropriate
• Anti-inflammatories are of some benefit (because the pain is from
inflammation of the nerve); and warm, moist heat or modalities may be helpful
• Exercises and physical therapy mobilize muscles and joints  facilitate the
removal of edema and promote recovery
• Muscle relaxants may offer symptomatic relief of the acute muscle spasms,
but only in the early stages (however, they do not directly relax skeletal muscle,
and they are also sedating)
• Translaminar epidural injections and selective nerve root blocks are
the second line modalities
MANAGEMENT

SURGICAL
• To relieve the pain by decompressing the neural
elements
• However, the hope of permanently relieving the
back pain is a fantasy—a false hope
• Two categories : central decompression of the
disk and directed fragmentectomy