The document discusses prolapse intervertebral disk (PID), noting that lumbar back ache is a common cause of chronic disability associated with the L5/S1 disk. With aging, the disk nucleus becomes desiccated, causing the annulus fibrosis to develop fissures and herniations of nucleus material. Physical stress can cause acute disk herniation, rupturing the annulus and extruding fibrocartilaginous material posteriorly or free in the spinal cord in severe cases. Clinical features of PID include sciatic radiation, numbness, weakness, and positive straight leg raise test. Imaging like X-ray, CT, MRI, and myelography are used for diagnosis. Treatment focuses on rest, reduction of protr

1. Prolapse Intervertebral Disk

2. PID
• Lumber back ache is
most common cause of
chronic disability.
• Majority of case are
associated with Inter
vertebral disk at L5 /
S1.

3. Pathology
• With ageing disk dries out the
nucleus pulposes turgid and
gelatinous bulb to desiccated
structure annulus fibrosis develop
fissure .
• Small herniation of nucleus
material squeeze through the
annulus.
• They penetrate the vertebral end
plate to produce SCHMORLS nodes
in 75 % of pt
• Displacement of facet joint is
inevitable due to disk space
collapse leading to OA.

4. Acute disk herniation or prolapse
• Less common but more dramatic.
• Physical stress is the causative factor.
• The dick will not rupture unless there is disturbance in hydrophilic property
of nucleus.
• When it rupture fibro cartilaginous material extrude posteriorly.
• With complete rupture nucleus may sequestrate and lie free spinal cord.
• Pain in PID is due to disruption of annulus fibrosis and tearing of post
longitudinal ligament and dura.

5. Stage

6. Clinical Features
• There is
–Sciatic radiation
–Parenthesis
–Numbness
–Weakness
–Depress reflex may be present

7. Clinical Feature
• Acute PID is uncommon in very young and very old.
• It occur in fit adult of 20 to 45 years.
• There is H/O lifting and stooping.
• Pain will be more on coughing and straining.
• Cauda equana is affected to cause urinary retention.
• There is sciatic sclerosis.
• Range of motion diminished.
• Para vertebral muscles spasm.
• SLR positive.
• Cross sciatic test may be positive.

8. Imaging
• X-ray
• Myelography( for rediculopathy)
• CT and MRI

9. Differential Diagnosis
• Inflammatory diseases
• Vertebral tumor
• Nerve tumor

10. Treatment
• 4R’s
–Rest
–Reduction
–Removal
–Rehabilitation