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Intervertebral disc prolapse(ivdp)

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Intervertebral disc prolapse(ivdp)

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Intervertebral disc prolapse(ivdp)

  1. 1. INTERVERTEBRAL DISC PROLAPSE(IVDP)
  2. 2.  Is a hydrostatic, load bearing structure between the vertebral bodies from C2-3 to L5-S1 . Nucleus pulposus + annulus fibrosus Is relatively avascular. L4-5, largest avascular structure in the body.
  3. 3. U
  4. 4. .
  5. 5. .
  6. 6. Vital Functions of the IVD  Restricted intervertebral joint motion  Contribution to stability  Resistance to axial, rotational, and bending load  Preservation of anatomic relationship
  7. 7. Is a medical condition affecting the spine in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out beyond the damaged outer rings.
  8. 8. posterolateral disc herniation – protrusion is usually posterolateral into vertebral canal, compress the roots of a spinal nerve. protruded disc usually compresses next lower nerve as that nerve crosses level of disc in its path to its foramen. (eg.protrusion of fifth lumbar disc usually affects S1 instead.  central (posterior) herniation: less frequently, a protruded disc above second lumbar vertebra may compress spinal cord itself or or may result in cauda equina syndrome. lateral disc herniation: may compress the nerve root above the level of the herniation L4 nerve root is most often involved & patient typically have intense radicular pain. TYPES OF HERNIATION
  9. 9. Degeneration Loss of fluid in nucleus pulposus Protrusion Bulge in the disc but not a complete rupture Prolapse Nucleus forced into outermost layer of annulus fibrosus- not a complete rupture Extrusion A small hole in annulus fibrosus and fluid moves into epidural space Sequestration Disc fragments start to form outside of the disc area. CLASSIFICATIONS OF HERNIATIONS
  10. 10. Schematic illustration a) Normal b) Bulging disk c) Focal bulge or protrusion. The nucleus material remains within the outermost fibres of the annulus fibrosus. d) Prolapse or extrusion. The nucleus material has penetrated the annulus fibrosus but is contained in front of the posterior longitudinal ligament. e) Sequester or free fragment.
  11. 11. Repetitive mechanical activities – Frequent bending, twisting, lifting, and other similar activities without breaks and proper stretching can leave the discs damaged. Living a sedentary lifestyle – Individuals who rarely if ever engage in physical activity are more prone to herniated discs because the muscles that support the back and neck weaken, which increases strain on the spine. Traumatic injury to lumbar discs- commonly occurs when lifting while bent at the waist, rather than lifting with the legs while the back is straight. CAUSES
  12. 12. Obesity – Spinal degeneration can be quickened as a result of the burden of supporting excess body fat. Practicing poor posture – Improper spinal alignment while sitting, standing, or lying down strains the back and neck. Tobacco abuse – The chemicals commonly found in cigarettes can interfere with the disc’s ability to absorb nutrients, which results in the weakening of the disc. CAUSES
  13. 13. NORMAL DISC HERNIATED DISC
  14. 14.  symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved.  Herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees, or feet.
  15. 15. Location The majority of spinal disc herniation cases occur in lumbar region (95% in L4-L5 or L5-S1).  The second most common site is the cervical region (C5-C6, C6- C7).  The thoracic region accounts for only 0.15% to 4.0% of cases.
  16. 16. Diagnosis is based on the history, symptoms, and physical examination. DIAGNOSIS
  17. 17. X-Ray : lumbo-sacral spine; Narrowed disc spaces. Loss of lumber lordosis. Compensatory scoliosis. CT scan lumber spine; It can show the shape and size of the spinal canal, its contents, and the structures around it, including soft tissues. Bulging out disc. MRI lumber spine; Intervertebral disc protrusion. Compression of nerve root.
  18. 18. NARROWED SPACE BETWEEN L5 AND S1 VERTEBRAE, INDICATING PROBABLE PROLAPSED INTERVERTEBRAL DISC - A CLASSIC PICTURE
  19. 19. Complications Cauda equina syndrome Chronic pain Permanant nerve injury Paralysis
  20. 20. TREATMENT OPTIONS Pain medications. Bed rest Oral steroids . Nerve root block . Surgery
  21. 21. Non-steroidal anti-inflammatory drugs (NSAIDs). Eg- Aspirin, Ibuprofen Oral steroids (e.g. prednisone or methylprednisolone). Benzodiazepines( lowerdose) Epidural cortisone injection. Indicated treatment.
  22. 22. Physical therapy include modalities to temporarily relieve pain (i.e. traction, electrical stimulation massage). Patient education on proper body mechanics. Weight control. Tobacco cessation. Lumbosacral back support. TREATMENT
  23. 23. surgery Surgery is generally considered only as a last resort, or if a patient has a significant neurological deficit. The presence of cauda equina syndrome is considered a medical emergency requiring immediate attention and possibly surgical decompression.
  24. 24. The indications for surgery 1 • persistent pain and signs of sciatic tension after 2–3 weeks of conservative treatment. 2 • a cauda equina compression syndrome – this is an emergency; 3 • neurological deterioration while under conservative treatment;
  25. 25. INTRADISCAL ELECTROTHERMIC THERAPY (IDET)  It is a fairly advanced procedure in which electrothermal catheter is inserted to the intervertebral disc heats the posterior annulus of the disk, causing contraction of collagen fibers  IDET is a minimally invasive outpatient surgical procedure developed over the last few years to treat patients with chronic low back pain that is caused by tears or small herniations of their lumbar discs.
  26. 26. NUCLEOPLASTY Nucleoplasty is the most advanced form of percutaneous discectomy developed to date. Tissue removal from the nucleus acts to “decompress” the disc and relieve the pressure exerted by the disc on the nearby nerve root
  27. 27. DISCECTOMY/MICRODISCECTOMY - This procedure is used to remove part of an intervertebral disc that is compressing the spinal cord or a nerve root.
  28. 28. CHEMONUCLEOLYSIS-  Chemonucleolysis is the term used to denote chemical destruction of nucleus pulposus [Chemo+nucleo+lysis].  This involves intradiscal injection of chymopapain which causes hydrolysis of he cementing protein of the nucleus pulposus.  This causes decrease in water binding capacity leading to reduction in size and drying the disc.
  29. 29. LAMINECTOMY- Removes the lamina part to relieve spinal stenosis or nerve compression
  30. 30. LUMBAR FUSION Fusion surgery helps two or more bones grow together into one solid bone. Fusion cages are new devices, essentially hollow screws filled with bone graft, that help the bones of the spine heal together firmly. lumbar fusion is only indicated for recurrent lumbar disc herniations, not primary herniations
  31. 31. DISC ARTHROPLASTY Artificial Disc Replacement (ADR), or Total Disc Replacement (TDR), is a type of arthroplasty. It is a surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial devices in the lumbar (lower) or cervical (upper) spine. Used for cases of cervical disc herniation
  32. 32. Assessment determining the onset, location, and radiation of pain, paresthesias, limited movement, diminished function of the neck, shoulders, and upper extremities NURSING MANAGEMENT
  33. 33. explanations about the surgery and reassurance that surgery will not weaken the back. Preoperative assessment also includes an evaluation of movement of the extremities as well as bladder and bowel function To facilitate the postoperative turning procedure, the patient is taught to turn as a unit (called logrolling) Encouraged to take deep breaths, cough PROVIDING PREOPERATIVE CARE
  34. 34. Vital signs are checked frequently and the wound is inspected for hemorrhage IV morphine -24-48 Sensation and motor strength of the lower extremities are evaluated at specified intervals, along with the color and temperature of the legs and sensation of the toes. Assess for CSF leakage ASSESSING THE PATIENT AFTER SURGERY
  35. 35. Assess for paralytic ileus Assess for urinary retention
  36. 36. Acute pain related to the surgical procedure Nursing Interventions  The patient may be kept flat in bed for 12 to 24 hours in cervical surgery  Pillow is placed under the head and the knee rest is elevated slightly to relax the back muscles( cervical surgery)  Extreme knee flexion must be avoided  Administering the prescribed postoperative analgesic agent, positioning for comfort, and reassuring the patient that the pain can be relieved. NURSING DIAGNOSIS
  37. 37. Impaired physical mobility related to the postoperative surgical regimen Nursing interventions  provide cervical collar cervical collar  provide L-S binders The neck should be kept in a neutral(midline) position Patients are assisted during position changes(log rolling)
  38. 38. Deficient knowledge about the postoperative course and home care management INTERVENTIONS  A cervical collar is usually worn for about 6 weeks.  Instructed about strategies for pain management and about signs and symptoms of complications  The nurse assesses the patient’s understanding of these management strategies  advised to avoid heavy work for 2 to 3 months after surgery.  Exercises are prescribed to strengthen the abdominal and erector spinal muscles
  39. 39. Avoid sitting/standing for prolonged periods Avoid twisting movements Regular follow up

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