This document summarizes information about a prolapsed intervertebral disc (PIVD). It describes the three components of an IV disc - the cartilage end plates, nucleus pulposus, and annulus fibrosus. It outlines the four stages of a PIVD from bulging to sequestration. Symptoms include radicular pain, weakness, and paraesthesia. Clinical tests to diagnose a PIVD are described, as well as MRI as the investigation of choice. Treatment options include non-operative measures like rest, medications, and physical therapy or operative techniques like endoscopic surgery, microdiscectomy, and laminectomy.

1. PROLAPSED INTERVERTEBRAL DISC
BY:- DR. BIPUL BORTHAKUR
PROFESSOR
DEPARTMENT OF ORTHOPAEDICS
SILCHAR MEDICAL COLLEGE AND HOSPITAL

3. THE IV DISC CONSISTS OF THREE DISTINCT
COMPONENTS :
1.THE CARTILAGE END PLATES
2.NUCLEUS PULPOSUS
3.ANNULUS FIBROSUS.
THE CARTILAGE RING ARE THIN LAYERS OF
HYALINE CARTILAGE BETWEEN TWO
ADJACENT VETEBRAL BODIES AND DISC
PROPER.

5. NUCLEUS PULPOSUS
Highly hydrated structure.
Hydrophilic matrix.
Low collagen and high PG ratio.
Characterised by compressibility.

6. ANNULUS FIBROSUS:-
High collagen and low PG ratio.
Lamella are thick anteriorly and laterally and THINNER
posteriorly.
Characterised by extensibility and tensile strength.

10. STAGES OF PIVD:
1)BULGING
2)PROTRUSION
3)EXTRUSION
4)SEQUESTRATION

13. SYMPTOMS OF PIVD
Radicular pain
Weakness
Paraesthesia
Cauda equina compression

14. L4 NERVE ROOT COMPRESSION
Sensory deficit in posterolateral of thigh , anterior knee
and medial leg
Motor weakness in quadriceps and anterior tibial
Reflex changes in patella tendon and anterior tibial
tendon

15. L5 NERVE ROOT COMPRESSION
Sensory deficit in anterolateral leg, dorsum of foot and
great toe.
Motor weakness in EHL, EDL ,EDB and gluteus medius.
Ankle jerk variable.

16. S1 NERVE ROOT COMPRESSION
Sensory deficit over lateral malleolus, lateral foot, heel, and
web of 4th and 5th toe.
Motor weakness of peroneus longus, brevis, gastrocnemius
soleus complex and gluteus maximus.
Ankle jerk absent.

17. CLINICAL TESTS FOR PIVD:
a) SLR
b) Lasegue’s test
c) Bowstring test
d) Prone knee bending (PKB) test

18. SLR TEST BOWSTRING TEST

19. LASEGUE TEST PRONE KNEE BENDING TEST

20. IMAGING
1.Radiograph.
2. MRI:- Investigation of choice.
3. MRI with Gadoliniun contrast.

21. DIFFERENTIAL DIAGNOSIS:-
1. Ankylosing spondylitis
2. Multiple myeloma
3. Hip arthritis
4. Extradural tumors
5. Peripheral neuropathy

22. TREATMENT
1. NON OPERATIVE.
2. OPERATIVE.

23. NON OPERATIVE:
1. Short period of rest.
2. Oral medications like NSAIDs , muscle
relaxants.
3. Physical therapy.
4. Exercises.

24. OTHER PROCEDURES
1. SELECTIVE NERVE ROOT BLOCK
2. LUMBAR EPIDURAL CORTICOSTEROID

25. OPERATIVE TREATMENT
INDICATIONS FOR OPERATIONS:-
Cauda equina syndrome.
Persistent limb pain > 6 wks.
Failed conservative treatment
Far lateral disc herniation.

26. OPERATIVE TECHNIQUE
1. ENDOSCOPIC SURGERY.
2. FENESTRATION
3. MICRODISCECTOMY.
4. HAMILAMINECTOMY/PARTIAL LAMINECTOMY.
5. LAMINECTOMY.
6. LAMINOTOMY.

27. THANK YOU