This document discusses intervertebral disc prolapse. It begins by describing disc anatomy, development, and location in the spine. It then explains the pathology of prolapse, which involves nuclear degeneration, displacement, and fibrosis. Risk factors for prolapse include heavy lifting, smoking, obesity, and improper posture. Clinical features include low back pain radiating to the buttocks, aggravated by certain movements. Investigations include CT, MRI, and myelography. Treatment options range from conservative measures like rest and physical therapy to operative procedures like fenestration, hemi-laminectomy, and endoscopic discectomy.

1. INTERVERTEBRAL DISC
PROLAPSE
HARI CHANDAN

2. Disc anatomy
 -Intervertebral disc lies between adjacent vertebrae in the the vertebral
column forming a fibrocartillagenous joint allowing movement of the
vertebra
■ -Development of disc starts from third week of intrauterine life until
■ third decade of life.
■ -23 discs through out the spine, absent only atlanto-axial articulation.
■ -Thinnest in thoracic region ; thickest in lumbar region
■ -Avascular

3. Disc anatomy
■ The cartilage end-plates
■ Nucleus puplopes
■ Annulus fibrosis

4. ■ Disc gives spine the mobility
■ Disc acts as shock absorber
■ Disc increases height of spine by 25%

5. PATHOLOGY
■ Prolapsed disc means the protrusion or extrusion of nucleus pulposes through a rent in
the annulus fibrosis.it is not a one time phenomena rather it’s a sequence of following
events
1)NUCLEAR DEGENERATION : - softening of nucleus and its fragments
- weakening and disintegration of the posterior
part of the annulus
2)NUCLEAR DISPLACEMENT : - disc protrusion, - disc extrusion , sequestrated disc

6. ■ 3)STAGE OF FIBROSIS :The is the stage of repair. The residual nucleus pulposus
becomes fibrosed.The extruded nucleus nucleus
pulposus becomes flattened,fibrosed and undergoes calcification.
■ The site of exit of nucleus is usually posteriolateral.

7. ETIOLOGY OF DISC PROLAPSE
■ Heavy and repetitive weightlifting
■ Cigarette smoking and tobacco consumers
■ Anxiety and depression
■ Women with greater number of pregnancies
■ Obesity
■ Improper postural habits
■ Occupations as auto drivers .

8. Clinical features
■ Low backache – repetitive , radiating to the buttocks and decreased by rest .pain
aggrevated when coughing,sneezing,straining,sitting.
■ Radiculopathy – pain in the distribution of sciatic nerve ,invariably due to disc
herniation. Leg pain equal to or more than back pain evidence the racdiculopathy may
be due to disc herniation.
■ Nerve root compression.

11. SLIGHT LEG RAISETEST (SLRT)
■ Inference : localized pain indicates a disc lesion.
radiating pain indicates sciatic radiculopathy.
SLRT at 40 degrees or less indicates root compression.

12. Investigations
■ Ct scan – posterior border of disc appears flat or convex
which is normally concave.

13. ■MRI– very usefull. Shows prolapsed disc, theca, nerve roots
clearly.

14. ■ Myelography : Radiopaque die is injected into spinal
canal and radiographs are taken. not in use now.
■ Radiography : Not reliable . 7-46% cases are missed .

15. Differential diagnosis
■ Spondylitis
■ Vascular insufficiency
■ Extra dural tumour
■ Spinal tuberculosis

16. Treatment
■ Conservative: Rest
Drugs – analgesics and muscle relaxants
Physiotherapy
Lumbar traction
Transcutaneous electrical nerve stimulation ( tens)

17. Operative treatment
■ Indications :
1. Failure of conservative treatment
2. Severe sciatic pain
3. Severe sciatic tilt

18. ■ Fenestration : Ligamentum flavum is excised and the spinal
canal at the affected region is exposed.no longer done as it
makes spine unstable
■ Hemi-laminectomy :The whole of the lamina on one side is
removed.
■ Fenistration : Requires mri and radiographic studies. Spine is
approached unilaterally, only the margin of upper and lower
lamina are removed.

19. CHEMONUCLEOLYSIS
■ Chymopapain with the property of dissolving fibrous and
cartilaginous tissue is injected into the disc,under X-ray
control

20. Endoscopic lumbar discectomy
■ Using a operative endoscope,through a small incision with
minimal damage and blood loss
■ Less invasive ,minimal damage,minimal blood loss,
excellent results
■ Come today, go tomorrow surgery.

21. THANKYOU