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1. TOPIC-
HERNIATION OF A
INTERVERTEBRAL
DISC
PRSENTED BY-
SHREYA YADAV
NURSING TUTOR

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. U

4. .

5. .

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. 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. posterolateral disc herniation –
protrusion is usually posterolateral into vertebral canal, compress theroots
of a spinal nerve.
protruded disc usually compresses next lower nerve as that nervecrosses
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
lateral disc herniation:
may compress the nerve root above the level of theherniation
L4 nerve root is most often involved & patient typically have intense
radicular pain.
TYPES OF HERNIATION

10. 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

11. 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

12. NORMAL DISC HERNIATED DISC

13.  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
Pain
Paresthisia

14. • GENERAL CONSIDERATIONS:
1.An intervertebral disk may herniate without causing
symptoms.
2.Symptoms depend on location, size, rate of
development and effect of surrounding structure.
3.Most of symptomatic disk herniations result in pain
, sensory changes, loss of reflex,and muscle
weakness that resolve without surgery.

15. LUMBER MANIFESTATIONS
1.Lower back pain with varying degree
of sensory and motor
dysfunction.
2.Pain radiating the lower back into the
buttocks and down the leg, referred to
as sciatica.
3.A stiff or unnatural posture
4.Some combination of paresthesias,
weakness, and reflux impairment.

16. 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.

17. Diagnosis is based on the history, symptoms, and physical
examination.
DIAGNOSIS

18. 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 softtissues.
Bulging out disc.
MRI lumber spine;
Intervertebral disc protrusion.
Compression of nerve root.

19. NARROWED SPACE
BETWEEN L5 AND S1
VERTEBRAE,
INDICATING PROBABLE
PROLAPSED
INTERVERTEBRAL DISC -
ACLASSIC PICTURE

20. TREATMENT OPTIONS
Pain medications.
Bed rest
Oral steroids .
Surgery

21. Indicated treatment.
Non-steroidal anti-inflammatory
drugs (NSAIDs).
Eg-Aspirin, Ibuprofen
Oral steroids
(e.g. prednisone or methylprednisolone).
Benzodiazepines( lowerdose)
Epidural cortisone injection.

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

24. surgery
Surgery is generally considered only as a last resort,
or if a patient has a significant neurological deficit.

25. INTRADISCAL ELECTROTHERMIC THERAPY(IDET)
heats
It is a fairly advanced procedure in
which electrothermal catheter is
inserted to the intervertebral disc
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. 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. DISCECTOMY/MICRODISCECTOMY -
This procedure is
used to remove part
of an intervertebral
disc that is
compressing the
spinal cord or a nerve
root.

28. 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

29. Assessment
determining the onset,
location, and radiation of pain,
paresthesias, limited movement,
diminished function of the neck, shoulders, and
upper extremities
NURSING MANAGEMENT

30. 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
Tofacilitate the postoperative turning procedure, the patient
is taught to turn as a unit (called logrolling)
Encouraged to take deep breaths, cough
PROVIDING PREOPERATIVE CARE

31. 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 THEPATIENT AFTER SURGERY

32. Assess for paralytic ileus
Assess for urinary retention

33. -Educate the client regarding lifestyle changes – smoking cessation,
increase activity and weight loss.
- Provide instructions regarding back anatomy and physiology.
- Teach the patient about importance of cervical collar use
and other methods.
- Teach about proper body mechanics
- Tell the client to avoid the prone position, long car rides an sitting in a
soft chair.
CLIENT EDUCATION AND
HEALTH MAINTENANCE

34. 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

35. 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)

36. Deficient knowledge about the postoperative course and home
care management
INTERVENTIONS
Acervical 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

37. Avoid sitting/standing for prolonged periods
Avoid twisting movements
Regular follow up