herniated disc disease.pptx

8/20/2019 Herniated Disc Disease.pptx

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Herniated Disc Disease

Normally, the colagen fbers o theannulus fbrosus are continuous andthus contain the nuclear material.

I the annular fbers become disrupted,displacement o the nuclear materialcan occur.

This situation is termed Herniatednucleus pulposus (HNP).



Intervertebral Disc

•nucleus pulposus•annulus fbrosus•hyaline cartilage

end plates



Herniated Nucleus Pulposus




Herniation :

. Intraspongi nuclear herniation

!. Protrusion (prolapsed inter"ertebraldisc)

#. $%truded

&. 'euestered




The progression to anactual HNP "aries romslo to sudden onset

o symptoms. There are our stages:() disc protrusion(!) prolapsed disc(#) disc e%trusion(&) seuestered disc



HNP

* herniated disc occurs most oten inthe lumbar region o the spineespecially at the +&+- and +-' le"els

(+ +umbar, ' 'acral). This isbecause the lumbar spine carries mosto the body/s eight. People beteenthe ages o #0 and -0 appear to be"ulnerable because the elasticity andater content o the nucleus decreasesith age.



Progressive Steps Tow ard

H erniation1any actors increase the ris2 or discherniation:

() +iestyle choices such as tobacco use, lac2o regular e%ercise, and inadeuate nutritionsubstantially contribute to poor disc health.(!) *s the body ages, natural biochemicalchanges cause discs to gradually dry outa3ecting disc strength and resiliency.

(#) Poor posture combined ith the habitual useo incorrect body mechanics stresses thelumbar spine and a3ects its normal ability tocarry the bul2 o the body/s eight.



DISC RUPTURES (HNP)

HI'T456 :

4N'$T :

Prodromal bac2 pain or "arying lengths o

time Intermittent

*cute, olloed soon ater onset o legpain

7irect trauma8sudden eight loading othe spine are not causal agents o discrupture, although may aggra"ate apree%isting lesion



SYM PTM S ! HERNI"TED

#UM $"R DIS% se"ere lo bac2 pain

pain radiating to the buttoc2s, legs, andeet

pain made orse ith coughing,straining, or laughing

tingling or numbness in legs or eet

muscle ea2ness or atrophy in laterstages

muscle spasm

http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm










HNP

HI'T456 : +49*TI4N 4 P*IN :

TH$ ;*9<

TH$ ;=TT49< TH$ THI>H TH$ +$> TH$ 44T



HNP

HI'T456 *>>5*?*TI4N

;$N7IN> 'T44PIN> +ITIN> 94=>HIN>

'N$$@IN> 'T5*ININ> *T 'T44+

5$+I$?$7 ;6 5$'T



HNP

PH6'I9*+ $A*1IN*TI4N

The bac2 :

+umbar spine is Battened, slightly

Be%ed 'ciatic scoliosis (ob"ious on bending

orard) 'tanding ith the a3ected hip C 2nee

slightly Be%ed +imitation o Be%ion C e%tension

Tenderness C muscle spasm in thestanding position



HNP

PH6'I9*+ $A*1IN*TI4N The e%tremities

5oot tension C irritation 'T5*I>HT +$> 5*I'IN> ;4D'T5IN> 'I>N +IP T$'T

954''4?$5 P*IN (D$+++$>5*I'IN> 'I>N)

$145*+ N$5?$ 'T5$T9H



HNP

PH6'I9*+ $A*1IN*TI4N TH$ $AT5$1ITI$'

544T 941P5$''I4N 14T45 D$*<N$''

9H*N>$' IN '$N'456 *PP5$9I*TI4N

9H*N>$' 5$+$A *9TI?IT6



DI"&NSTIC TESTS

* spine Aray may be perormed to rule outother causes o bac2 or nec2 pain. Hoe"er, itis not possible to diagnosis herniated dis2 by

spinal Aray alone. * spine 15I and8or spine 9T ill sho spinal

canal compression by the herniated dis2. * myelogram may be perormed to defne the

siEe and location o dis2 herniation. *n $1> may be perormed to determine the

e%act ner"e root(s) that is (are) in"ol"ed. * ner"e conduction "elocity test may also be

perormed.

















Radiographic Evidence of

H N P



Criteria for the diagnosis of the acuteradicular syndrom e (sciatica due to an

H N P):. +eg pain (including buttoc2) as the dominant

complaint hen compared to bac2 pain

!. neurological symptoms that are spesifc

(e.g., paresthesia in typical dermatomaldistribution)

#. signifcant '+5 changes (any one or acombination o these)

'+5 less than -0F o normal ;ostring discomort 9rosso"er pain

&. neurological signs G ea2ness, asting,sensory loss or reBe% alteration (at least ! o

&)



Treat' ent

9onser"ati"e treatment : ;ed rest

=nloading the spine

*ntiinBammatory drugs

*nalgesics

1uscle rela%ant medication



Treat' ent

'urgery, indications : Increasing neurological defcit

'ignifcant neurological defcit ithsignifcant '+5

;ladder C boel in"ol"ement

ailure o conser"ati"e treatment

5ecurrent o sciatica syndrome



Treat' ent

'urgery, treatment options P4'T$5I45 *PP54*9H

'T*N7*57 +*1IN$9T416

1I954+*1IN$9T416 P4'T$5I45 1I945+*1IN$9T416 G +*T$5*+ P4'T$5I45 +=1;*5 INT$5;476 ='I4N

*NT$5I45 *PP54*9H *NT$5I45 +=1;*5 INT$5;476 ='I4N

P$59=T*N$4=' 7I'9$9T416 *PP54*9H



Surical ptions

. 1icrosurgery is an approach to remo"e the HNP ith minimaldisruption o bone or sot tissue. * number o technicalproblems can occur hen remo"ing disc herniation ithoutany bone resection. In many cases o HNP, e%truded

ragments may migrate pro%imally or distally to the discspace. *dhesions beteen the ner"e root and disc oten ma2eit dicult to mobiliEe the ner"e root to e%pose the HNP. Topre"ent e%cessi"e traction o the ner"e root many surgeonsreer to microdisectomy as a small incision ith adeuatebone remo"al, including a portion o the superior and ineriorlamina that may reuire a partial acetectomy to pre"entdamage to the ner"e root.

!. +aminotomy is a traditional approach used to remo"edisplaced disc material in patients ith HNP. The surgeonorms a hole in the lamina to reach and remo"e the discithout disrupting the continuity o the entire lamina. Thisapproach is mista2enly called a laminectomy, the more

e%tensi"e remo"al needed or a ider e%posure.



Surical ptions

#. Percutaneous discectomy is a method or treatment o HNP. This procedure uses a localiEing probe olloed by a cannuia,hich holds the nucleotome probe. The nucleotome probesimultaneously cuts and suc2s nuclear material rom the discspace into a special cannister. This procedure in"ol"es nomuscle dissection, bone remo"al or large s2in incision. This isan outpatient procedure that reuires a local anesthetic. Thesuccess o this procedure is based on decompression o thedisc space by producing a hole in the annulus ith the cuttingprobe and e"acuating the nuclear material ith the cuttingand suction probe. Proponents o this techniue ad"ise its uselimited to disc protrusions (bulging disc ith intact annulus contained). The maority o surgical discectomies, hoe"er

are or e%truded or seuestered discs (noncontained).

&. 9hemonucleolysis is a procedure here an enEyme isinected directly into the disc to dissol"e it. This procedureas idely used rom JKJJL- until a double blind studydemonstrated no signifcant di3erence beteen chymopapaininections and placebo

herniated disc disease.pptx

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