Herniated Intervertebral Disc

Children experience sciatica pain in the straight leg test between

30 and 70 degrees

Assessment

5 Ps to determine NV status PQRST questions.

If patients are in severe pain, what can they use

A PCA pump or patch (fetynol). Give something for breakthrough pain

Artificial disc surgery

A herniated disc is replaced with an artificial disc, similar to hip replacement.

A herniated intervertebral disc

Also called ruptured disc, slipped disc, or herniated nucleus propulsus. Occurs when a spinal disc ruptures, allowing the fluid to leak out and irritate nearby nerves. This causes a decreased ability in the disc to cushion the joints, causing decreased mobility and back pain.

etiology of herniated intervertebral disc

As you age, there is loss of fluid content in the nucleus propulsus and increases risk for tears in the annulus fibrosis. The disc shrinks and there is a decreased ability to absorb shock and increased risk for herniation.

Back pain is usually the result of

Bending, lifting, and standing. Can be linked to certain lifestyle habits such as bad posture, low fitness, smoking, athletic injuries, heavy backpacks, pregnancy, diseases.

Blood tests for HID

CBC, Erythrocytes sedimentation rate ( more than 100= inflammation), C-Reactive protein (inflammatory marker), HLA-B27 ( surface antigen to help identify a major histocompatibility complex)

Imaging tests for HID

CT scans are the most common. MRI is used in severe cases. Myelogram, electromyogram, nerve conduction study

Cervical Disc herniation

Can result in numbness, tingling, muscle spasms, and weakness in the areas serviced by affected nerves. Can have neck and shoulder pain with pain that shoots down the arms and fingers. Rare to find on both sides.

With hot and cold which one do you give first

Cold to get the inflammation down.

Cauda Equina Syndrome

Compression of the nerve roots of cauda equina. MEDICAL EMERGENCY. needs immediate SX to relieve pressure on nerves. Main problems = urinary incontinence and paralysis. Can cause sexual dysfunction. In L1-L2.

Intervetebral discs normally provide

Cushioning, shock absorption, and support for vertebrae

How are the biceps and triceps affected in cervical herniated discs

Decreased biceps and supinator reflexes. Hyperactive triceps reflexes.

myelogram

Dye injected into the spinal fluid and visualized by X-ray. Can be used to identify areas of pressure on the spinal cords and nerves

Use what kind of mattress

Firm to support the spinal column

If a patient has a patch on and they are still in pain because it has not taken effect

Give them something else for pain

Prevention for herniated intervertebral disc

Good back care (posture, exercise regularly, maintain healthy weight, proper body mechanics, weight bearing exercises)

Laser surgery

Inserting a needle into the disc and delivers laser energy to vaporize the tissue in the disc. This reduces the size of the disc and relieves pressure.

What are the spinal vertebrae's that are mostly affected

L4-L5 and L5- S1

Younger adults are ________ to develop herniated intervetebral discs than older adults because

Less likely; they're more active.

Most common location for intervetebral herniated disc

Lumbar region.

"Foot drop" is caused by a

Lumber herniated disc.

Electromyogram

Measures the electrical activity of the muscles at rest and during contraction

What kind of exercise to do

Moderate core exercises.

What is the first line therapy to reduce pain and swelling

NSAIDs

What to give for severe pain

Opioids

Breakthrough pain

Pain that occurs between doses of pain medication

Straight leg test

Patient supine, passively raise patient's leg to point of pain or 90 degrees

Spinal fusion

Performed to joint two or more vertebrae's together using bone graft, screws, and rods. This prevents motion between the two vertebrae and reduces pain. Tissue rejection can occur if donor bones are used.

laminectomy

Performed to remove the lamina, or part of the vertebrae that covers the spinal cord. This enlarges the spinal canal and relieves pressure on the associated nerves

Discectomy

Removes all or part of the ruptured disc muscles and other tissues are dissected away from the spine to allow for surgical exposure of the ruptured disc. After removal of the disc, surrounding structures are returned to their natural positions

A herniated disc in the lumbar region causes a condition known as

Sciatica. The sciatic nerve is the longest nerve in the body. Usually sciatica only effects one side of the body with pain, Burning, tingling, numbness radiating from the butt to the leg and foot. May be more severe when standing, walking, and sitting. May be aggregated by sneezing and coughing

Laminotomy

Simpler than a laminectomy. Only a portion of the lamina is removed.

What can you place under the knees or neck to decrease pressure on the nerve roots

Small pillows

Mobility tests for HID

Straight leg raise test, gait test, reflex test, muscle strength test

Pts with sciatica will have a positive

Straight leg test

If the herniated disc is not compressing on a nerve

The pt may be asymptomatic.

If a disc is pressing on spinal cord instead of a nerve

There will be neurological deficits in the body.

If nerve compression is present

There will be pain in the lower back, butt, hips, thighs, and legs. Numbness and tingling (shooting pains down leg) and muscle weakness

Meds to treat neuropathic pain

These may also reduce pain related to nerve damage. Gabapentin, pre-Gabalin, duloxetine.

Herniation of what disc is a medical emergency

Thoracic. Because it may result in paralysis and and those nerves control the lungs.

Nerve conduction study

Used to measure the speed of electrical impulses through the nerve.