Herniated Intervertebral discs

Occurs when irritation or compression of all or part of the sciatic nerve, orig in lower back, produces pain and neurological manifestations. -Longest nerve; divided by 2 main branches, ea innervates one side of the lower portion of body. -travels through pelvis; deep into butt and down leg. *pressure on one or more lumbar nerve roots can affect sciatica. -Pain, burning, tingling and numbness radiates to butt and into leg and foot. -Only one side of body can be severe standing, walking or sitting. -Aggravated by sneezing or coughing too. -Forward tilt to the trunk when standing and change in mobility, motor function and knee and ankle reflexes. Spinal change may include absence of normal lumbar lordosis or scoliosis; muscle spasms and sex. dysfunc.

A herniated disc in lumbar; cause sciatica

Herniated disc is replaced with an artificial disc. Alternative to spinal fusion to maintain flexibility of sp. joint

Artificial Disc Surgery

Spinal canal branches into a bundle of free flowing nerve roots @ L1-L2, resembling horses tail; Compression of these nerves. permanent neurological impairment; urinary incont. and paralysis. Causes: Massive lumbar disc herniation, spinal stenosis, and trauma *Medical Emergency; Immediate Surgery to relieve pressure on nerves.

Cauda Equina Syndrome

result numbness, tingling muscle spasms and weakness -stiff neck -neck and shoulder pain that shoots down arm or fingers -If cervical disc compresses spinal cord instead of nerve root symptoms in lower body.

Cervical Discs

remove all or part of the herniated disc. Muscle and tissue dissected away from spine allow for surgical exposure of ruptured disc -after disc removal, surrounding structures are returned.

Discectomy Herniated disc surgery

*Degenerative disorders; -spondylosis -spinal stenosis -osteoporosis *systemic disorders -osteomyelitis -osteoporosis -neoplasms *referred pain -gastrointestinal -gu -abdominal aortic aneurysms -hip pathology -fibromyalgia **pregnancy; change in posture; increase anterior weight

Diseases that attribute to back problems

*health hx *physical exam *imaging *blood test, inflammation, infection, arthritis, *CT, MRI, myelogram *C-reactive protein; inflammation *HLA-B27; autoimmune test *CBC *ESR; settlement rate of RBC-inflammation *electromyogram;test that is used to record the electrical activity of muscles

Dx

*Loss of fluid content in the nucleus pulposus and increase suscept. to tears in the annulus fibrosis occur with aging. Shrinking disc, decrease ability to absorb shock, and increase risk of herniation. *Pressure of body weight and vertebrae column occurs C5-C6, C6-C7, L4-L5 and L5-S1 *May occur gradually b/c degenerative changes or abruptly to trauma, MVA, lifting something heavy. **Abruptly herniation assoc with nerve root compression, severe pain and muscle spasms.

Etiology

*Slow onset of pain maybe assoc with neurological symptoms -weakness or tingling **if occurs centrally rather than posterolaterally; pressure on SC. *Risk Factors: ages 30-50; discs degenerate naturally with age. -excess weight -reg heavy lifting/bending and twisting -previous back problems and smoking *Genetic Factors; Male, Tall, bone disorders, degenerative disc disorder *Prevention: Proper body mech, good posture and sitting and standing -exercise regularly -decrease pressure on vertebrae column. *Manifestations; depends on severity and location of herniation. *Most common*; Lumbar L4-L5, L5-S1, then cervical C5-C6, C6-C7

Gradual Herniated disc

Older adults less likely to develop than younger adults due to nucleus pulposus being diminished and can't protrude out as easily

Herniated disc

Remove lamina, or part of vertebra that covers the spinal cord. Enlarges the spinal canal and relieves pressure on the assoc. nerves.

Laminectomy; surgery for herniated disc; depends on location and integrity of spinal column

similar to laminectomy, only portion removed. Usually performed with other procedures ie. discectomy or spinal fusion

Laminotomy Herniated Disc Surgery

*If not compressing a nerve, maybe asymptomatic. -if nerve compression, pain in lower back, butt, thigh and leg. *numbness and tingling, muscle weakness.

Lumbar Discs

If no surgical intervention needed on bones, ligaments or muscles. Req smaller incision and less disruption of tissues.

Microdiscectomy Herniated disc surgery

Dosing S/E Contraindications Severe pain and neurological symptoms after 1-2 months consider surgery

Nursing responsibilities

lie between adjacent bone of the vertebral column. -outer annulus fibrosus; composed of strong fibrocartilage; inner nucleus pulposus contain loose fibers in a mucoprotein gel. -provide cushioning, shock absorption, and support for the vertebrae during movement. -herniation occurs when the nucleus pulposus protrudes through a compromised annulus fibrosus. -occurs in cervical and lumbar discs mostly. ***herniation of a thoracic disc is a Medical Emergency resulting in paralysis.

Patho

*NSAIDS; decrease , pain and swelling *Opioids (sciatica) *antispasmodics; decrease muscle spasms *neuropathic pain; gabapentin (Neurontin), duloxetine (Cymbalta); pregabalin (Lyrica); decreases pain r/t nerve damage. milder s/e than opioids *Tramadol (Ultram); centrally acting opiate receptor agonist; mild/moderate pain. *Epidural injections; of cortisone/corticosteroids or anesthetics; decrease pain and inflammation. *hot/cold therapy; nonpharm

Pham. herniated discs

*Relieve pain Heal the involved disc and regain mobility -assess -provide education on procedures, meds., thx -support -nursing care b4/after procedure 5 P's neurovascular assessment: -pulse -pallor -paresthesia -paralysis -pain

Primary Goals

join 2 or more vertebrae together using bone grafts, screws and rods. prevent motion between the 2 vertebrae and reduce pain. Anterior or post.

Spinal fusion Herniated Disc Surgery

*Raise 30 to 70 degrees; any sciatic pain? + if feel pain. L4-S1 *sciatic common in children

Straight leg test; DX Sciatica

*Emergency surgery to relieve pressure on the cauda equina

Therapies Cauda equina syndrome

*Application of hot/cold thx *NSAIDS or other analgesics *Antispasmodics (atropine, phenobarbital) *Neuropathic pain meds *Epidural cortisone injections *Surgery *PT *Chiropractic thx

Therapies for Lumbar herniated disc

Ruptured disc, slipped disc, or herniated nucleus pulposus -spinal cord ruptures, allowing fluid in the disc to leak out and irritate nearby nerves. *Causes a decrease in the ability of the disc to cushion the joints of the vertebrae, causing back pain and limited mobility.

herniated intervertebral disc

*NSAIDS *Antispasmodics *Epidural cortisone inj *Surgery *PT

therapies Sciatica

*Application of heat/cold *NSAIDS or other analgesics *Antispasmodics *Nerve pain meds *Epidural cortisone inj *Surgery *PT *chiropractic thx

therapies for Cervical Herniated Disc