HerniaHernia NucleusNucleus PulposusPulposus

By Melany TaurusiaBy Melany TaurusiaUWKSUWKS

AnatomyAnatomy

DefinitionDefinition

HNP HNP → → part or all of the soft, gelatinous part or all of the soft, gelatinous central portion of an central portion of an

intervertebral intervertebral disk (the nucleus disk (the nucleus pulposus) is forced pulposus) is forced through a through a weakened part of the disk weakened part of the disk → → nerve root irritation nerve root irritation →→ back pain back pain and leg pain and leg pain

Alternative Names

• Lumbar radiculopathyLumbar radiculopathy

• Herniated intervertebral diskHerniated intervertebral disk

• Prolapsed intervertebral diskProlapsed intervertebral disk

• Slipped diskSlipped disk

• Ruptured disk Ruptured disk

CausesCauses

• trauma or straintrauma or strain

• degenerative changesdegenerative changes

IncidenceIncidence

• The most common causes of lower The most common causes of lower back painback pain

• Most herniation Most herniation →→ lumbar area of the lumbar area of the spine (15 times more often than spine (15 times more often than cervical disk herniation)cervical disk herniation)

Risk factorsRisk factors

• middle aged and older menmiddle aged and older men

• involved in strenuous physical involved in strenuous physical activity. activity.

• congenital conditions congenital conditions →→ affect the affect the size of the lumbar spinal canalsize of the lumbar spinal canal

SymptomsSymptoms

• severe low back pain severe low back pain • pain radiating to the buttocks and legspain radiating to the buttocks and legs• pain made worse with coughing , pain made worse with coughing ,

straining, or laughing straining, or laughing • tingling or numbness in legs or feet tingling or numbness in legs or feet • muscle weakness or atrophy in later muscle weakness or atrophy in later

stages stages • Muscle spasmMuscle spasm

Signs and testsSigns and tests

• neurological examinationneurological examination →→ to evaluate to evaluate muscle reflexesmuscle reflexes sensationsensation muscle strengthmuscle strength

• Straight-leg-raising testStraight-leg-raising test

→→ leg pain leg pain

Diagnostic TestDiagnostic Test

• Spine X-raySpine X-ray

• Spine MRI and/or spine CTSpine MRI and/or spine CT

• MyelogramMyelogram

• EMG EMG

Lateral (side) MRI view of a herniated L5-S1 disc.  Lateral (side) MRI view of a herniated L5-S1 disc.  Note the protrusion of disc material beyond the normal Note the protrusion of disc material beyond the normal

confines of the disc space compared to healthy discs above thisconfines of the disc space compared to healthy discs above this

TreatmentTreatment

• ConservativeConservative

☺ ☺ Rest → slow mobilizationRest → slow mobilization

☺ ☺ Pain medicationsPain medications

☺ ☺ Chiropractic/osteopathic Chiropractic/osteopathic manipulations manipulations and Physical therapyand Physical therapy

☺ ☺ Epidural steroid injectionsEpidural steroid injections

☺ ☺ Ozone theraphyOzone theraphy

• SurgerySurgery

☺ ☺ Lumbar laminectomyLumbar laminectomy

☺ ☺MicrodiscectomyMicrodiscectomy

☺ ☺ microendoscopic lumbar discectomymicroendoscopic lumbar discectomy

Lumbar laminectomy (open Lumbar laminectomy (open decompression)decompression)

microendoscopic lumbar microendoscopic lumbar discectomydiscectomy

ComplicationsComplications

• chronic back pain chronic back pain

• permanent spinal cord injury (very permanent spinal cord injury (very rare) rare) – loss of movement or sensation in the loss of movement or sensation in the

legs or feet legs or feet – loss of bowel and bladder function loss of bowel and bladder function

PreventionPrevention

• Safe workSafe work

• play practicesplay practices

• proper lifting techniquesproper lifting techniques

• weight controlweight control

Exercises to treat sciatica from Exercises to treat sciatica from herniated discherniated disc