Handout Orthopedic Nursing Hnp (herniated Nucleus Pulposus)

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Herniated Nucleus Pulposus (HNP) Alternative Names  Lumbar radiculopathy  Cervical radiculopathy  Herniated intervertebral disk  Prolapsed intervertebral disk  Slipped disk  Ruptured disk Definition A herniated nucleus pulposus is a slipped disk along the spinal cord. The condition occurs when all or part of the soft center of a spinal disk is forced through a weakened part of the disk. Causes These disks may herniate (move out of place) or rupture from trauma or strain Brought about by as a car accident or lifting a very heavy object *Radiculopathy refers to any disease affecting the spinal nerve roots. A herniated disk is one cause of radiculopathy (sciatica).

SYMPTOMS OF HERNIATED CERVICAL DISK  Arm muscle weakness  Deep pain near or over the shoulder blades on the affected side  Neck pain, especially in the back and sides  Increased pain when bending the neck or turning head to the side  Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers, or chest  Pain made worse with coughing, straining, or laughing  Spasm of the neck muscles Exams and Tests  physical examination  history  neurological examination will evaluate muscle reflexes, sensation, and muscle strength  examination of the spine will reveal a decrease in the spinal curvature in the affected area “Leg pain”

 that occurs when you sit down on an exam table and lift your leg straight up usually suggests a herniated lumbar disk

Lumbar area

 Most herniation takes place  Occurs 15 times more often than cervical (neck) disk herniation  It is one of the most common causes of lower back pain Cervical disks  8% of the time and the upper-to-mid-back (thoracic) disks only 1 - 2% of the time *Nerve roots (large nerves that branch out from the spinal cord)  may become compressed, resulting in neurological symptoms, such as sensory or motor changes Prevalence  middle-aged and older men  involved in strenuous physical activity  congenital conditions that affect the size of the lumbar spinal canal Symptoms SYMPTOMS OF HERNIATED LUMBAR DISK Muscle spasm Muscle weakness or atrophy in later stages Pain radiating to the buttocks, legs, and feet Pain made worse with coughing, straining, or laughing  Severe low back pain  Tingling or numbness in legs or feet    

Foraminal compression test of Spurling  -is done to diagnose cervical radiculopathy. For this test, you will bend your head forward and to the sides while the health care provider provides slight downward pressure to the top of the head. Increased pain or numbness during this test is usually indicative of cervical radiculopathy DIAGNOSTIC TESTS  EMG may be done to determine the exact nerve root that is involved.  Nerve conduction velocity test may also be done.  Myelogram may be done to determine the size and location of disk herniation.  Spine MRI or spine CT will show spinal canal compression by the herniated disk.  Spine x-ray may be done to rule out other causes of back or neck pain. However, it is not possible to diagnosis herniated disk by spinal x-ray alone. Treatment

 Short period of rest with pain and antiinflammatory medications  Followed by physical therapy include steroid injections  Surgery MEDICATIONS

2 >(NSAIDs) and narcotic pain killers will be given to people with a sudden herniated disk caused by some sort of injury (such as a car accident or lifting a very heavy object) that is immediately followed by severe pain in the back and leg

 persistent, severe back pain develops  numbness  loss of movement

 weakness  bowel or bladder changes

>NSAIDs are used for long-term pain control >narcotics may be given if the pain does not respond to anti-inflammatory drugs >muscle relaxants are usually given ff the patient has back spasms >steroids may be given either by pill or directly into the blood through an IV INJECTIONS  Steroid injections  in the area of the herniated disk can help control pain for several months  reduce swelling around the disk and relieve many symptoms.  done on an outpatient basis, using x-ray or fluoroscopy to identify the area where the injection is needed.

LIFESTYLE CHANGES

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Any extra weight being carried by an individual, especially up front in the stomach area will make back pain worse. Diet and exercise are crucial to improving back pain in overweight patients Training on how to properly lift, dress, walk, and perform other activities Work on strengthening the muscles of the abdomen and lower back to help support the spine. Flexibility of the spine and legs is taught in many therapy programs. Back braces to help support the spine *overuse of these devices can weaken the abdominal and back muscles, leading to a worsening of the problem.

SURGERY *Done if symptoms persist despite other treatments

Diskectomy  removes a protruding disk  requires general anesthesia (asleep and no pain) and 2 - 3 day hospital stay.  Encouraged the pt. to walk the first day after surgery to reduce the risk of blood clots *Complete recovery takes several weeks. If more than one disk needs to be taken out or if there are other problems in the back besides a herniated disk, more extensive surgery may be needed. This may require a much longer recovery period. Microdiskectomy  procedure removing fragments of nucleated disk through a very small opening

Chemonucleolysis  involves the injection of an enzyme (called chymopapain) into the herniated disk to dissolve the protruding gelatinous substance. This procedure may be an alternative to diskectomy in certain situations Possible Complications  Long-term back pain  Loss of movement or sensation in the legs or feet  Loss of bowel and bladder function  Permanent spinal cord injury (very rare) When to Contact a Medical Professional

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Weight belts can be helpful in preventing injuries in those whose work requires lifting of heavy objects

Prevention Safe work and play practices, proper lifting techniques, body mechanics and weight control may help to prevent back injury in some people.