PROLAPSED INTERVERTEBRAL DISC
DEFINITION
A prolapsed intervertebral disc, commonly known as a herniated disc or
slipped disc, refers to a condition in which the soft inner core of an
intervertebral disc protrudes through the tough outer layer. This can result in
compression of nearby nerves, leading to symptoms such as localized or
radiating pain, numbness, tingling, or weakness in the affected area.
CAUSES AND RISK FACTORS
1.AGE: As people age, the intervertebral discs lose water content and
elasticity, making them more prone to degeneration and herniation.
2.TRAUMA: Sudden trauma or injury to the spine, such as from a fall or car
accident, can cause a disc herniation.
3.REPETITIVE STRAIN: Activities or occupations that involve repetitive
bending, lifting, or twisting motions can put stress on the spine and increase
the risk of disc herniation.
4.GENETICS: There may be a genetic predisposition to developing disc
herniation, as certain inherited traits can affect the structure and integrity of
the intervertebral discs.
5. OBESITY: Excess body weight can increase the load on the spine and
accelerate disc degeneration, raising the risk of disc herniation.
6. POOR POSTURE: Maintaining poor posture, such as slouching or sitting
for long periods without adequate lumbar support, can contribute to disc
degeneration and herniation over time.
7. SMOKING: Smoking has been linked to accelerated disc degeneration and
weakened spinal structures, increasing the likelihood of disc herniation.
8. OCCUPATION: Jobs that involve heavy lifting, repetitive motions, or
prolonged sitting or standing may increase the risk of disc herniation due to
the strain placed on the spine.
9. GENDER: Men are more likely than women to experience disc herniation,
although the reasons for this difference are not fully understood.
10. EXISTING SPINAL CONDITIONS : Pre-existing spinal conditions such
as degenerative disc disease, spinal stenosis, or spondylolisthesis can
predispose individuals to disc herniation by weakening the spinal structures.
SIGNS AND SYMPTOMS
1. Pain (localized or radiating)
2. Numbness and tingling
3. Muscle weakness
4. Changes in reflexes
5. Difficulty with mobility
6. Aggravation of pain by specific activities
7. Bowel or bladder dysfunction (in severe cases)
PATHOPHYSIOLOGY
Normal Intervertebral Disc Structure
Degeneration and Weakening
Development of Tears or Fissures
Nucleus Pulposus Herniation
Compression of Neural Structures
Inflammatory Response
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V
Neural Impingement and Ischemia
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1.Normal Disc Structure:The intervertebral
disc consists of a tough outer layer (annulus V
fibrosus) and a soft inner core (nucleus
Secondary Changes
pulposus).
2.Degeneration: Aging, repetitive stress, or
injury cause degenerative changes in the DIAGNOSTIC EVALUATION
disc, leading to loss of water content,
1.History collection
decreased elasticity, and structural
alterations. 2.Physical Examination
3.Tears/Fissures: Degeneration may result in 3.maging Studies:
tears or fissures in the annulus fibrosus,
- X-RAYS: Rule out other
weakening the disc’s integrity.
causes, assess spinal
4.Herniation: Weakening of the annulus alignment, and detect
fibrosus allows the nucleus pulposus to degenerative changes.
bulge or herniate through the outer layer of
- MRI (MAGNETIC
the disc.
RESONANCE IMAGING):
5.Compression: Herniated disc material can Provide detailed images of
compress nearby neural structures, leading soft tissues, including discs,
to irritation, inflammation, and mechanical nerves, and surrounding
distortion. structures, confirming the
diagnosis and assessing
6.Inflammation:Compression triggers an
severity.
inflammatory response, contributing to
nerve sensitization, pain transmission, and - CT (COMPUTED
tissue damage. TOMOGRAPHY) SCAN:
Occasionally used for
7.Neural Impingement: Prolonged
additional information,
compression may cause neural
especially in surgical
impingement and ischemia, resulting in
planning.
nerve dysfunction, demyelination, and
axonal injury. 4.Other Tests: Depending
on symptoms and medical
8.Secondary Changes: Chronic compression
history, may include
can lead to osteophyte formation, spinal
electromyography (EMG) to
assess nerve function or nerve conduction studies to evaluate nerve
impulses.
MEDICAL MANAGEMENT
1. PAIN MANAGEMENT: NSAIDs, muscle relaxants, analgesics,Epidural
steroid injections for inflammation,Nerve pain medications and short-term
oral steroids.
2. PHYSICAL THERAPY: Exercises, manual therapy, and modalities.
3. ACTIVITY MODIFICATION: Posture correction and ergonomic
adjustments.
4. BRACING: Lumbar support braces or belts.
8. FOLLOW-UP AND MONITORING: Regular appointments and repeat
imaging as needed.
SURGICAL MANAGEMENT
1. Discectomy: Removing the herniated portion of the disc.
2. Laminectomy: Removing part of the vertebra to relieve pressure.
3. Spinal Fusion: Joining adjacent vertebrae together.
4. Artificial Disc Replacement: Replacing the damaged disc with a
prosthesis.
5. Endoscopic Discectomy: Minimally invasive removal of the herniated
disc material.
6. Nucleoplasty: Using radiofrequency energy to shrink and remove disc
material.
7. Percutaneous Laser Disc Decompression: Vaporizing disc material
with a laser.
NURSING MANAGEMENT
1. Pain Management: Administer medications, teach relaxation techniques.
2. Mobility Assistance: Help with positioning, educate on proper body
mechanics.
3. Patient Education: Provide information about the condition, treatments,
and self-care.
4. Assessment and Monitoring: Regularly check neurological status and
watch for complications.
5. Prevention of Complications: Encourage deep breathing, prevent
pressure ulcers.
6. Collaboration and Communication :Coordinate care with the team,
provide emotional support.
7. Promotion of Self-Care: Teach self-care techniques and encourage
independence.
8. Follow-Up and Rehabilitation: Schedule follow-up appointments,
arrange for rehabilitation services.
