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NUCLEUS PULPOSUS HERNIATION, ANGGRAINI BARUS 1808260110 - Coggle Diagram
NUCLEUS PULPOSUS HERNIATION
ANATOMY
The vertebral column (spine or backbone) is a curved structure composed of bony vertebrae that are interconnected by cartilaginous intervertebral discs.
DEFENITION, ETIOLOGY & RISK FACTOR
Etiology
Disc herniation and disc degeneration are associated terms, being nucleus pulposus herniation a possible evolution from a degenerative disc. Disc degeneration is usually associated with the loss of proteoglycans.
Multiple factors influence the degenerative process such as genetic, mechanical, and behavioral.
Risk Factor
Genetic
Smoking
Heavy physical workload
Aging
Height
Obesity
Defenition
Nucleus pulposus herniation is the most common cause of - sciatic pain and one of the most common indications for spine surgery worldwide.
This condition presents as a displacement of the nucleus pulposus beyond the intervertebral disc space.
PATHOPHYSIOLOGY
Disc herniation is a consequence of degenerative changes in the annulus; those changes are age-related adaptive modifications in the disc structure that encompass desiccation, fissures, disc narrowing, mucinous degeneration, intradiscal gas (vacuum), osteophytes, inflammatory changes, and subchondral sclerosis. Annulus fissures predispose to a weakness, which allows disc material to bulge or migrate outside the annulus margins.
Symptoms
Arm or leg pain. If your herniated disk is in your lower back, you'll typically feel the most pain in your buttocks, thigh and calf. You might have pain in part of the foot, as well. If your herniated disk is in your neck, you'll typically feel the most pain in your shoulder and arm. This pain might shoot into your arm or leg when you cough, sneeze or move into certain positions. Pain is often described as sharp or burning.
Numbness or tingling. People who have a herniated disk often have radiating numbness or tingling in the body part served by the affected nerves.
Weakness. Muscles served by the affected nerves tend to weaken. This can cause you to stumble, or affect your ability to lift or hold items.
DIFFERENTIAL DIAGNOSIS
Conjoined nerve root
Facet joint cyst
Facet joint/ligamentum flavum hypertrophy
Neurinoma/schwannoma
Spondylolisthesis
DIAGNOSIS APPROACH
Physical Examination
A disk herniation lateral to the nerve root ( a "shoulder disk") causes the patient to lean away from the side of the herniation, whereas a herniation medial to the nerve root (an "axillary disk") causes the patient to lean towards the side of the herniation. There may be paraspinal muscle spasm, as indicated by obliteration of the central furrow.
Numerous examination maneuvers (eg, Lasegue classic test, Lasegue rebound sign, Lasegue differential sign, Braggard sign, flip sign, Deyerle sign, Mendel-Bechterew sign, well-leg test or Fajersztajn sign, both-legs or Milgram test) are available but they cloud the issue, in that the sciatic nerve-root tension or straight-leg raising test (SLRT) is the basis for nearly all of them.
The SLRT should always be performed bilaterally. The test is considered positive if sciatic pain is reproduced between 30º and 70º of elevation.
Imaging
X-ray
Patient suspected of having disk herniation is to show indirect evidence of disk degeneration, such as disk-space narrowing, endplate changes, osteophytes, facet-joint degeneration, and alteration of sagittal balance.
MRI
MRI with gadolinium contrast enhancement is often used to evaluate patients who have already undergone decompression surgery and are suspected of having recurrent or residual disk herniation.
COMPLICATION & PROGNOSIS
Prognosis
The majority of patients suffering from nucleus pulposus herniation experience symptoms resolution without surgery.
Conservative treatment is effective, and patients usually experience symptom relief after a couple of weeks. However, some cases do not improve with conservative treatment and may require more invasive therapies such as nerve root steroid injection or even surgery.
Complications
Conservative treatment is effective, and patients usually experience symptom relief after a couple of weeks. However, some cases do not improve with conservative treatment and may require more invasive therapies such as nerve root steroid injection or even surgery.
Cauda equina syndrome is another complication that results from lumbosacral nerve roots compression with possible bowel or bladder dysfunction. It is a rarely occurring condition (less than 1%). However, it is considered an absolute indication for acute surgical resolution, and early decompression is associated with symptoms improvement.
EPIDEMILOGY
The estimated prevalence of disc herniation is approximately 1 to 3%. The highest observed incidence is between 30 to 50 years, and it is more frequent in men than in women (ratio 2 to 1).
TREATMENT
Therapeutic management of nucleus pulposus herniation encompasses conservative and surgical treatment. Conservative treatment is the main strategy due to the natural history of nucleus pulposus herniation, with good response to pain treatment or nerve root steroid injection as well as some cases of spontaneous regression.
Some patients will not benefit from conservative treatment and will require surgery to decompress the nerve involved. Classical surgical indications are motor deficit, cauda equina syndrome, and persistent pain after conservative treatment.
ANGGRAINI BARUS
1808260110
