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Herniated Intervertebral Disk - Coggle Diagram
Herniated Intervertebral Disk
Definition
When a spinal disk’s soft center (nucleus pulposus) pushes out through a tear in the tougher exterior (annulus fibrosus).
Causes
Age-related degeneration (disk dries out).
Trauma or sudden strain (e.g. lifting, twisting)
happens more in men aged 30-50
poor posture (Slouching or incorrect sitting/standing positions over time, increases pressure on the disks)
smoking (Reduces oxygen supply to the disks → speeds up degeneration)
obesity (Extra body weight puts more stress on the spine)
Pathophysiology
Disks lose ability to absorb shock due to aging or wear and tear . They shrink and slip easily
where it happens?
Lumbar region (most common): especially L4-L5 and L5-S1.
Cervical region: commonly C5-C6 or C6-C7.
S&S
L4-L5
5th Lumbar is affected
Pain in hip, thigh, foot; muscle spasm, paresthesia, foot drop, reduced ankle reflex
L5-S1
1st Sacral is affected
Pain in glutes, calf, heel, foot sole; toe walking difficulty; paresthesia in lateral foot
C5-C6
6th cervical is affected
Pain in neck, shoulder, thumb; reduced biceps reflex; forearm numbness
Complication
Cauda equina syndrome: a medical emergency with bowel/bladder incontinence and leg paralysis from severe nerve compression.
Diagnosis
Straight leg raise test
It’s a physical exam maneuver used to check for nerve root irritation or compression, particularly from a herniated lumbar disk, which can cause sciatica.
Imaging: X-ray, CT, MRI, or myelogram (dye + X-ray).
Treatment
Medications
NSAIDS, analgesics
Muscle relaxants
Anticonvulsants (Gabapentin, Pregabalin) for nerve pain
Sedatives or tranquilizers if needed
Non-surgical
Continue light activities for 2–6 weeks
Physiotherapy, heat therapy, posture correction
Surgical Options
Diskectomy: removes part or all of the disk
Laminectomy: removes part of vertebra to relieve pressure
Spinal fusion: stabilizes spine using bone graft (often from iliac crest) or implant (e.g. BAK device)
IDET: uses heat to shrink and seal bulging disk
Microdiskectomy: A minimally invasive surgery to remove the part of the herniated disk that is pressing on a nerve.
Foraminotomy: Surgery to enlarge the foramen, which is the small opening where the nerve roots exit the spinal canal.
What is spinal fusion?
joins two or more of vertebras so they grow into one solid piece. It helps stop pain and prevent more damage by making that part of the spine steady and strong. The surgeon puts a piece of bone (called a bone graft) or a metal device between the vertebrae to help them grow together over time.
Health Education
Sleep on a firm mattress as it provides better spinal support and helps maintain natural alignment of spine during rest
While lying supine, flex knees at 45° with a small pillow under knees and a small pillow under the head. Flexing the knees reduce lumbar spine pressure and relaxes the back muscles helping to alleviate nerve root compression and pain. Pillow under the head maintains neutral neck alignment.
Avoid bending, lifting, or twisting the back. These movements increase pressure on the affected disk and can worsen the herniation.
Follow a diet to maintain or lose body weight. Excess weight increases mechanical load on the spine and disks
Wear flat-heeled shoes with good support. Proper footwear improves posture and balance.
Use proper lifting techniques and maintain good body mechanics. Lifting with knees (not back) and keeping the load close to the body minimizes strain on the lumbar spine and reduces the risk of aggravating the disk herniation.
pre-op care
Assessment
baseline neurological status (motor strength, sensation, reflexes).
Assess pain level and location.
Check vital signs.
Pt education
Explain the procedure, expected outcomes, and possible risks.
Preparation
Ensure informed consent is signed.
NPO status as ordered
Encourage the patient to empty their bladder before surgery.
post-op care
Neurological Monitoring:
Regularly check motor function, sensation, and reflexes.
Assess pain frequently
Pain management
Administer analgesics as prescribed.
Mobility
Assist with gradual mobilization as ordered.
Teach proper body mechanics to avoid strain.
Encourage ambulation when permitted, usually with support.
Wound care
Monitor the surgical site for bleeding, drainage, or signs of infection.
Keep the dressing clean and dry.
Report any signs of infection immediately (redness, swelling, fever).
Bladder and Bowel Function
Monitor for urinary retention or incontinence.
Encourage regular bowel movements, provide stool softeners if needed.
Pt education
Teach about activity restrictions (no heavy lifting, twisting, bending).
Teach signs of complications to watch for (e.g., increased pain, numbness, weakness).