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Prolapsed intervertebral disc - Coggle Diagram
Prolapsed intervertebral disc
definition
prolapsed disc
displacement of disc material extends beyond intervertebral disc space, but still contained between annulus fibrosis
herniated disc
material from nucleus of spinal disc leaks out through a crack or tear of disc
sequestrated fragment
piece of disc breaks off and migrates to spinal canal
epidemiology
most common age 30-50
male:female = 2:1
often asymptomatic
flexion and compression is only way to make a healthy disc prolapse
symptoms
often asymptomatic, but when symptoms are present it is very painful through nerve root irritation and compression
pathophysiology
with ageing, discs lose water and slowly degenerate
structural breakdown = reduced water retention, cracks and fissures in annulus fibrosis
annulus fibrosius weaknes over time and nucleus pulposus can escape
herniation = nucleus pulposus bulges or ruptures through annulus fibrosus, causing mechanical compression on spinal cord/nerve root, pain , numbness etc
causes irritation and inflammatory chemicals (chemokines) released for inflammation
prognosis
1/3 sequestrations disappear and most get smaller
96% regression rate for sequestrations
symptoms ease before scan does
assessment
motor signs - myotomes and reflexes
OMG
palpation
balance test
slump test
ROM (active and passive)
leg length testing
muscle length testing
gait, posture
schobers test
light touch sensory test and dermatomes
neurodynamic test (slump/SLR)
treatment
exercise
manual therapy
psychological therapies eg confidence to return to work
hydrotherapy
trigger point release
balance improvement (if a fall was involved)
sliders, gliders, tensioners
heat and ice
accessory mobs
proprioceptive taping
stretching to loosen affected muscles
massage
epidural injections for acute sciatica
decompression surgery if all else fails