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Angeles University Foundation

Lumbar Herniated Disc


Written Report in RLE

College of Nursing S.Y. 2011-2012

Submitted to: Teresa Cabanayan RN.MN. Submitted by: Regina G. Bolado


Lumbar Herniated Disc

By: Peter F. Ullrich, Jr., MD As a disc degenerates, it can herniate (the inner core leaks out), which is known as a disc herniation or a herniated disc. The weak spot in the outer core of the disc is directly under the spinal nerve root, so a herniation in this area puts direct pressure on the nerve, which in turn can cause sciatica. Pain that radiates down the leg and is caused by a herniated disc is called a radiculopathy.

Ruptured, Slipped or herniated disk About herniated disk, this ruptured of vertebral disk can be cause by normal sign of aging or traumatic injury, strain and intervertebral joint degeneration. Herniated disk can push painfully against nerve root sending pain down to sciatic nerve and resulting into burning tingling and numbing sensation from lower back down to honorable feet. Vertebral disk are the spinal columns shock absorbers that disk cushon the vertebral bones allow them to twist or bend (allowing mechanical stress applied to spine when body moves) that can ruptured embolus fibroses so where in the nucleus pulposus herniates into spinal canal.. A vertebral disk has two main parts the soft inner nucleus called the nucleus pulposus and tough fibrous surrounded by ring outer wall, called the embolus fibroses. A herniated disk occurs when small tears form on the wall of an interred disk; damage the pieces of the nucleus which can hardly break apart with age push through the tears and out of the disk wall. With that the vertebrae move closely together and in return it exerts pressure in nerve roots as they exit in the vertebrae. The herniated disk often compresses nerve root causing pain.

Herniation occurs in three stages: Protrusion the nucleus pulposus presses against the embolus fibroses Extrusion- the nucleus pulposus bulge forcibly through the embolus fibroses, pushing against the nerve root. Sequestration - occurs when the embolus give way as the disk core burst and presses against the nerve root

Risk Factors Advancing age Male History of back injury Previous hernaited disk Long periods of sitting and lifting or pulling heavy objects Frequent bending or twisting

Exposure to constant vibration such as driving Lack regular exercise Smoking Overweigt Signs and symtoms Severe lower back pain(buttocks, legs, feet) initial sign Numbness or titillating in your hands or legs. Sudden pain after trauma, subsiding after few days only to return shorter intervals with progressive intensity Sciatic pain after trauma Sensory or motor loss in the area innervated by the compress spinal nerve root Weakness and atrophy of leg muscle(later sign)

Lumbar Herniated Disc Treatments

In most cases, if a patients low back and/or leg pain is going to get better after a lumbar herniated disc it will start to do so within about six weeks. While waiting to see if the disc will heal on its own, several non-surgical treatment options can help reduce the back pain, leg pain and discomfort caused by the herniated disc. Several of the most common nonsurgical treatments include: Physical therapy Osteopathic/chiropractic manipulations Non-steroidal anti-inflammatory drugs (NSAIDs) Oral steroids (e.g. prednisone or methyprednisolone) An epidural (cortisone) injection If the pain and other symptoms continue after six weeks, and if the pain is severe, it is reasonable to consider microdiscectomy surgery as an option to alleviate the pain from the herniated disc. Lumbar Herniated Disc Surgery A microdiscectomy is designed to take the pressure off the nerve root by removing the portion of the disc that is pressing on it, and to provide the nerve with a better healing environment.Using microsurgical techniques and a small incision, a microdiscectomy can usually be done on an outpatient basis or with one overnight stay in the hospital, and most patients can return to work full duty in one to three weeks. With an experienced surgeon, the success rate of surgery for a lumbar herniated disc should be about 95%. Usually, only the small portion of the disc that is pushing against the nerve root needs to be excised, and the majority of the disc remains intact. Unfortunately, approximately 10% of patients will experience another disc herniation at the same location. This is most likely to happen early in the postoperative period (within the first three months), although it can happen years later. Usually a recurrence can be handled with another microsurgery, but if it keeps recurring multiple times, a fusion surgery to stop the motion at the disc level and remove all the disc material may be considered. Nursing responsibilities: 1. 2. 3. 4. With the patient and doctor, plan a pain control regimen. Encourage the patient to express his concerns about the disorder. Urge the patient to perform as much self-care as his immobility and pain allow. Help the patient identify and perform care and activities that promote rest and relaxation. 5. Use anti embolism stockings, as prescribed, and encourage the patient to move his legs, as allowed. 6. Assess the patients pain status and his response to the pain-control regimen. 7. Perform neurovascular checks of the patients legs such as color, motion, temperature, and sensation. 8. Monitor vital signs, and check for bowel sounds and abdominal distention. 9. Teach the patient about treatments, which include bed rest and pelvic traction. 10.Urge the patient to maintain an ideal body weight to prevent lordosis caused by obesity. 11.Discuss all prescribed medications with the patient.

12.If surgery is required, explain all preoperative and postoperative procedures and treatments to the patient and his family.

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