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Prolapsed Intervertebral Disc: By: Diksha Solanki Bot 4 Year

A prolapsed intervertebral disc occurs when the soft central portion of an intervertebral disc bulges out beyond the damaged outer rings of the disc. It most commonly affects the lower back. The main symptoms are low back pain, sciatic pain radiating down the leg, and possible neurological symptoms depending on the nerve root compressed. Diagnosis involves clinical examination and imaging tests like MRI. Treatment includes conservative options like rest, medications, physical therapy and surgery if conservative options fail. Occupational therapy focuses on pain relief, muscle relaxation, activity modification and exercises to restore function.

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344 views

Prolapsed Intervertebral Disc: By: Diksha Solanki Bot 4 Year

A prolapsed intervertebral disc occurs when the soft central portion of an intervertebral disc bulges out beyond the damaged outer rings of the disc. It most commonly affects the lower back. The main symptoms are low back pain, sciatic pain radiating down the leg, and possible neurological symptoms depending on the nerve root compressed. Diagnosis involves clinical examination and imaging tests like MRI. Treatment includes conservative options like rest, medications, physical therapy and surgery if conservative options fail. Occupational therapy focuses on pain relief, muscle relaxation, activity modification and exercises to restore function.

Uploaded by

ISIC IRS
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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BY: DIKSHA SOLANKI

BOT 4th year

PROLAPSED
INTERVERTEBRAL DISC
DEFINITION

 PIVD is also known as slip disc or spinal disc


herniation.

 it is medical condition affecting the spine in


which a tear in the outer, fibrous ring (annulus
fibrosus) of an intervertebral disc allows the
soft, central portion (nucleus pulposus) to
bulge out beyond the damaged outer rings.
WHAT IS INTERVERTEBRAL DISC?

 It is a hydrostatic, load bearing structure


between the vertebral bodies from C2-3 to L4-
5.
 The intervertebral discs provide cushioning
between vertebrae and absorb pressure put
on the spine. 
 It is relatively avascular
 L4-5, largest avascular structure in the body.
RELEVANT ANATOMY

 The intervertebral disc consists of :


 the cartilage end-plates disc recieves nutrition
from vertebral bodies via end-plates, by
diffusion.
 Nucleus pulposus is a gelatinous material
 Annulus fibrosus a structure composed of
concentric rings of fibrocartilagious tissue.
PATHOLOGY OF DISC PROLAPSE

 THE TERM ‘PROLAPSED DISC’ MEANS


THE PROTRUSION OR EXTRUSION OF
THE NUCLEUS PULPOSUS THROUGH A
RENT IN ANNULUS FIBROSUS.
STAGES
STAGE OF DEGENERATION { NUCLEUS DEGENERATION}
 softening of the nucleus and its fragments.
 Weakening of posterior part of the annulus

NUCLEUS DISPLACEMENT :
The nucleus is under positive pressure at al the times.

STAGE OF PROTRUSION {just a bulge}


STAGE OF EXTRUSION {out,but in contacy}
 Annulus becomes weak due to injury

 Nucleus tends to bulge through the defect called DISC


PROTRUSION.

 Finally the nucleus comes out of the annulus called DISC


EXTRUSION.
STAGE OF SEQUESTRATION
The extruded disc may loose its contact with parent
disc called SEQUESTRATED DISC.
STAGE OF PULPOSUS FIBROSIS.[becomes
flattened]
DIAGNOSIS
this is mainly clinical

CLINICAL FEATURES

 Patient is usually an adult between 20-40 yrs of age.


 Commonest symptom is LOW BACKACHE
 SCIATIC PAIN
 NEUROLOGICAL SYMPTOMS
1) LOW BACKACHE
 The onset of backache may be ACUTE or CHRONIC.

 ACUTE BACKACHE is severe with the spine held rigid


by muscle spasm and any movement at the spine painful.

 CHRONIC BACKACHE , the pain is dull and diffuse,


usually made worse by exertion , forward bending , sitting
or standing in one position for a long time.

 Relived by REST.
2) SCIATIC PAIN

 Usually associated with LBA.


 pain radiates to the gluteal region , the back of the
thigh and leg.
 Pattern of radiation depends upon the root
compressed.
 Radiation may begin on walking,
 Relieved on rest.
3) NEUROLOGICAL SYMPTOMS

 Patient complains of PARAESTHESIAS


 NUMBNESS in the leg or foot
 Weakness in muscles.
 Disc compression causes CAUDA EQUINA
syndrome.
irregular LMN type paralysis in lower limbs,
bilateral absent ankle jerks
Hypoaesthesia in region of L5 to S4 dermatomes
Urinary and bowel incontinence.
EXAMINATION
 the back and limbs are examined with the patient undressed.
Following observations are made:
1) POSTURE :
 flattened lumbar spine.
 whole trunk is shifted forwards on the hip.
 Trunk is tilted to one side (SCIATIC TILT or SCOLIOSIS).
2) MOVEMENTS
 Patient is unable to bend forwards.
 any such attempts initiates severe muscle spasm in paraspinal
muscles.

3) TENDERNESS
 Diffuse tenderness in the lumbo-sacral region.

4) STRAIGHT LEG RAISING TEST(SLRT)


 Indicates nerve root compression
 positive SLRT at 40 degree or less.
4) LASEGUE TEST
 modification of SLRT where first the hip is lifted to 90
degree, with the knee bent.
 knee is gradually extended by the examiner .
 if nerve stretch is present, it will not be possible to do so ,
patient will experience pain in the back of the thigh or leg.
NEUROLOGICAL EXAMINATION

 Motor weakness
 Sensory loss or loss of reflex corresponding to the affected
nerve root.
 examination of the muscles supplied by L4, L5 and S1 roots
affected more commonly.
 weakness in extensor hallucis longus is easily detected by
asking the patient to dorsiflex the big toe against resistance.
 Supplied by L5.
 hypoaesthesia in the dermatome of the affected root.
INVESTIGATIONS
 X-rays
Affected disc space may be narrowed.

 Myelography

 CT scan
Posterior border of disc is flat or convex.
Loss of pre-thecal fat shadow

 MRI scan
TREATMENT

 CONSERVATIVE TREATMENT
i. REST : on hard bed , not more than 2-4 days.
ii. DRUGS: analgesics and muscle relaxants,
iii. OCCUPATIONAL THERAPY : for ADLs
iv. PHYSIOTHERAPY : hot water fermentation &
gentle arching exercises, TENS
TREATMENT

 OPERATIVE TREATMENT
a) LAMINOTOMY hole is made in the lamina for
wider exposure,
b) LAMINECTOMY laminae on both sides, with
spinous process,
are removed. Such a wide
exposure is required
for a big, central disc
producing CAUDA
EQUINA SYNDROME.
OT INTERVENTION

 Conservative treatment
 remediations
 precautions
CONTRAINDICATIONS

spinal extension ( bending back) is


contraindicated
When no position or movement decreases or
centralizes the pain.

 Spinal flexion
(bending forward) is
contraindicated
When extension relieves the symptoms
ACUTE PHASE

 to relieve pain.
 to promote muscle relaxation.
 To relieve inflammation and pressure against
the pain sensitive or neurologic structures.
 patient education.
 prevention.
 POSTURE AND ACTIVITY MODIFICATION:

Avoid flexed postures


Sitting for long duration
Avoid bending or lifting activities
Asymmetric postures(flexion and rotation).
 If symptoms are severe. BED REST (max. for
2 days).
 Use hard bed
 do short periods of walking at regular
intervals .
 Walking promotes lumbar extension and
stimulates fluid mechanics to help reduce
swelling in the disc/connective tissues.
 If patient presents with inability to straighten
up, make the patient lie prone with 2-3
pillows under the abdomen.
 By this nucleus shifted forwards and relieves
pain and gains a lordosis.
 CRYOTHERAPY : reduces muscle spasm and
inflammation in acute phase.
 TENS
 US
 TRACTION
EXERCISES

 Passive extension
 Lateral shilt correction
CHRONIC STAGE

 To restore range of motion


 Restore muscle strength , endurance and
function.
 education to manage posture to prevent
reccurence.
STRETCHING AND FLEXIBILITY
EXERCISES.
 Knee to chest postion ( stretching of lumbar
erector spinae and soft tissue posterior to the
spine)
 one leg raise or side leg raise
CORE STABILITY EXERCISES

 It relieves back pain


 Provides more support to your back by
strengthning the muscles of your spine.
 BRIDGING
 PLANK
 SLIDE PLANK
 WALL SQUAT
 STRENGTHNING EXERCISES
 RELAXATION EXERCISES
 SWIMMING WORKOUTS
 PATIENT EDUCATION
 INSTRUCTING PATIENT ON HOW TO
MODIFY ENVIRONMENT EG: BED, CHAIRS,
CAR SEATS, WORK AREASSS
THANK YOU

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