Herniated

Nucleus
Pulposus
 Anatomy Review

• Intervertebral Disc
- Absorbs the stress
and shock the body
incurs during
movement

- Prevents the
vertebrae from
grinding against one
another
 Anatomy Review

• Annulus Fibrosus
- A sturdy tire-like structure that encases a gel-like
center, the nucleus pulposus.
- Enhances the spine’s rotational stability and helps
to resist compressive stress.

• Nucleus Pulposus
- Center portion of each intervertebral disc
- Filled with a gel-like elastic substance
- Transmits stress and weight from vertebra to
vertebra.
 Each disc is made up of two parts:
annulus fibrosus & nucleus pulposus.
 Alternative Names

• Lumbar radiculopathy;
• Cervical radiculopathy;
• Herniated intervertebral disk;
• Prolapsed intervertebral disk;
• Slipped disk;
• Ruptured disk
 Herniated Nucleus Pulposus:
• A slipped disk along the spinal cord.

• Occurs when all or part of the soft center of a

spinal disk is forced through a weakened part
of the disk.

• Displacement of the central area of the disc

(nucleus) resulting in impingement on a nerve
root.
Herniated Nucleus Pulposus:
 Stages of HNP
1. Disc
Degeneration
- Chemical changes
associated with
aging causes discs
to weaken, but
without a
herniation.
2. Prolapse
- The form or
position of the disc
changes with some
slight impingement
into the spinal
canal.
- Also called a bulge
or protrusion.
3. Extrusion
- The gel-like
nucleus pulposus
breaks through
the tire-like wall
(annulus fibrosus)
but remains
within the disc.
4. Sequestration or
Sequestered Disc
- Nucleus pulposus
breaks through
the annulus
fibrosus and lies
outside the disc in
the spinal canal
(HNP).
 Predisposing FACTORS

• Advanced age
• History of back trauma
• Male
• Congenital conditions
 Precipitating FACTORS

• Sedentary lifestyle
• Sitting without lumbar support
• Cigarette smoking
• Chronic coughing
• Strenuous activities
 CLINICAL MANIFESTATIONS
• Arm muscle weakness

• Deep pain near or over the shoulder

blades on the affected side

• Neck pain, especially in the back

and sides

• Increased pain when bending the

neck or turning head to the side
 CLINICAL MANIFESTATIONS
• Pain radiating to the shoulder,
upper arm, forearm, and rarely the
hand, fingers or chest

• Pain made worse with coughing,

straining, or laughing

• Spasm of the neck muscles

 MEDICAL MANAGEMENT
• Nonsteroidal anti-inflammatory
(NSAIDs) & narcotic pain killers
- Given to clients with a sudden
herniated disk caused by some sort of
injury (such as a car accident or lifting
a very heavy object) that is
immediately followed by severe pain
in the back and leg.
• NSAIDs
- are used for long-term pain
control, but narcotics may be given
if the pain does not respond to anti-
inflammatory drugs.
• Muscle Relaxants
- For back spasms

• On rare occasions, steroids may

be given either by pill or directly
into the blood through an IV.
• Steroid injections
- Helps control pain for
several months.
- Reduces swelling
around the disk and
relieve many symptoms
- Spinal injections are
usually done on an
outpatient basis, using
x-ray or fluoroscopy to
identify the area where
the injection is needed.
 Surgical Management
 Diskectomy
- Removal of a
protruding disk
- This procedure
requires general
anesthesia (asleep
and no pain) and 2
- 3 day hospital
stay.
 Microdiskectomy
- a procedure
removing fragments
of nucleated disk
through a very small
opening.

- Use of electron
microscope through
a small incision to
remove a portion of
the HNP that is
displaced
 Chemonucleolysis
- involves the injection
of an enzyme (called
chymopapain) into
the herniated disk to
dissolve the
protruding gelatinous
substance.

- This procedure may

be an alternative to
diskectomy in certain
situations.
 Foraminotomy
- A decompression
surgery that is
performed to
enlarge the
passageway where
a spinal nerve root
exits the spinal canal
 POSSIBLE NURSING DIAGNOSIS

• Pain acute/chronic related to

injuring agents, nerve
compression, muscle spasm
• Impaired physical mobility
related to pain and discomfort
• Fatigue related to inability to
maintain usual routines,
compromised concentration
• Ineffective coping related to
situational crisis
• Knowledge deficit regarding
condition, prognosis, and
treatment related to lack of
knowledge
 NURSING RESPONSIBILITIES
• Bed rest with firm mattress; log roll; side lying
position with knees bent and pillow between
legs to support legs

• Avoid flexion of the spine- brace/corset,

cervical collar to provide support

• Heat/cold therapy to decrease muscle

spasms
 NURSING RESPONSIBILITIES
• Massage, relaxation techniques
• Progressive mobilization with
approved exercise program –
includes abdominal/thigh
strengthening
• Teaching good body mechanics
• Weight loss