GAYETA, MAYCHELLE H.
disk's central portion herniates
Herniated Nucleus Pulposus (HNP)
Alternative Names
Lumbar radiculopathy
Cervical radiculopathy
Herniated intervertebral disk
Prolapsed intervertebral disk
Slipped disk
Ruptured disk
Bulging disk
Compressed disk
Definition
A herniated nucleus pulposus is a
slipped disk along the spinal cord. The
condition occurs when all or part of
the soft center of a spinal disk is
forced through a weakened part of the
disk.
Anatomy
Description: The spinal column is
made up of 26 vertebrae that are
joined together and permit forward
and backward bending, side bending,
and rotation of the spine. Five distinct
regions comprise the spinal column,
including the cervical (neck) region,
thoracic (chest) region, lumbar (low
back) region, sacral and coccygeal
(tailbone) region. The cervical region
consists of seven vertebrae, the
thoracic region includes 12 vertebrae,
and the lumbar region contains five
vertebrae. The sacrum is composed of
five fused vertebrae, which are
connected to four fused vertebrae
forming the coccyx. Intervertebral
disks lie between each adjacent
vertebra.
Each disk is composed of a gelatinous
material in the center, called the
nucleus pulposus, surrounded by rings
of a fibrous tissue (annulus fibrosus).
In disk herniation, an intervertebral
through the surrounding annulus
fibrosus into the spinal canal, putting
pressure on a nerve root. (There is
often a progression of small fissures in
the annulus fibrosis before the disk
herniates.) Disk herniation most
commonly affects the lumbar region
between the fifth lumbar vertebra and
the first sacral vertebra. However, disk
herniation can also occur in the
cervical spine. The incidence of
cervical disk herniation is most
common between the fifth and sixth
cervical vertebrae. The second most
common area for cervical disk
herniation occurs between the sixth
and seventh cervical vertebrae. Disk
herniation is less common in the
thoracic region.
Predisposing factors associated with
disk herniation include age, gender,
and work environment. The peak age
for occurrence of disk herniation is
between 20–45 years of age. Studies
have shown that males are more
commonly affected than females in
lumbar disk herniation by a 3:2 ratio.
Genetic factors are suspected of
playing a role in disk herniation.
Prolonged exposure to a bent-forward
work posture is correlated with an
increased incidence of disk herniation.
Pain from a herniated disk is usually
greatest when sitting and is lessened
when standing.
There are four classifications of disk
pathology:
• A protrusion may occur where a
disk bulges without rupturing
the annulus fibrosis.
• The disk may prolapse where
the nucleus pulposus migrates
to the outermost fibers of the
annulus fibrosis.
• There may be a disk extrusion,
which is the case if the annulus
 fibrosis perforates and material
of the nucleus moves into the
epidural space.
• The sequestrated disk may
occur as fragments from the
annulus fibrosis and nucleus
pulposus are outside the disk
proper.
Causes
These disks may herniate (move out of
place) or rupture from trauma or strain
Brought about by as a car accident or
lifting a very heavy object
*Radiculopathy refers to any disease
affecting the spinal nerve roots. A
herniated disk is one cause of
radiculopathy (sciatica).
Lumbar area
Most herniation takes place
Occurs 15 times more often than
cervical (neck) disk herniation
It is one of the most common causes
of lower back pain
Cervical disks
8% of the time and the upper-to-mid-
back (thoracic) disks only 1 - 2% of the
time
*Nerve roots (large nerves that branch
out from the spinal cord)
may become compressed, resulting
in neurological symptoms, such as
sensory or motor changes
Prevalence
middle-aged and older men
involved in strenuous physical
activity congenital conditions that
affect the size of the lumbar spinal
canal
Symptoms
SYMPTOMS OF HERNIATED LUMBAR
DISK Muscle spasm
Muscle weakness or atrophy in later
stages
Pain radiating to the buttocks, legs,
and feet
Pain made worse with coughing,
straining, or
laughing
Severe low back pain
Tingling or numbness in legs or feet
SYMPTOMS OF HERNIATED CERVICAL
DISK 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
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
Exams and Tests
physical examination
history
neurological examination will
evaluate muscle reflexes, sensation,
and muscle strength examination of
the spine will reveal a decrease in the
spinal curvature in the affected area
“Leg pain”
that occurs when you sit down on an
exam table and lift your leg straight
up usually suggests a herniated
lumbar disk
Foraminal compression test of
Spurling
-is done to diagnose cervical
radiculopathy. For this test, you will
bend your head forward and to the
sides while the health care provider
provides slight downward pressure to
the top of the head.Increased pain or
numbness during this test is usually
indicative of cervical radiculopathy
DIAGNOSTIC TESTS
EMG may be done to determine the
exact nerve root that is involved.
Nerve conduction velocity test may
also be done.
Myelogram may be done to
determine the size and location of disk
herniation.
Spine MRI or spine CT will show
spinal canal compression by the
herniated disk.
Spine x-ray may be done to rule out
other causes of back or neck pain.
However, it is not possible to diagnosis
herniated disk by spinal x-ray alone.
Treatment
Short period of rest with pain and
anti- inflammatory medications
Followed by physical therapy include
steroid injections
Surgery
MEDICATIONS
>(NSAIDs) and narcotic pain
killers will be given to people 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
>narcotics may be given if the pain
does not respond to anti-inflammatory
drugs
>muscle relaxants are usually given
ff the patient has back spasms
>steroids may be given either by pill
or directly into the blood through an IV
INJECTIONS
Steroid injections
in the area of the herniated disk can
help control pain for several months
reduce swelling around the disk and
relieve many symptoms.
done on an outpatient basis, using x-
ray or fluoroscopy to identify the area
where the injection is needed.
SURGERY
*Done if symptoms persist despite
other treatments
Diskectomy
removes a protruding disk
requires general anesthesia (asleep
and no pain) and 2 - 3 day hospital
stay.
Encouraged the pt. to walk the first
day after surgery to reduce the risk
ofblood clots
*Complete recovery takes several
weeks. If more than one disk needs to
be taken out or if there are other
problems in the back besides a
herniated disk, more extensive
surgery may be needed. This may
require a much longer recovery
period.
Microdiskectomy
procedure removing fragments of
nucleated disk through a very small
opening
Chemonucleolysis
involves the injection of anenz yme
(called chymopapain) into the
herniated disk to dissolve the
protruding gelatinous substance. This
procedure may be an alternative to
diskectomy in certain situations. Prevention

Possible Complications Safe work and play practices, proper

lifting techniques, body mechanics
Long-term back pain and weight control may help to
Loss of movement or sensation in the prevent back injury in some people.
legs or feet
Loss of bowel and bladder function
Permanent spinal cord injury (very
rare)

When to Contact a Medical

Professional

persistent, severe back pain develops

numbness
loss of movement
weakness
bowel or bladder changes

LIFESTYLE CHANGES

• Any extra weight being carried by

an individual, especially up front in the
stomach area will make back pain
worse.
• Diet and exercise are crucial to
improving back pain in overweight
patients
• Training on how to properly lift,
dress, walk, and perform other
activities
• Work on strengthening the muscles
of the abdomen and lower back to
help support the spine.
• Flexibility of the spine and legs is
taught in many therapy programs.
• Back braces to help support the
spine
*overuse of these devices can

weaken the abdominal and back

muscles, leading to a worsening
of the problem.
• Weight belts can be helpful in
preventing injuries in those whose
work requires lifting of heavy objects