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    Pid

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    Codillia Cheong
    Otho

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    Pid

    Uploaded by

    Codillia Cheong
    59 views18 pages
    Otho

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    © © All Rights Reserved

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    Otho

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    59 views18 pages

    Pid

    Uploaded by

    Codillia Cheong
    Otho

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 18

    Pathology of Intervertebral Disc

    Injury
    Annular Injury
    Annular rings
    Softened
    Overstretched
    Torn

    Normal viscoelasticity is exceeded


    Cannot stabilize or limit motion
    Nucleus pulposus exerts pressure on weak
    part
    Buckling occurs - Disc Bulge

    Pathology of Intervertebral Disc


    Injury
    Extrusion
    Fragmentation of
    nucleus pulposus
    Nuclear material
    dissects its way
    through breaches in
    annulus fibrosus

    Pathology of Intervertebral Disc


    Injury
    Prolapses
    Fissures provide
    pathway for irritating
    nuclear fluid to
    escape onto
    perineural tissue *
    Persistent and
    chronic back pain

    * - Hampton et al

    Prolapsed Intervertebral Disc (PID)


    Clinical features
    Any age, but commonly in fit adult of 20 -45
    years
    Sudden onset; while lifting ,felt severe back
    pain
    Then pain is felt in the buttock & lower limb.
    Worst by coughing & straining
    Paraesthesia in the leg;occasionally muscle
    weakness.

    Cauda Equina Syndrome:


    Rare
    Sudden, partial or complete loss of voluntary bladder
    function
    due to massive disc impingement on spinal nerves
    Can include loss of sensation ( saddle anaesthesiaS3,4),& anal sphincter control

    Treatment:
    Urgent decompression is mandatory for prevention of
    irreparable / irreversible bladder damage
    12 hours is the maximum time prior to irreversible
    changes

    Prolapsed Intervertebral Disc (PID)


    Clinical features

    o/e- scoliosis +
    Tenderness at affected site
    Paravertebral muscle spasm
    ROM is reduced
    SLR positive on affected site
    Bowstringing S/- (+)ve.
    Cross sciatic tension +ve.
    With high or mid-lumbar prolapse, femoral stretch test
    +ve

    Prolapsed Intervertebral Disc (PID)


    Clinical features
    CNS- power
    L5=weak knee flexion & extension of EHL
    S1=weak FHL, planter flexion & eversion of foot

    Sensory
    Loss on outerside of leg & dorsum of foot.
    Loss on lateral border of foot
    Reflex- L5= quadriceps reflex seem to increased
    because of weak hamstrings
    S1= depressed ankle jerk

    Prolapsed Intervertebral Disc (PID)


    Diagnosis
    X-ray- to exclude bone disease.
    Late cases may show narrowed disc space &
    osteophytes

    CT& MRI
    Very useful for diagnosis.

    Prolapsed Intervertebral Disc (PID)


    Differential diagnosis
    Infections- constitutional symptoms, severe
    spasm, marked tenderness, raised ESR ,, Xray findings of bone destruction, joint space
    narrowing
    Ankylosing spondylitis- stiffness of all axial
    skeleton, Typical x-ray finding of Bamboo
    spine

    Prolapsed Intervertebral Disc (PID)


    Differential diagnosis
    Vertebral tumours- severe continuous pain,
    marked spasm, general illness, raised ESR,
    bony destruction or sclerosis in X-ray.
    Nerve tumours,eg neurofibroma of cauda
    equina cause continuous pain. Ct & MRI
    confirm the lesion.

    Prolapsed Intervertebral Disc (PID)


    Management

    Rest
    Reduction
    Removal
    Rehabilitation

    Prolapsed Intervertebral Disc (PID)


    Management
    Rest
    In bed with hip & knee in slight flexion.
    NSAID

    Reduction
    Pelvic traction with 10kg x 2 weeks will reduce
    herniation in 90%.
    Epidural Depomedrol injection
    Chemonucleolysis- harmful> effective

    Prolapsed Intervertebral Disc (PID)


    Management
    Removal indication for operation.
    Cauda equina syndrome not responding to traction
    in 6to 12 hrs.(maximum)
    Neurological deterioration while under conservative
    Treatment
    Persistant pain & S/ of cross sciatic tension after 6
    wks of conservative treatment

    Physical therapy

    electrical stimulation/TENS
    Postural education / body mechanics
    Massage / mobilization
    Stretching / body work
    Exercise / strengthening
    Tract

    Injections

    Epidural blocks
    Facet blocks
    Trigger point
    SI joint

    Surgery:

    Laminectomy
    Fusion
    Discectomy
    Percutaneous Lumbar Discectomy
    Success rate variable 50 -85 %
    Low rate of complications:
    Infection
    Peripheral nerve injury

    Benefits:

    Outpatient procedure
    Minimal to no epidural scarring
    No general anesthesia
    Spine stability preservation
    Decreased cost

    Persistent post operative back pain & scitica

    May be due to
    1-residual disc material in spinal canal
    2- disc prolapsed in another level
    3-nerve root pressure by hypertrophic facet
    joint
    4-narrow lateral recess due to fibrosis

    Spondylolysis
    Spondylolisthesis

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