Intervertebral Disc Disease/Back Pain

Question 1

Low Back PAIN AFFECTS

Answer 1

80% of adults in US
- MJR CONTRIBUTOR to missed work days
-disability

Question 2

Patho of back pain

Answer 2

due to musculoskeletal problem

Question 3

Radicular pain

Answer 3

Irritation of nerve root

Question 4

Referred pain

Answer 4

The source of pain is another location

Question 5

Lumbar region

Answer 5

Bears most weight*
Is most flexible
Contains nerve roots
Has poor biochemical structure

Question 6

Risk Factors of Low Back Pain

Answer 6

Lack of muscle tone*
Excess body weight*
Poor posture*
Cigarette smoking
Prior compression fractures*
Congenital spinal problems - scoliosis
Family history of back pain

Question 7

Occupational Risk Factors for back pain

Answer 7

Repetitive lifting – nurses, construction
Vibration = truck driver
Extended periods of sitting - school
Health care personnel engaged in patient care

Question 8

Chronic low back pain

Answer 8

Lasts longer than 3 months
Involves repeated incapacitating episode
often progressive

Question 9

Various Chronic low back pain

Answer 9

Degenerative or metabolic disease
Weakness from scar tissue
Chronic strain
Congenital spine problem

Question 10

Spinal stenosis

Answer 10

Narrowing of spinal canal

Question 11

Spinal stenosis : Acquired conditions

Answer 11

Osteoarthritis, RA, tumors, trauma

Question 12

Spinal stenosis : Inherited conditions

Answer 12

Congenital spinal stenosis – narrow spinal canal
scoliosis

Question 13

Spinal stenosis s/s

Answer 13

Pain in low back and radiates to buttocks and leg
↑with walking/prolonged standing
Numbness, tingling, weakness, heaviness in legs and buttocks
Pain ↓ when bends forward or sits down

Question 14

Spondylosis

Answer 14

Structural defect, forward displacement, heredity

Question 15

Spondylolisthesis

Answer 15

Vertebrae slides forward
Graded 1-4 severity

Question 16

Low Back Pain Overall Goals

Answer 16

Satisfactory pain relief
Return to previous level of activity
Correct performance of exercises
Adequate coping
Adequate self-help management

Question 17

Low Back Pain Health Promotion

Answer 17

Proper body mechanics
“Back School program” – specific therapy for back
Appropriate body weight
Proper sleep positioning
Firm mattress*
Stop smoking
Weight reduction
Sufficient rest periods
Local heat and cold application
Physical therapy
Exercise and activity throughout day
Complementary and alternative therapies

Question 18

Treat as outpatient if back pain is not severe

Answer 18

NSAIDs, muscle relaxants
Massage
Back manipulation
Acupuncture
Cold and hot compresses

Question 19

If they have severe low back pain

Answer 19

corticosteroids
opioids

Question 20

Low Back Pain Drug therapy

Answer 20

Mild analgesics
Antidepressants
Gabapentin (Neurontin)

Question 21

Minimally invasive therapy for low back pain

Answer 21

Epidural corticosteroid injections
Implanted devices to deliver analgesia

Question 22

Low Back Pain Nursing Dx

Answer 22

Acute pain
Impaired physical mobility
Ineffective coping
Ineffective health management

Question 23

Intervertebral Disc Disease Patho

Answer 23

Intervertebral discs separate vertebrae and help absorb shock
Disease involves deterioration, herniation, or other dysfunction
Involves all levels

Question 24

Degenerative Disc Disease Patho

Answer 24

Loss of elasticity, flexibility, & shock-absorbing capabilities
Disc becomes thinner as nucleus pulposus dries out → load shifted to annulus fibrosus → progressive destruction → pulposus seeps out (herniates)

Question 25

Radiculopathy

Answer 25

Radiating pain Numbness Tingling ↓ Strength and/or range of motion

Question 26

IDD S/S

Answer 26

Low back pain Radicular pain +Straight leg raise ↓ or absent reflexes Paresthesia Muscle weakness

Question 27

Multiple Nerve root compression s/s

Answer 27

Severe low back pain Progressive weakness Increased pain Bowel and bladder incontinence** quickly Medical emergency

Question 28

Cervical Disc Disease

Answer 28

Pain radiates to arms and hands ↓ reflexes and handgrip May include shoulder pain and dysfunction Higher the problem the more it affects the body Check the strength before and after (better or worse)

Question 29

Dx of Disc Diseases

Answer 29

X-rays Myelogram, MRI or CT Epidural venogram or discogram EMG

Question 30

Conservative Therapy

Answer 30

Start here 1st Limitation of movement Local heat or ice Ultrasound and massage Skin traction Transcutaneous electrical nerve stimulation (TENS) Back-strengthening exercises Twice a day Encouraged for a lifetime Teach good body mechanics Avoid extremes of flexion and torsion Most patients heal in 6 months Unless don’t follow lifestyle changes

Question 31

Drug Therapy for Disc Diseases

Answer 31

NSAIDs Short-term corticosteroids Opioids Muscle relaxants Antiseizure drugs, antidepressants GABApentin Epidural corticosteroids injections

Question 32

Surgery is indicated when IDD is debilitating

Answer 32

Conservative treatment fails Radiculopathy worsens Loss of bowel or bladder control Constant pain Persistent neurologic deficit

Question 33

Intradiscal electrothermoplasty (IDET)

Answer 33

Minimally invasive outpatient procedure Denervates nerve fibers

Question 34

Radiofrequency discal nucleoplasty (coblation nucleoplasty

Answer 34

Needle inserted similar to IDET Breaks up nucleus pulposus

Question 35

Interspinous process decompression system (X Stop)

Answer 35

To treat lumbar stenosis Titanium: fits into mount placed on vertebrae** Lifts vertebrae off pinched nerve

Question 36

Laminectomy

Answer 36

Surgically remove disc through excision of part of vertebra

Question 37

Discectomy

Answer 37

Surgically decompress nerve root Microsurgical or percutaneous technique

Question 38

Artificial disc replacement

Answer 38

Charité or Prodisc-L disc for lumbar DDD Prestige cervical disc system Surgically placed in spine through small incision after damaged disc is removed Allows for movement at level of implant

Question 39

Spinal fusion

Answer 39

Spine is stabilized by creating ankylosis (fusion) of contiguous vertebrae Uses a bone graft from patient’s fibula or iliac crest or from donated cadaver bone Metal fixation can add to stability Bone morphogenetic protein (BMP) to stimulate bone grown of graft

Question 40

Nursing Management after back surgery

Answer 40

Vital Signs** RN job Wound Inspection Motor strength Urinary retention voiding Positioning (logroll)** Home Care

Question 41

PostOp spinal surgery

Answer 41

Opioids for 24-48 hours Patient-controlled analgesia (PCA) Switch to oral drugs when able Muscle relaxants Assess and document pain intensity and pain management effectiveness Monitor GI and bowel function Administer stool softeners** Monitor and assist with bladder emptying Loss of tone may indicate nerve damage Notify surgeon immediately if bowel or bladder incontinence

Question 42

CSF leakage after spinal surgery

Answer 42

Monitor for and report severe headache or leakage of CSF Clear or slightly yellow drainage on dressing + for glucose Frequently assess for peripheral neurologic signs

Question 43

Teaching Post-Op spinal surgery

Answer 43

Proper body mechanics Avoid prolonged sitting or standing Encourage walking, lying down, shifting weight No lifting, twisting Use thighs and knees to absorb shock Firm mattress or bed board

Question 44

Baclofen (Lioresal)

Answer 44

used for spasticity

Question 45

Baclofen (Lioresal) MOA

Answer 45

acts within the spinal cord to suppress hyperactive reflexes with no direct effects on skeletal muscle

Question 46

Baclofen (Lioresal) adverse effects

Answer 46

CNS effects, GI symptoms, urinary retention, *no antidote for overdose and withdrawal also for severe MS

Question 47

During logroll, who counts off when to move

Answer 47

Head of the bed