Prolapsed/herniated disc Flashcards
1
Q
What is the defintion of a prolapsed/herniated disc?
A
Damaged disc of cartilage that is pressing on nerves
2
Q
How common is a prolapsed/herniated disc?
A
Most common in ages 30-50. Twice as many men are affected than woman
3
Q
What is the pathophysiology of a prolapsed/herniated disc?
A
- Annulus fibrosus around the disc degrades/damaged
- Nucleus pulposus bulges out through a weakness in annulus fibrosus
- Sciatic nerve is often affected
4
Q
What are the risk factors/aetiology of prolapsed/herniated disc?
A
- Age
- Smoking
- Bending awkwardly
- Heavy lifting
- Sitting for long periods of time
- Overweight
- Injury to the back
5
Q
What are the signs/symptoms of a prolapsed/herniated disc?
A
- Asymptomatic
- Severe and sudden back pain – eased by lying down, made worse if back is moved, coughing or sneezing
- Neck pain
- Unilateral leg/hip/buttock pain – if sciatic nerve involved
- +ve leg straightening test
- Numbness
- Tingling sensation
- Weakness
- Loss of tendon reflex – red sign
- +ve Babinski reflex – red sign
- Look out for cauda equine syndrome! – saddle anaesthesia, urinary retention, faecal incontinence, laxity of anal sphincter, weakness in one or both legs
6
Q
What investigations are required to diagnose a prolapsed/herniated disc?
A
- Nerve conduction test
- X-ray
- MRI
7
Q
What are the surgical treatments for prolapsed/herniated disc?
A
- Surgery to free compressed nerve
- Disctectomy - removal of part of disc
- Prosthetic intervertebral disc replacement
- Percutaneous intradiscal laser ablation
8
Q
What are the pharmacological treatments for prolapsed/herniated disc?
A
- Analgesia
- Benzodiapepine
- Tricyclic antidepressants/gabapentin
9
Q
What are the non pharmacological treatments for prolapsed/herniated disc?
A
- Physiotherapy
- Chiropractor
- Osteopath – manipulation
- Keep active
- Heat
- Massage
- Do nothing
