Intervertebral Disc Disease ; Problems Flashcards
Intervertebral discs separate vertebrae and help absorb ?
Shock
Intervertebral disc disease involves (3)
Involves cervical, thoracic, lumbar spine
Deterioration
Herniation
Dysfunction of discs
Degenerative disc disease is the?
Loss of fluid leads to loss of elasticity, flexibility and shock absorbing capabilities ; normal process of aging unless also have pain
Degenerative disc disease
Disc become ??
Thinner as nucleus pulposus dries out
Load shifted to annulus fibrosis resulting in progressive destruction as the nucleus pulposus seeps out ( herniated or slipped disc )
Etiology (3)
Age related degeneration
Repeated stress & trauma
Spinal stenosis
Notes
Most common sites for this is?
L4-5, L5-S1, C5-6, C6-7
How does DDD happen ?
And results in?
Herniated discs pinch nerves that emerge through the intervertebral foramen
resulting in radiculopathy and radiating pain, numbness, tingling, decreased strength and ROM
How does osteoarthritis affected DDD?
Bone spurs form from damaged cartilage
Notes
Clinical manifestations
Low back pain
Radicular pain follows sciatic nerve
Positive straight leg raise
Decreased reflexes
Paresthesia !!
Muscular weakness
Compression of multiple nerve roots !!
( cause equine syndrome !! )
- severe low back pain
- progressive weakness
- increased pain
- bowel and bladder incontinece
- saddle anesthesia
May develop slowly and suddenly
( medical energy that requires immediate surgical decompression to prevent paralysis )
Pain radiates to arm and hands following the nerve
Decreased flexes and hand grip
May include shoulder pain and dysfunction
What are the 4 diagnostic studies?
X ray
Myelogram, MRI, CT
Epidural venogran, discogram
EMG
What is some conservative therapy we can do?
Don’t over think it, similar to back pain
Limitation of spinal movement
Local heat or ice
Ultrasound and massage
Skin traction
TENS
( transcutaneous electrical nerve stimulation )
Drug therapy we can give are?
Don’t overthink
Same as low back pain
NSAIDS
Short term corticosteroids
Opioids
Muscle relaxtants !!
Anti seizure drugs
Antidepressants
Epidural corticosteroid injections
It’s important to teach patients back strengthening exercises
- how many times a day?
It’s encouraged for a lifetime
We want to teach good body mechanics
Avoid extreme Flexion and torsion
Most patients heal within how many months ??
Twice a day
6
Surgical therapy
Indication is needed when? (5)
Conservative treatment fails
Radiculopathy worsens
Loss of bowel or bladder control
Constant pain
Persistent neurologic deficit
What are the 7 surges for intervertebral disc disease?
Intradiscal electrothermoplastly (IDET)
Radiofrequency fiscal nucleoplasty ( Coablation nucleoplasty )
Interspinous process decompression system
Laminectomy
Discectomy
Artificial disc replacement
Spinal fusion
Intradiscal electrothermoplastly
It’s minimally invasive
How does it work ?
And body will produces?
Needle inserted into affected disc
Wire threaded into disc and heated which destroyed nerve fibers
New reinforcing proteins and fibers of the annulus
Radiofrequency fiscal nucleoplasty
( coablation nucleoplasty )
Needles inserted similar to IDET
How does it work?
Up to 20% of nucleus is removed
And it decompressed disc
Probe generates energy that breaks up nucleus pulposus
Notes
Interspinous process decompressions system ( X stop )
Titanium : fits into mouth placed on vertebrae
To treat lumbar spinal stenosis
Lifts vertebrae off pinched nerve
What is laminectomy ?
Surgically excise protruding disc through of part of vertebra ( lamina )
Notes
Discectomy
Surgically decompressed nerve root by removing damaged part
Micro surgical - microscope
Percutaneous - uses fluoroscopy and laser
Artificial disc replacements goals
Restore movement and elimated pain
- surgically placed in spine through small incision after damaged disc is removed
- allows for movement at level of implant
What is a spinal fusion?
Used a bone graft from a patients __
Or donated cadaver bone (allograft )
Metal fixation can added stability and ___ motion
Bone morphogenetic protein will help stimulate ___
Stabilized by creating an ankylosis ( fusion ) of contiguous vertebrae
Fibula or iliac crest
Decreased
Bone growth of graft
Notes
Nursing management post surgery
Maintain proper alignment
Postoperative activity varies
Lumbar fusion
- pillows under thighs when supine
- between legs when side lying
- log roll to change position
Reassure patient
Opioids for 24-48 hours
PCA
Switch to oral when able
Muscule relaxtans
Assess and document pain
Potential for cerebrospinal fluid (CSF) LEAKAGE after spinal surgery
How will you do this? (2)
Noting amount, color, characteristics
Yellow drainage ( halo sign )
Positive glucose
Assess peripheral neurologic status how?
How long?
Compare to what?
Movement and sensations
- report new weakness or Paresthesia
Every 2-4 hours for 48 hours
Baseline ( preoperative status )
Assess circulation how post op? (3)
Temperature
Capillary refill
Pulses
Monitor for GI and Bowel function
And administer ?
Monitor and assist bladder emptying
Loss of tone may indict ___
May require ??
Notify surgeon immediacy if bladder or bowel incontinece for nerve damage !!
Constiparion
Stool softeners and laxative
Nerve damage
Catherization
Notes
Nursing management
Spinal fusion
Post op
Prolonged healing time and extended activity limited
Rigid orthosis ( chair back brace )
- teach preferred method to apply and remove
Cervical spine
- observe for spinal cord edema
- respiratory distressed and decreased neurologic donation of upper extremities
Immobilize neck hard or soft collar
Assess surgical site
Asses bone graft donor site
- iliac or fibula
- most painful
- pressure dressing
- neurovascular assessment
Notes
Teaching spinal fusion
Proper body mechanics
Avoid prolonged sitting or standing
Encourage walking Lying down
Avoid lifting, twisting, bending, stooping
Use thighs and knees to absorb shock
Firm mattress or bed board
