Spinal Column Disorders Flashcards
risk factors for lower back pain
lack of muscle tone and core strength
excess body weight
poor posture
cigarette smoking (nicotine decreases circulation to discs)
psychological factors (depression/excessive stress)
occupation/hobbies
cause of pain in lower back pain
musculoskeletal origin
acute lumbosacral strain (overuse, improper use, or trauma)
instability to the lumbosacral bony mechanism
osteoarthritis of the lumbosacral vertebrae
degenerative disc disease
herniation of intervertebral disc
intervertebral disc disease (IVDD)
aka degenerative disc disease
normal process of aging occurring in any area of spine
results from loss of fluid within the disc
discs can lose their elasticity, flexibility, and shock absorbing capabilities
spinal disc bulges outward between the vertebrae and can press against spinal nerves
bulging disc
no tear or rupture is present
contained
herniated disc
tear or rupture is present in outer portion of disc
non-contained
causes of bulging or herniated disc
from aging or repeated stress and trauma to the spine
can also result from spinal stenosis (narrowing of spinal canal forces disc to bulge)
manifestations of IVDD
pain
back or leg pain may be reproduced by raising leg and flexing foot at 90 degrees
paresthesia or muscle weakness in legs, feet, or toes
reflexes can be be depressed or absent
manifestation of cervical disc disease
pain in upper back and upper extremities
paresthesia or muscle weakness in upper extremities
depressed or absent relfexes
diagnostic studies for IVDD
history and physical
x-ray
CT
MRI
myelogram
discogram
electromyography
myelogram
uses contrast medium to view spinal cord injury, cysts and tumors
contrast in injected into the cervical or lumbar spine followed by x-ray projections
helpful when cause of pain is not found with MRI or CT
discogram
dye is injected into the soft center of the disk
injection may reproduce back pain
dye will move into any cracks in the disc’s exterior to show up on an x-ray or CT
usefulness is controversial
electromyography
detects the electrical activity generate by muscle cells when electrically or neurologically activated
signals analyzed to detect nerve dysfunction, muscle dysfunction, problems with nerve-to-muscle signal transmission, activation threshold, or the amount and speed of conduction of an electrical impulse through a nerve
determines severity of nerve irritation, injury, or compression
conservative therapy for IVDD
restrictive activities: brace, corset, belt
meds: analgesics, anti-inflammatory, muscle relaxants
local ice or heat
physical therapy: ultrasound, massage, traction
epidural corticosteroid injections to reduce inflammation and acute pain
education to prevent further injury
surgical treatment for IVDD
intradiscal electro-thermoplasty (IDET)
radiofrequency discal nucleoplasty
laminectomy with or without spinal fusion
discectomy
percutaneous laser discectomy
artificial disc replacement
spinal fusion
IVDD surgery nursing interventions
post op care: skin assessment
pillow under/between legs
proper body alignment
pain management
assess dressing for CSF leak (halo)
CMS checks
paralytic ileus bladder emptying issues
lifting restrictions and proper body mechanics
log roll q2h post laminectomy
