herniated nucleus pulposis

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Imaging Study of Herniated Nucleus Pulposis :

Imaging Study of Herniated Nucleus Pulposis June 17, 2011 Ben Hammett Casey Lauf Daniel Dowdy

What is a Herniated Nucleus Pulposus?:

What is a Herniated Nucleus Pulposus? Description: A herniated nucleus pulposus is when the nucleus pulposus ruptures through the annulus fibrosis and can put pressure on the spinal nerves. Signs & Symptoms: Immediate pain with forward bending, twisting and lifting. Delayed or immediate onset of neurological symptoms including numbness and tingling which may radiate down one extremity or both extremities. These signs and symptoms will be consistent with the spinal segment to which the nucleus pulposis herniated.

What is a Herniated Nucleus Pulposus? Con’t:

What is a Herniated Nucleus Pulposus? Con’t Incidence: Immediate pain with forward bending, twisting and lifting. Most commonly seen in patients 30-55 years old and 90% prevalence in the L4-5 and L5-S1 levels. 1 Diagnosis: Upon examination the patient will present with altered myotomes, dermatomes and reflexes consistent with the involved spinal segment. Straight Leg Raise will be positive for neurological involvement. This test has good sensitivity but poor specificity. 2 Imaging will show positive signs with disc herniation. (Discussed further in later slides.)

What is a Herniated Nucleus Pulposus? Con’t:

What is a Herniated Nucleus Pulposus? Con’t Prognosis: Patients can have good outcomes with conservative treatment evidenced by Vroomen et.al. 3 showing that, “After 12 weeks, 73% of patients showed reasonable to major improvement without surgery.” Impact of Functioning: This can decrease their functioning ability to perform ADL’s, IADL’s and hinder their ability to perform work related duties.

Radiographic Image:

Radiographic Image

Radiographic Image Description:

Radiographic Image Description Findings in image: Decreased disc height of L5/S1 intervertebral disc evidenced by decreased space between vertebral disc. Decreased space of intervertebral foramen of L5/S1. Slight retrolisthesis of L5 on S1.

T2 MRI Image:

T2 MRI Image

T2 MRI Image Description:

T2 MRI Image Description Findings in image: Prolapsed disc of L4/L5. Loss of disc height at L4/L5. Narrowing of spinal canal. Decreased fluid L4/L5 disc evidenced by decreased intensity on image.

Impairments based on Images:

Impairments based on Images Biomechanically, due to the decreased disc height, the superior facet will encroach downward on the inferior facet limiting extension and side bending. Physically, the patient will have decreased strength in the muscles innervated by the nerve root involved, causing a deviation in gait and functional activities. Pain due to the encroached nerve may also limit ROM in all planes.

Questions to Classmates:

Questions to Classmates Related to the radiograph image: What treatments are absolutely contraindicated for this patient? And Why? Related to the T2 MRI: What benefits would backward bending have on this patient? And Why?

References:

References 1 Palacio LE, et.al. “Lumbar Disk Problems in the Athlete.” eMedicine Eds. Andrew D. Perron, et.al. 12 Oct, 2007. Medscape 2 July 2009 http://emedicine.medscape.com/article/93419-overview 2 Deville WL, et.al. The test of Lasegue: systematic review of the accuracy in diagnosising herniated discs. Spine. 25(9): 1140-7. 3. Vroomen PC, de Krom MC, Knottnerus JA. Predicting the outsome of sciatica at short-term follow up. Br J Gen Pract. Feb 2002; 52(475): 119-23.

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