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Herniated Discs & Discectomy, Laminectomy, & Spinal Fusion Essay

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Herniated Intervertebral Disk, also called_____.
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Ruptured disk Herniated Nucleus Pulposus Slipped Disk
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What is a Herniated Intervertebral Disk?
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A rupture of cartilage surrounding a disk A protrusion of nucleus pulposus from within the disk through the annulus fibrosus (outer collar) Pressure applied on the spinal root in that area
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Where are intervertebral disks located, and what do they act as?
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Located between vertebrae Act as shock absorbers
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Herniated Intervertebral Disks are a result of what?
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Weakened or torn annulus, trauma, lifing heavy objects, degenerative disorders of the spine (osteoarthritis, aging) Degenerative disk disease
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Are the effects of a herniated disk abrupt or gradual, and what usually causes it?
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Can be ABRUPT or GRADUAL Usually a result of twisting (not just lifting)
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Who typically experiences a Herniated Intervertebral Disk?
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MEN Ages 30-50
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What preventable action causes the deterioration of the the disk? How?
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SMOKING Smoking breaks down cartilage
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What area of the spine do most herniated intervertebral disks occur?
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LUMBAR area (L4-5)
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Where do most cervical herniations occur?
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C6-7
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Manifestations of Herniated LUMBAR disks
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Recurrent sciatica (sciatic nerve) – Pain radiates down posterior leg to ankle; increased by sneezing or coughing – Muscle spasms Postural deformity (forward tilt and flexion of hip and knee) Motor deficit- weakness Sensory deficit- paresthesias/ numbness
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Manifestations of Herniated CERVICAL disks
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Redicular pain (pain along dermatome- shoulder, neck, arm) Paresthesias Muscle spasms and stiff neck Decreased/ absent arm reflexes Paralysis
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What needs to be ruled out when suspecting a herniated Cervical disk?
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STROKE or HEART ATTACK Due to similar manifestations (pain along dermatome and paresthesias)
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How is a Herniated Intervertebral Disk diagnosed?
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By ruling out causes: degenerative disk disease, tumor, etc This is done by: – x-ray – CT scan or MRI – Electromyography (EMG) – Myelogram w/ contrast medium – Myelogram
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What is the conservative approach for treating a herniated disk?
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Pain relief Healing of involved disk by fibrosis Usually prescribed for 2-6 weeks
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What surgeries may be done to fix a herniated disk?
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Laminectomy Discectomy Spinal fusion Foraminotomy Intradiscal Electrothermal Therapy (IDET) Microdiskectomy
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Laminectomy
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Removal of part of lamina (bony arch on dorsal surface) with removal of protruding nucleus pulposus
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Discectomy
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Removal of nucleus palposus LAPAROSCOPICALLY is #1 choice
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Spinal Fusion
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Stabilization of vertebrae with either bone graft or surgical implant Bone donor site is from patient’s iliac crest and requires wound care at donor site
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Foraminotomy
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Enlargement of neuroforamen where nerve root exists spinal cord (Open up so the pressure is relieved)
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Intradiscal Electrothermal Therapy (IDET)
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Heated needle into disk will seal the disc wall
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Microdiscectomy
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Microsurgical instruments allow small incision LEAST INVASIVE of the disc surgeries
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What does the pre-operative care for a Posterior Laminectomy consist of?
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Return demonstration of Logrolling Pain management Use of fracture bedpan Use incentive spirometry, cough, and leg exercises (Pre-medicate for turn, cough, deep breathe)
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What does the post-operative care for a Posterior Laminectomy consist of?
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HOB flat or slightly elevated Small pillow under head Turn Q2H (w/ logrolling) Monitor for nerve compression (leg strength, sensation, feet/ toe movement) Compare bilateral findings * Report weakness or sensory impairment immediately (compare to pre-op status; may not immediately return) Assess for Urinary Retention (void within 8H) Assess for CSF leakage (check for glucose) Ambulate as ordered
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What is involved with nursing care for a Cervical Laminectomy?
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HOB slightly elevated Maintain position of cervical collar, if ordered Assess for weakness and sensation (hand grips, arm strength, move hands and fingers) Assess for ability to swallow Assess for clear secretions Assess for hoarseness, tracheal swelling, stridor
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What should be in a room for a patient post-op of Cervical Laminectomy? Why?
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SUCTION and OXYGEN They are at risk for aspiration
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What should be done to promote health after a disc injury?
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Prevention through body mechanics When lifting, bend at knees and use legs Position object to body at waist height Use of back support Add Williams position for sitting: HOP at 30-40 degrees with knees slightly flexed (takes stress off back muscles)
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Nursing Diagnoses for Herniated Discs
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Acute Pain Chronic Pain Constipation
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Continuity of Care for Herniated Discs
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Control Pain Perform ADLs