Herniated
Nucleus
Pulposus
Anatomy Review
• Intervertebral Disc
- Absorbs the stress
and shock the body
incurs during
movement
- Prevents the
vertebrae from
grinding against one
another
Anatomy Review
• Annulus Fibrosus
- A sturdy tire-like structure that encases a gel-like
center, the nucleus pulposus.
- Enhances the spine’s rotational stability and helps
to resist compressive stress.
• Nucleus Pulposus
- Center portion of each intervertebral disc
- Filled with a gel-like elastic substance
- Transmits stress and weight from vertebra to
vertebra.
Each disc is made up of two parts:
annulus fibrosus & nucleus pulposus.
Alternative Names
• Lumbar radiculopathy;
• Cervical radiculopathy;
• Herniated intervertebral disk;
• Prolapsed intervertebral disk;
• Slipped disk;
• Ruptured disk
Herniated Nucleus Pulposus:
• A slipped disk along the spinal cord.
• Occurs when all or part of the soft center of a
spinal disk is forced through a weakened part
of the disk.
• Displacement of the central area of the disc
(nucleus) resulting in impingement on a nerve
root.
Herniated Nucleus Pulposus:
Stages of HNP
1. Disc
Degeneration
- Chemical changes
associated with
aging causes discs
to weaken, but
without a
herniation.
2. Prolapse
- The form or
position of the disc
changes with some
slight impingement
into the spinal
canal.
- Also called a bulge
or protrusion.
3. Extrusion
- The gel-like
nucleus pulposus
breaks through
the tire-like wall
(annulus fibrosus)
but remains
within the disc.
4. Sequestration or
Sequestered Disc
- Nucleus pulposus
breaks through
the annulus
fibrosus and lies
outside the disc in
the spinal canal
(HNP).
Predisposing FACTORS
• Advanced age
• History of back trauma
• Male
• Congenital conditions
Precipitating FACTORS
• Sedentary lifestyle
• Sitting without lumbar support
• Cigarette smoking
• Chronic coughing
• Strenuous activities
CLINICAL MANIFESTATIONS
• Arm muscle weakness
• Deep pain near or over the shoulder
blades on the affected side
• Neck pain, especially in the back
and sides
• Increased pain when bending the
neck or turning head to the side
CLINICAL MANIFESTATIONS
• Pain radiating to the shoulder,
upper arm, forearm, and rarely the
hand, fingers or chest
• Pain made worse with coughing,
straining, or laughing
• Spasm of the neck muscles
MEDICAL MANAGEMENT
• Nonsteroidal anti-inflammatory
(NSAIDs) & narcotic pain killers
- Given to clients with a sudden
herniated disk caused by some sort of
injury (such as a car accident or lifting
a very heavy object) that is
immediately followed by severe pain
in the back and leg.
• NSAIDs
- are used for long-term pain
control, but narcotics may be given
if the pain does not respond to anti-
inflammatory drugs.
• Muscle Relaxants
- For back spasms
• On rare occasions, steroids may
be given either by pill or directly
into the blood through an IV.
• Steroid injections
- Helps control pain for
several months.
- Reduces swelling
around the disk and
relieve many symptoms
- Spinal injections are
usually done on an
outpatient basis, using
x-ray or fluoroscopy to
identify the area where
the injection is needed.
Surgical Management
Diskectomy
- Removal of a
protruding disk
- This procedure
requires general
anesthesia (asleep
and no pain) and 2
- 3 day hospital
stay.
Microdiskectomy
- a procedure
removing fragments
of nucleated disk
through a very small
opening.
- Use of electron
microscope through
a small incision to
remove a portion of
the HNP that is
displaced
Chemonucleolysis
- involves the injection
of an enzyme (called
chymopapain) into
the herniated disk to
dissolve the
protruding gelatinous
substance.
- This procedure may
be an alternative to
diskectomy in certain
situations.
Foraminotomy
- A decompression
surgery that is
performed to
enlarge the
passageway where
a spinal nerve root
exits the spinal canal
POSSIBLE NURSING DIAGNOSIS
• Pain acute/chronic related to
injuring agents, nerve
compression, muscle spasm
• Impaired physical mobility
related to pain and discomfort
• Fatigue related to inability to
maintain usual routines,
compromised concentration
• Ineffective coping related to
situational crisis
• Knowledge deficit regarding
condition, prognosis, and
treatment related to lack of
knowledge
NURSING RESPONSIBILITIES
• Bed rest with firm mattress; log roll; side lying
position with knees bent and pillow between
legs to support legs
• Avoid flexion of the spine- brace/corset,
cervical collar to provide support
• Heat/cold therapy to decrease muscle
spasms
NURSING RESPONSIBILITIES
• Massage, relaxation techniques
• Progressive mobilization with
approved exercise program –
includes abdominal/thigh
strengthening
• Teaching good body mechanics
• Weight loss
