Herniated disc, surgical treatment


Spinal disc herniation, also known as a slipped disc, is a medical condition affecting the spine in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings. Disc herniation is usually due to age-related degeneration of the outer ring, known as the anulus fibrosus, although trauma, lifting injuries, or straining have been implicated as well. Tears are almost always postero-lateral (on the back of the sides) owing to the presence of the posterior longitudinal ligament in the spinal canal. Disc herniations are normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the anulus fibrosus are still intact, but can bulge when the disc is under pressure. In contrast to a herniation, none of the central portion escapes beyond the outer layers. Most minor herniations heal within several weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear are generally effective. Severe herniations may not heal of their own accord and may require surgery. The condition is widely referred to as a slipped disc, but this term is not medically accurate as the spinal discs are firmly attached between the vertebrae and cannot "slip" out of place. Lumbar disc herniations occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Symptoms can affect the lower back, buttocks, thigh, anal/genital region (via the perineal nerve), and may radiate into the foot and/or toe. The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica. The femoral nerve can also be affected[25]and cause the patient to experience a numb, tingling feeling throughout one or both legs and even feet or even a burning feeling in the hips and legs. A hernia in the lumbar region often compresses the nerve root exiting at the level below the disk. Thus, a herniation of the L4/5 disc will compress the L5 nerve root. With the patient and doctor, plan a pain control regimen. Encourage the patient to express his concerns about the disorder. Urge the patient to perform as much self-care as his immobility and pain allow. Use antiembolism stockings, as prescribed, and encourage the patient to move his legs, as allowed. Assess the patient’s pain status and his response to the pain-control regimen. Perform neurovascular checks of the patient’s legs such as color, motion, temperature, and sensation. Monitor vital signs, and check for bowel sounds and abdominal distention. Teach the patient about treatments, which include bed rest and pelvic traction. Urge the patient to maintain an ideal body weight to prevent lordosis caused by obesity. Discuss all prescribed medications with the patient. If surgery is required, explain all preoperative and postoperative procedures and treatments to the patient and his family.



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