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Herniated Nucleus Pulposus (HNP)
Alternative Names
 Lumbar radiculopathy
 Cervical radiculopathy
 Herniated intervertebral disk
 Prolapsed intervertebral disk
 Slipped disk
 Ruptured disk
Definition
A herniated nucleus pulposus is a slipped disk along
the spinal cord. The condition occurs when all or part
of the soft center of a spinal disk is forced through a
weakened part of the disk.
Causes
These disks may herniate (move out of place) or
rupture from trauma or strain
Brought about by as a car accident or lifting a very
heavy object
*Radiculopathy refers to any disease affecting the
spinal nerve roots. A herniated disk is one cause of
radiculopathy (sciatica).
Lumbar area
 Most herniation takes place
 Occurs 15 times more often than
cervical (neck) disk herniation
 It is one of the most common causes of
lower back pain
Cervical disks
 8% of the time and the upper-to-mid-back
(thoracic) disks only 1 - 2% of the time
*Nerve roots (large nerves that branch out from the
spinal cord)
 may become compressed, resulting
in neurological symptoms, such as
sensory or motor changes
Prevalence
 middle-aged and older men
 involved in strenuous physical activity
 congenital conditions that affect the size of
the lumbar spinal canal
Symptoms
SYMPTOMS OF HERNIATED LUMBAR DISK
 Muscle spasm
 Muscle weakness or atrophy in later stages
 Pain radiating to the buttocks, legs, and feet
 Pain made worse with coughing, straining,
or laughing
 Severe low back pain
 Tingling or numbness in legs or feet
SYMPTOMS OF HERNIATED CERVICAL DISK
 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
 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
Exams and Tests
 physical examination
 history
 neurological examination will evaluate
muscle reflexes, sensation, and muscle
strength
 examination of the spine will reveal a
decrease in the spinal curvature in the
affected area
“Leg pain”
 that occurs when you sit down on an
exam table and lift your leg straight
up usually suggests a herniated
lumbar disk
Foraminal compression test of Spurling
 -is done to diagnose cervical
radiculopathy. For this test, you will
bend your head forward and to the
sides while the health care provider
provides slight downward pressure
to the top of the head. Increased
pain or numbness during this test
is usually indicative of cervical
radiculopathy
DIAGNOSTIC TESTS
 EMG may be done to determine the exact
nerve root that is involved.
 Nerve conduction velocity test may also be
done.
 Myelogram may be done to determine the
size and location of disk herniation.
 Spine MRI or spine CT will show spinal
canal compression by the herniated disk.
 Spine x-ray may be done to rule out other
causes of back or neck pain. However, it is
not possible to diagnosis herniated disk by
spinal x-ray alone.
Treatment
 Short period of rest with pain and anti-
inflammatory medications
 Followed by physical therapy include steroid
injections
 Surgery
MEDICATIONS
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>(NSAIDs) and narcotic pain killers will be given to  persistent, severe back pain develops
people with a sudden herniated disk caused by  numbness
some sort of injury (such as a car accident or lifting a
 loss of movement
very heavy object) that is immediately followed by
severe pain in the back and leg  weakness
 bowel or bladder changes
>NSAIDs are used for long-term pain control

>narcotics may be given if the pain does not

respond to anti-inflammatory drugs

>muscle relaxants are usually given ff the patient LIFESTYLE CHANGES

has back spasms
• Any extra weight being carried by an
>steroids may be given either by pill or directly into individual, especially up front in the stomach
the blood through an IV area will make back pain worse.
• Diet and exercise are crucial to improving
INJECTIONS
back pain in overweight patients

 Steroid injections
 in the area of the herniated disk can
help control pain for several months
 reduce swelling around the disk and
relieve many symptoms.
 done on an outpatient basis, using
x-ray or fluoroscopy to identify the
area where the injection is needed.
• Training on how to properly lift, dress, walk,
and perform other activities
• Work on strengthening the muscles of the
abdomen and lower back to help support the
spine.
• Flexibility of the spine and legs is taught in
many therapy programs.
• Back braces to help support the spine

SURGERY *overuse of these devices can

weaken the abdominal and back
*Done if symptoms persist despite other treatments muscles, leading to a worsening of
the problem.

Diskectomy • Weight belts can be helpful in preventing

 removes a protruding disk injuries in those whose work requires lifting
 requires general anesthesia (asleep and of heavy objects
no pain) and 2 - 3 day hospital stay.
 Encouraged the pt. to walk the first day Prevention
after surgery to reduce the risk of blood
clots Safe work and play practices, proper lifting
techniques, body mechanics and weight control may
help to prevent back injury in some people.
*Complete recovery takes several weeks. If more
than one disk needs to be taken out or if there are
other problems in the back besides a herniated disk,
more extensive surgery may be needed. This may
require a much longer recovery period.

Microdiskectomy
 procedure removing fragments of nucleated
disk through a very small opening

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

Possible Complications
 Long-term back pain
 Loss of movement or sensation in the legs
or feet
 Loss of bowel and bladder function
 Permanent spinal cord injury (very rare)
When to Contact a Medical Professional