Intervertebral Disc Prolapse (IVDP)- 2021 Latest post

Intervertebral Disc Prolapse
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Intervertebral Disc Prolapse

IVDP is a hydrostatic, load bearing structure between the vertebral bodies from C2-C3 to L4-S2.

IV disc consist of 3 distinct component.
1. The Cartilage end plate: Here the cartilage end plate cover the disc both from both the side above and below.
2. Annulus fibrous: water + proteoglycans + Collagen type I
3. Nucleus pulposus: water + proteoglycans + Type II collagen
Function Of IVDP
Restricted IV joint motion
Contribution to stability
Resistance to axial rotation and bending load
Preservation of anatomic relationship
Intervertebral disc prolapse
Also known as spinal disc herniation.
Intervertebral Disc Prolapseis a condition which is affecting the spine in which there will be  a tear in outer fibrous ring ( Annulus Fibrous) of the Intervertebral Disc Prolapse causes the soft central portion ( nucleus pulposus) to buldge out & causes pressure on the spinal cord and its accompanying nerve roots.
Types of herniation
1.posterlateral disc herniation – Occurs in L5
2. Central disc herniation – Occurs in L2, Cauda equina
3. Lateral disc Herniation – Occurs in L4 root
Pathology
It occur in 3 stages
1.Nucleus degeneration
2. Nucleus displacement
3.stage of fibrosis
1.Nucleus degeneration
Degeneration changes occur in disc before the displacement of nuclear material.
Softening of nucleus and its fragmentation.
2.Nucleus displacement
It includes
1. Protrusion : Nuclues tends to buldge within Annulus fibrous.
2.prolapse : Tear in the Annulus fibrosis begin
3.Extrusion : Tear has opened up & the nucleus pulposus cone out of annulus fibrous
4.Sequestrum : Fragment comes out compity with tear of annulus fibrous
3.stage of fibrous
Here, calcification of buldged part occur along with osteophytes formation.
Causes 
Repetitive mechanical activity
Traumatic injury to lumbar disc
Living a sedentary life style
Obesity
Practising poor posture
Tobacco abuse
Loction
-Lumbar: L4 -L5 or L5 -S1
-Cervical: C5-C6 or C6 -C7
Clinical features
Serve low back pain
Radiating pain occur to the buttocks legs & feet
Walking can be painful or difficult
Pain get worse with coughing, straining, or laughing activity
Muscle spasm
Muscle weakness
Tingling or numbness in leg or feet
Loose of bladder kr bowel control
Examination 
Inspection : Look for postrual abnormalities ( scoliosis, lordosis,  kyphosis)
Palpation:
1.Tenderness
2. Movement
Tenderness: At the level of posterior articulation of the involved segment and pain on percussion of affected IV space.
Movement:
To test flexion- Patient standing position ask the patient to bend forwards
Lateral flexion- Patient should be in standing poistion and ask the patient to bend to the left or right.
Extension- Ask the patient to bend backward
Rotation- Patient standing position ask the patient to rotate from the waist to left and right.
SLR test- Ask the patient to raise the leg at 90° without flexing the knee.
Femoral nerve test-  In standing position ask the patient to lift the leg in prone.
Position- Pain is present in anterior aspect of thigh indictates high level disc lesion.
Special test :
A. Lumbar
SLR
Slump test
Passive lumbar extension test
Laregue’s test
Bowstring test
Prone knee bending test
B.Cervical 
Spurling test
Distraction test
Compression test
ULTT
Shoulder abduction test
Investigation
1.X-ray: Narrowed disc space- Loss of lumbar lordosis
2. Ct scan – Bulging of disc
3.MRI- Intervertebral disc protrusion, compression of nerve root
4.Myography
Differential diagnosis
-Ankylosing spondylitis
-vascular insuffiency
-Extra dural tumor
-Spinal tuberculosis
Complication 
Cauda equina syndrome
Chronic pain
Permanent injury
Paralysis
Treatment
Conservative treatment
Pain medication- NSAID’S muscle relaxant
Best rest
Oral sterioid
Nerve root block
Surgical treatment
Surgery treatment is recommended when conservative treatment get failed.
Fenestration
Laminectomy
Hemi laminectomy
Laminotomy
Nucleoplasty
Percutaneous disecting
Physiotherapy treatment
Before surgery
1.Cryotherapy for acute
It is indicated during acute low back pain as it reduces pain, swelling and muscles spasm
It delays the nerve conduction
2. Thermotherapy
Heat can causes vasodilation due to this there will be reduce the muscle ischemia.
It decreases the pain and relive the muscle spasm
a. Superficial heat
b.SWD
c.Ultrasound
3. Tens: Given in both chronic and acute condition
4. Traction:  It stretches the spinal muscle and ligament and thereby reduce the intra disasular pressure.
It distract the vertebral body and facet joint.
5. corset and braces
They increases intra abdominal pressure the force is diverted against the diaphragm and thoracic spine.
Some amount of  load will be transmitted to the oblique & transverse abdominal muscles.
6. Spinal manipulation
Mannual force is use to bring abduction the passive movement either within or beyond the active range of motion.
7. Massage
Massage help by stimulating the tissue and thus relaxes the contracted muscles.
8. Exercise
Flexion exercise 
Sitting
Forward bending
Increased lumbar lordosis
Fixed lumbar lordosis with bending lordosis
Bridging
Knee hugs
Pelvic tilt
Extension exercise
Lying
Walking
Repeated back bend
Decreased lumbar lordosis
Prone as elbow
Extension control
Hamstring stretch
Reasons
Reduces pain
To strengthen the muscle
To stretch contracted muscle, ligament, capsule
To improve mobility
To improve posture
Physiotherapy after surgery 
Principle
Mobilization should be done as early as possible
Normal lumbar lordosis to be maintained
1. Immediate
-Chest pt
-Upper limb movemet
-Gluteal and quadriceps isometric
-Hip and knee flexion by heel drag
2. In 2nd and 3rd post operative days
-Turning the whole body as one unit from supine and side lying positions.
3. After week
-Isometric abdominal exercise
-Assisted spinal extension position
-Supported sitting
4. After 4 week
-Graded spinal extension exercises
-Graded spinal flexion, rotation, and side flexion exercises
-Ambulation with correct posture and gait.

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