FOR MEDICAL STUDENTS

1. INTERVERTEBRAL DISC
PROLAPSE
HARI CHANDAN

2. Disc anatomy
 -Intervertebral disc lies between adjacent vertebrae in the the vertebral
column forming a fibrocartillagenous joint allowing movement of the
vertebra
■ -Development of disc starts from third week of intrauterine life until
■ third decade of life.
■ -23 discs through out the spine, absent only atlanto-axial articulation.
■ -Thinnest in thoracic region ; thickest in lumbar region
■ -Avascular

3. Disc anatomy
■ The cartilage end-plates
■ Nucleus puplopes
■ Annulus fibrosis

4. ■ Disc gives spine the mobility
■ Disc acts as shock absorber
■ Disc increases height of spine by 25%

5. PATHOLOGY
■ Prolapsed disc means the protrusion or extrusion of nucleus pulposes through a rent in
the annulus fibrosis.it is not a one time phenomena rather it’s a sequence of following
events
1)NUCLEAR DEGENERATION : - softening of nucleus and its fragments
- weakening and disintegration of the posterior
part of the annulus
2)NUCLEAR DISPLACEMENT : - disc protrusion, - disc extrusion , sequestrated disc

6. ■ 3)STAGE OF FIBROSIS :The is the stage of repair. The residual nucleus pulposus
becomes fibrosed.The extruded nucleus nucleus
pulposus becomes flattened,fibrosed and undergoes calcification.
■ The site of exit of nucleus is usually posteriolateral.

7. ETIOLOGY OF DISC PROLAPSE
■ Heavy and repetitive weightlifting
■ Cigarette smoking and tobacco consumers
■ Anxiety and depression
■ Women with greater number of pregnancies
■ Obesity
■ Improper postural habits
■ Occupations as auto drivers .

8. Clinical features
■ Low backache – repetitive , radiating to the buttocks and decreased by rest .pain
aggrevated when coughing,sneezing,straining,sitting.
■ Radiculopathy – pain in the distribution of sciatic nerve ,invariably due to disc
herniation. Leg pain equal to or more than back pain evidence the racdiculopathy may
be due to disc herniation.
■ Nerve root compression.

11. SLIGHT LEG RAISETEST (SLRT)
■ Inference : localized pain indicates a disc lesion.
radiating pain indicates sciatic radiculopathy.
SLRT at 40 degrees or less indicates root compression.

12. Investigations
■ Ct scan – posterior border of disc appears flat or convex
which is normally concave.

13. ■MRI– very usefull. Shows prolapsed disc, theca, nerve roots
clearly.

14. ■ Myelography : Radiopaque die is injected into spinal
canal and radiographs are taken. not in use now.
■ Radiography : Not reliable . 7-46% cases are missed .

15. Differential diagnosis
■ Spondylitis
■ Vascular insufficiency
■ Extra dural tumour
■ Spinal tuberculosis

16. Treatment
■ Conservative: Rest
Drugs – analgesics and muscle relaxants
Physiotherapy
Lumbar traction
Transcutaneous electrical nerve stimulation ( tens)

17. Operative treatment
■ Indications :
1. Failure of conservative treatment
2. Severe sciatic pain
3. Severe sciatic tilt

18. ■ Fenestration : Ligamentum flavum is excised and the spinal
canal at the affected region is exposed.no longer done as it
makes spine unstable
■ Hemi-laminectomy :The whole of the lamina on one side is
removed.
■ Fenistration : Requires mri and radiographic studies. Spine is
approached unilaterally, only the margin of upper and lower
lamina are removed.

19. CHEMONUCLEOLYSIS
■ Chymopapain with the property of dissolving fibrous and
cartilaginous tissue is injected into the disc,under X-ray
control

20. Endoscopic lumbar discectomy
■ Using a operative endoscope,through a small incision with
minimal damage and blood loss
■ Less invasive ,minimal damage,minimal blood loss,
excellent results
■ Come today, go tomorrow surgery.

21. THANKYOU