Disk Disruption
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Transcript Disk Disruption
Disk Disruption
Anterior Diskectomy
What is an Anterior
Diskectomy?
Anterior diskectomy is a surgical
procedure that is performed to
decompress the nerve root. Partial
removal of the lamina to allow access to
the intervertebral disk.
Pathophysiology Chronic
Low Back Pain
Degenerative disk disease
Lack of exercise
Prior injury
Structural and Postural abnormalities
Systemic Disease
Obesity
Degeneration of the disk
Degeneration of the disk causes the
intervertebral narrowing and a lessening
of the effectiveness of the disks in ceasing
as shock absorbers.
The tough fibrous outer covering of the
disk is more likely to develop tiny tears as
part of the degeneration, predisposing the
patient to a herniated nucleus pulposus.
MRI of herniated disk
Clinical Manifestations
Back pain the most common complain. It
is described as sharp or throbbing.
Pain can be from mild to severe, radiating
down your leg.
Damage in the middle or lower part of the
back: numbness, tingling or weakness in
the buttocks, legs or feet.
Other Symptoms
Pain can radiate when you cough, sneeze
or strain.
Prolonged sitting or standing can trigger
pain or get worse.
Depending on the nerve root involved,
reflexes may be absent or depressed.
Diagnostic Studies
MRI or CT, to localize the site of the
herniation.
X-Ray, to locate structural defects.
Electromyogram (EMG) to look for signs
of nerve damage caused by disk
herniation.
Physical Assessment
Ambulation may be stiff, may have a limp.
Inspect for swelling triggered by muscle spsam
and alignment of the vertebral.
Check for tenderness.
Check for sensation, patient may have
paresthesia.
Loss of bladder or bowel control.
Neurological assessment.
Interventions/Non-Surgical
Managment
Proper alignment
Exercise
Anti-inflammatory analgesics
Hot or Cold therapy
Diet
Alternative Therapy
Percutaneous Laser Disk Decompression
Proper Alignment and
Exercise
Semi-Fowler’s position aka Williams
position.
Firm matress or back board.
Isometric exercises most effective.
Typical exercises for chronic low back
pain. (Chart 43-3, p.928)
Drug Therapy
Tylenol-may help control discomfort.
NSAIDS-Aspirin, Advil, Motrin.
Muscle relaxants-Flexeril.
Opioid analgesics and nonsteroidal
anaglesics.
Epidural injection
Heat and Cold
Therapy/Diet Therapy
Moist heat for 20-30mins, 4xQD.
Deep heat therapy.
Ice therapy or ice packs 10-15mins q12hrs.
Chronic pain can be lessened by
controlling weight
Alternative Therapy and Percutaneous
Laser Disk Decompression
Imagery, magnetic field therapy, music.
PLDD-local anesthetic and laser with a
thin needle under fluoroscopy. Bed rest
for 24 hours after procedure.
Surgery
Diskectomy-removing portion of disk
Laminectomy-removing one or more
vertebral laminae and herniated nucleus.
Alternative Surgeries:
Percutaneous lumbar diskectomy
Microdiskectomy
Laparoscopic lumber diskectomy
Surgery Cont:
The goal is to stop the herniated disk
from pressing on and irritating the
surrounding nerves.
Anterior Diskectomy-incision made from
the umbilicus to the mons pubis.
Divided the subcutaneous tissue and
behind the peritoneum and outside the
peritoneal cavity.
Surgery Cont:
Exposure of the anterior disk.
Decortication of the vertebral end plates.
The iliac vessel and the ureter were both
protected to avoid iatrogenic injuries.
Interbody lumbar fusion with synthes
femoral ring allograft under fluroscopy.
Estimated loss of blood.
Diskectomy
Nurse Management Care
Postoperative
Assess for complications in the first 24-48 hours.
Cerebrospinal fluid
Fluid volume deficit
Acute urinary retention
Paralytic ileus
Fat embolism
Persisitent nerve root pain
Infection
Continued Care
Pain control-PCA (Morphine)
Inspect surgical dressing.
Maintain proper alignment.
Logrolling
Deep breathing
SCDs or PCBs
Have sufficient staff available to move pt.
Care Continued
Frequent monitoring of peripheral signs of
extremities.
Assess sensation
Any new muscle weakness or paresthesis.
Assess for flatus, BS on all four Quads.
Health Teaching
Weight loss if needed with dietitian
Stop smoking
Use moist heat
Perform strengthening exercises
Proper body alignment by PT
Take meds as directed
Healing process may take up to 6-12mo.
Identify support systems
Preop Medications
Dextrose 5% NACL 0.45% 1000ml,
60ml/hr with Potassium Chloride 20mEq.
Cefazolin Sodium Injection/1 Gm IV Q8hrs
IVPB (Mix D5W 50ml infuse over 30mins)
Lovenox 30MG=0.3ml SC QD at 0900.
Tylenol 650=2 tabs PO Q4hrs, temp >38.
Ketorolac Injection 30MG=1ml IV Q6 PRN
Labs
WBC-11.6 (5.0-10.0) Increase r/t surgery,
trauma, stress, inflammation.
RBC-2.82 (4.4-5.9) Decrease r/t surgery
Hgb-8.7 (11-16) Elvated could be affecting value
as well as decrease in RBC.
Hct-25.6 (37-47) Same as Hgb.
Lymophocyte-14.4 (24.4%) Possible infection.
Potassium- 3.4 (3.5-5) Trauma, surgery
Questions/ 1. A diskectomy surgical
procedure is which of the following.
A. A surgical excision of part of the posterior arch of the
vertebra to gain access to part or all of the protruding
disk to be removed.
B. A surgical procedure using a tube that is passed
through the retroperitoneal soft tissue to the lateral
border of the disk.
C. A surgical procedure to decompress the nerve root.
Involving the partial removal of the lamina to allow
access to the intervertebral disk.
D. A mircrodiskectomy surgery through a 1-inch incision,
removing small fragments and decreased tissue trauma.
Question/The nurse assess a patient
with a herniated disk except which of
the following.
A.Walking on heels or toes often causes
severe pain on affected leg or back.
B. Sharp low back pain radiating to thigh
or calf.
C. Severe pain when raising a straight leg.
D. May lose handgrip strength.
References
Lewis, S.M., and Heitkemper, M.M., and Dirksen, S.R.,
Medical Surgical Nursing Assessment and Management
of Clinical Problems 5th ed, St. Louis: Mosby, Inc., 1996,
pg 1808-1810.
Ignatavicius, D.D., and Workman, M.L., Medical Surgical
Nursing Critical Thinking for Collaborative Care 4th ed,
Philadelphia: W.B. Saunders Company.
Presentation by:
Rebecca Valverde
Instructor Francisco Felix
Lecture Mon and Thur