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