Prolapse Intervertebral disc

Prolapse Intervertebral disc

It is a protrusion or extrusion of the nucleus pulposus through a rent in the annulus fibrosus known as Prolapse Intervertebral disc (PIVD).
A prolapsed disc is commonly known as ‘slipped disc”.
The prolapsed intervertebral disc is also known as herniated disc.

PIVD

It can be divided into four stages:

The early stage is known as ‘bulging’.
The second stage can be called as ‘protrusion.
The third stage is known as ‘extrusion’.
the last stage is known as ‘sequestration’.

STAGES OF PIVD

pathology:

Bulging-
At this early stage, the disc is stretched and doesn’t completely return to its normal shape when pressure is relieved.
It retains a slight bulge at one side of the disc.
Some of the inner disc fibres could be torn and nucleus pulposus is spiling outwards into the disc fibres but not out of the disc.
Protrusion-
At this stage, the bulge is very prominent and the soft jelly centre has spilled out to the inner edge of the outer fibres.
Extrusion-
In the case of a herniated spinal disc, the has nucleus pulposus completely spilled out of the disc and now protruding out of the disc fibres.
Sequestration-
Here some of the nucleus pulposus is breaking off away from the disc into the surrounding area.

Types of herniation

(1)Central
(2)Paramedial
(3)Lateral

Causes:

In children may often suffer from prolapsed disc due to birth defect or injury.
During adolescence, rapid growth leads to PIVD.
Heavy manual labour.
Sometimes playing sports like football, gymnastics, weightlifting and track and field.
Repetitive lifting and twisting.
Postural stress.
obesity.
Poor and inadequate strength of the trunk.
Sitting for long hours.
increasing age

Symptoms:

Pain in back and buttock
Weakness or numbness in one or both leg.
painful or difficult walking.
From the lower back down one or both legs pain runs.
In flexion or twist pain gets worse in buttock or back.
tight hamstring muscle decreased flexibility in the lower back and pain or difficulty with arching the back backwards
Sometimes patience may often complain of sciatic pain.

leg pain in PIVD

Investigation:

X-ray :
decrease in the height of space between discs
nerve bundle sclerosis
bone spurs
facet hypertrophy and instability during flexion and extension of limbs.

diagnostic test

CT Scan:
MRI Scan:

Special Tests for PIVD-

SLR test

SLR TEST

Laesegue test
Bowstring test
Femoral stretch test

TREATMENT:

Conservative Management-

Rest: Rest and Anti-inflammatory and analgesics.
Continue bed rest and traction for 2 weeks may reduce the herniation in over 90% cases.
If no improvement with rest and traction, epidural injection of corticosteroid and local anaesthetic are given.
Chemonucleolysis

PHYSIOTHERAPY TREATMENT:

Cryotherapy: reduces muscle spasm and inflammation in acute phase.
TENS: relieves pain in both acute and chronic phases.
US: as phonophoresis increases extensibility of connective tissues
Moist heat: used as an adjunct before applying specialised techniques to decrease muscle spasm.
SWD- pulsed SWD in acute condition and continuous SWD in chronic cases.
IFT
Soft tissue manipulation- to reduce local muscle spasm and induce relaxation.
Traction- may be beneficial to relieve nerve root compression and radiculopathy or paraesthesias in the acute phase of PIVD. Reduces nuclear protrusion by decreasing the pressure on the disc or by placing tension on the posterior longitudinal ligament. Time of traction should be short in acute phase else there could be an increase in disc pressure leading to increased pain due to fluid imbibition ( less than 15 minutes of intermittent traction and less than 10 minutes of sustained traction).

Local support in the form of corset : lumbosacral belt
Passive Extension
Active range of motion exercises within painfree range
lower limb ex.like ankle toe movements, heel drag, hip abduction/adduction.
Isometrics of extensors
Core stability exercise:
Bridging
Leg lifts
Leg and arm raise
Wall Squat

BACK EXERCISES
wall squats
EXTENTION EX OF BACK
bridging

Abdominal strengthening exercises: Isometric abs, knee to chest, bicycle exercises.

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