Prolapsed Intervertebral Disc Research Paper

Introduction

PIVD stands for prolapsed intervertebral disc. It occurs due to the outgrowth of the disc. This outgrowth is the nucleus pulposus that seeps through a shred in the annulus fibrosus.
It is also called slipped or herniated disc.

It occurs in four stages:
1. Bulging: initially, when the disc cannot get back to its original state, after being stretched and retains a tin bump at one end of the disc.
2. Protrusion: post bulging, the bump becomes very prominent and the substance starts to spill out of the disc.
3. Extrusion: the jelly (nucleus pulposus) has entirely spilled out and is sticking out of the fibres.
4. Sequestration: the material strats breaking off and moves in the surrounding area.

Anatomy
PIVD is a pathology allied

The pain in and around the vertebrae can occur due to skeletal anomalies such as inflammation and degeneration.
The thoracic discs are barel affected because of PIVD, the upper two cervical space, coccyx and sacrum do not contain any disc. So, they aren’t at risk.
The causes of PIVD vary depending upon age, heredity and lifestyle.
It can be caused due to birth defects, during adolescence, over stretching in sports, extensive manual labour, weight lifting, obesity, prolonged sitting etc.
Clinical features
The signs and symptoms of disc herniation can range from mild to severe pain in areas like neck, shoulder, lower back, etc even radiating to the arms, legs and even the chest.
Cervical disc herniation is majorly responsible for numbness, pain and weakness in the neck, head, arms, shoulders and hands along with a tingling sensation.
While lumbar disc herniation affects the lower back along with dull or shooting pain in the buttocks, thigh and groin by dint of the perennial nerve. This will further radiate to the foot.
If the sciatic nerve gets affected, it leads to sciatica.
When the femoral nerve gets affected, it causes a numb and tingling sensation in both lower limbs.

Diagnosis and

Forward flexion test: to check if there’s radiating pain or not
5. Hyperextension test: to check if there’s lumbar strain
6. To palpate if there’s tenderness
7. Gluteal stretch: to check if the piriformis is affected
8. Femoral stretch test: to check if the nerve is impinged
9. Gait pattern:
I. Due to conditions like spasticity and contractures the hip range of movement decreases and causes the hip to slightly excessively flex during the gait cycle.\
II. Due to hip abductor weakness, the patient acquires trendelenburg gait. Imagery diagnosis
1. X-ray: it done to check if theres a decrease in height of the disc, sclerosis, hypertrophy, etc
2. CT-scan: it gives a detailed and more elaborate anatomic view of the spine
3. MRI-scan: it helps in detecting the cuts and tears through multiple tissue layers
4. EMG study: detects whether a nerve is impinged or not

Treatment
Medical management
• OTC drugs: medicines that are safe to be take without prescription, if the pain is shooting/excruciating
 For example: ibuprofen, naproxen, etc

• Narcotics drugs: to produce analgesic effect.
 Example: oxcodone
• Nerve pain medication: pain relievers and anti depressants, to reduce nerve pain.
 Example: gabapentin, pregabalin, tradamol,