Herniated Nucleus Pulposus (HNP) Quiz

Herniated Nucleus Pulposus (HNP)

• Also known as lumbar radiculopathy, cervical radiculopathy, herniated intervertebral disk, prolapsed intervertebral disk, slipped disk, or ruptured disk
• Occurs when all or part of the soft center of a spinal disc is forced through a weakened part of the disc, resulting in impingement on a nerve root

Stages of HNP

• Disc Degeneration: chemical changes associated with aging cause disc to weaken, but without a herniation
• Healthy Disc: well-hydrated nucleus with no bulging or loss in disc height and has an intact outer annulus
• Early Degeneration: early signs of degeneration, including fissures in the annulus, loss of hydration and disc height, resulting in bulging
• Advanced Degeneration: severe loss of hydration and disc height, resulting in bulging, bone spur formation, and spinal stenosis
• Prolapse: formation or position of the disc changes with some slight impingement into the spinal canal, also called a bulge or protrusion
• Extrusion: gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc
• Sequestration or Sequestered Disc: nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP)

Clinical Manifestations

• Arm muscle weakness
• Deep pain near or over the shoulder blades on the affected side
• Neck pain, especially in the back and sides
• Increased pain when bending the neck or turning head to the side
• Pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers, or chest
• Pain made worse with coughing, straining, or laughing
• Spasm of the neck muscles

Diagnostic Exams

• Physical Examination: fever, vertebral tenderness, limited spinal mobility, and sciatica
• Straight Leg Raise Test: positive if pain in the sciatic distribution is reproduced between 30 degrees and 70 degrees passive flexion of the straight leg
• X-ray: to identify deformities and narrowing of disk space
• CT/MRI: to show spinal canal compression by the herniated disk
• Electromyography: measures muscle response to nervous stimulation
• Nerve Conduction Velocity Test: evaluates nerve function by testing the speed of impulses travel through a nerve
• Myelogram: determines the size and location of disk herniation using contrast dye

Medical and Surgical Management

• Medical Management:
• NSAIDs (Ibuprofen, Naproxen Na) to relieve pain and swelling
• Narcotics (Opioids) for severe pain
• Muscle Relaxants for back spasms
• Steroid Injections to control pain for several months and reduce swelling around the disk
• Surgical Management: not specified in the text