prolapsed intervertebral disc|pivd definition|pivd stages|pivd types|intervertebral disc prolapse

Intervertebral disc prolapsed/ IVDP

Definition

It is the most common cause of back pain in individuals. In IVDP there is displacement of disc material (Nucleus pulposus or annulus fibrosis) beyond the intervertebral space.

Other name used is prolapsed disc, herniated disc.

Intervertebral Disc 

 There are four stages of Intervertebral disc prolapsed

1. Buldging

It is the early stage of disc protusion, only the disc is stretched and does not return back to the normal position when the pressure is relieved.

2. Protrusion

In this stage there is prominent disc bulge, were the nucleus pulposus has spilled out in to annulus fibrosis and barely some fibers remain inside.

3. Extrusion

In this stage nucleus pulposus has completely spilled out of annulus fibrosis and protruding out of the disc fibers.

4. Sequestration

There is complete break off of annulus fibrosis and spread into the surrounding (epidural) area.

The two types of disc lesion

Self contained disc lesion	Disc lesion with nuclear lesion
Also known as Contained disc	Also known as Non contained disc
Which means the nucleus pulposus remain contained within the annulus fibrosis.	This means herniation or ruture of disc by disc protrusion into central or foraminal canal.

Common site of disc protrusion

C₅ – C₆  :- cervical lesion

L₄ – L₅ :-Lumbar lesion

Causes : -

Increasing age, sitting for long hours, poor and inadequate strength of trunk, obesity, postural stress, repetitive lifting and twisting, heavy manual labour

Clinical sign and symptoms

In early stage

a)Severe low back pain

b)Radiating pain to the buttocks and b/l lower leg

c) Pain increase during coughing and huffing

d)Lower back muscles go for muscle spasm

In later stage

a) Sensation impairment, tingling and numbness over bilateral lowerlimb

b)Muscle weakness and atrophy in later stage

c)Loss of bowl and bladder control in case of cauda equine syndrome

d)neurological symptoms: paraesthesia, numbness, muscle weakness, cauda equine syndrome

e)Deformity: Flat /  khyphotic lumbar spine, Scoliosis

Lumbar examination

Clinical examination

• Posture :- Stand rigid, flattened lumbar spine, flat foot
• Movement :- Unable to bend forward, muscle spasm over paraspinal area.Special examination
• SLR
• Lasegue
• Femoral stretch test
• Well leg raising test
• Neurological test

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