LESSONPLAN ON

INTERVERTEBRAL DISC
PROLAPSE
LESSON PLAN ON MANAGEMENT OF INTERVERTEBRAL DISC PROLAPSE

GROUP:

PLACE:

UNIT:

TOPIC:

NAME OF THE TEACHER: Mrs.Krishna Priya V S

TIME:

AV AIDS: Pictures, Power point presentation and Black Board

PREVIOUS EXPOSURE TO STUDENTS:

METHOD F TEACHING:
GENERAL OBJECTIVES: By the end of the class, the students will gain the knowledge regarding IVDP and its management
and they can apply their knowledge into their practice.

SPECIFIC OBJCTIVES: By the end of teaching programme, the students will able to:

i. discuss the basics of intervertebral disc.

ii. define intervertebral disc prolapse.

iii. illustrate the incidence of intervertebral disc prolapse.

iv. Enlist the etiology and risk factors of intervertebral disc prolapse.

v. discuss the sites of intervertebral disc prolapse.

vi. enumerate the clinical features

vii. explain the methods of diagnostic evaluation

viii. describe the differential diagnosis.

ix. explain the treatment of intervertebral disc prolapse.

x. Discuss the self care management of intervertebral disc prolapse.

TIME SPECIFIC CONTENT TEACHER’S LEARNER’S A-V AIDS EVALUATION
OBJECTIVE ACTIVITY ACTIVITY

2min Introduce the

topic INTRODUCTION

The term prolapsed intervertebral disc is another

name for a herniated or ruptured disc, which is a spinal
condition that occasionally produces symptoms such as
back or neck pain, as well as pain, tingling, numbness, and
muscle weakness in the extremities.
A quite common, painful disorder of the spine, in
which the outer layer of an intervertebral disc ruptures and
part of its pulpy core protrudes,causing painful and
sometimes disabling
pressure on a nerve. About 95% of disc prolapses occur in
the lower back, but they can affect any part of the back or
neck.
What you mean
Discuss the Lecture cum Listen and Pictures by intevertebral
2min
basics of discussion discuss disc?
BASICS OF INTERVERTEBRAL DISC
intervertebral
disc Intervertebral discs are tough fibrous pads joining
each of the spinal vertebrae. Each intervertebral disc is
composed of a tough outer layer of ligament, the annulus
fibrosis, and a soft gelatinous core, the nucleus pulposus.
The structure acts as a
shock absorber to cushion the vertebrae during movements
of the spine, and to minimise jarring when jumping or
running.

Lecture cum Listen and Hand out What do ypu

1min Define DEFINITION discussion discuss mean by
intervertebral A prolapsed (slipped) disc is a problem where the inter- intervertebral
disc prolapse disc prolapse?
vertebral disc is forced out of the annulus fibrosus (the
outer covering of the disc) due to mechanical forces
increasing intradiscal pressure.
INCIDENCE Lecture cum Listen and LCD What is the the
2 min Illustrate the discussion discuss incidence of
incidence of Before age 40, approximately 25% of people show intervertebral
intervertebral evidence of disc degeneration at one or more levels. Past disc prolapse?
disc prolapse?
age 40, more than 60% of people show evidence of disc
degeneration at one or more levels on MRI (Furman).
Asymptomatic cervical disc herniation is present in 10% of
individuals younger than 40 years and in 5% older than 40
(Furman).
Incidence of cervical spine disc herniation with
radiculopathy is 5.5 per 100,000 population, as opposed to
self-reported neck pain, which occurs in 21,300 per
100,000 population (Hogg-Johnson).
Thoracic disc herniation is rare, occurring in 0.1 per
100,000 population and comprising 0.75% of all disc
injuries (Hannani).
Lumbar disc herniation occurs 15 times more frequently
than disc herniation in the cervical spine ("Herniated
Nucleus Pulposus").
Lifetime prevalence of lumbar disc disease resulting in
sciatica is 5% of males and 2.5% in females (Sahrakar).
Individuals between 30 and 55 years of age are most at risk
for acute lumbar disc herniation, with 90% of injuries
occurring at the L4-L5 and L5-S1 levels (Palacio).

5min Enlist the Lecture cum Listen and LCD Which are the
etiology and ETIOLOGY AND RISK FACTORS discussion discuss etiology and risk
risk factors? factors of
intervertebral
Usually the intervertebral discs become less flexible disc prolapse?

with the aging, which increases the risk of injury.

 A prolapsed disc can also occur as a consequence of
an injury such as falling, repeated straining, hard
lifting, and also overweight.
 Mechanical forces increasing intra discal pressure.
 Disc prolapse can result from general wear and tear,
such as when performing jobs that require constant
sitting and squatting.
 Traumatic- 80% cases traumatic origin
 Increased tension
 Degeneration-15%.Disc loses elasticity and fluid
content can’t resist body weight and reliable to
herniate.
 Genetic factors
3min Discuss the Lecture cum Listen and BlackBoard What are the
sites of discussion discuss sites of
intervertebral SITES intervertebral
disc prolapse? disc prolapse?

 Lumbosacral region-L4/5 and L5/S1.80% occures

at this region.
 Lower cervical region-C5/6 and C6/7.19% Occures
at this region.
 Dorsal region-constitute 1%of all disc prolapsed

Enumerate What are the

3min the clinical Lecture cum Listen and LCD
CLINICAL FEATURES discussion discuss clinical features
features? of intervertebral
disc prolapse?
 The main symptom of a prolapsed intervertebral
disc is
low back pain. This is usually something that most
people tolerate.
 Parastheasia or numbness
 Muscle weakness How can
Lecture cum Listen and LCD diagnose
Explain the DIAGNOSTIC EVALUATION
3 min discussion discuss intervertebral
methods of
diagnostic disc prolapse?
evaluation? A careful physical exam and history is almost always the
first step. Depending on the site of symptoms, doctor will
examine the neck, shoulder, arms, and hands, or our lower
back, hips, legs, and feet.

The doctor will check:

 For numbness or loss of feeling

 muscle reflexes, which may be slower or missing
 muscle strength, which may be weaker
 posture, or the way your spine curves

The doctor may also ask to:

 Sit, stand, and walk. While you walk, your doctor

may ask you to try walking on your toes and then
your heels.
 Bend forward, backward, and sideways
 Move your neck forward, backward, and sideways
 Raise your shoulders, elbow, wrist, and hand and
check your strength during these tasks

Leg pain that occurs when you sit down on an exam table
and lift your leg straight up usually suggests a slipped disk
in your lower back.

In another test, you will bend your head forward and to the
sides while the health care provider puts slight downward
pressure on the top of your head. Increased pain or
numbness during this test is usually a sign of pressure on a
nerve in your neck.

DIAGNOSTIC TESTS

 EMG may be done to determine the exact nerve

root that is involved.
 Myelogram may be done to determine the size and
location of disk herniation.
 Nerve conduction velocity test may also be done.
 Spine MRI or spine CT will show that the herniated
disk is pressing on the spinal canal.
 Spine x-ray may be done to rule out other causes of
back or neck pain.
5 min Lecture cum Llisten and
Explain the TREATMENT LCD Explain the
treatment of discussion discuss treatment of
intervertebral intervertebral disc
disc prolapse. PRINCIPLES OF TREATMENT prolapse?

The aim of treatment is to achieve remission of symptoms,

mostly possible by conservative means.

CONSERVATIVE TREATMENT

The first treatment for a slipped disk is a short period of

rest with medications for the pain, followed by physical
therapy. Most people who follow these treatments will
recover and return to their normal activities. A small
number of people will need to have more treatment, which
may include steroid injections or surgery.

MEDICATIONS

People who have a sudden herniated disk caused by injury

(such as a car accident or lifting a very heavy object) will
get nonsteroidal anti-inflammatory medications (NSAIDs)
and narcotic painkillers if they have severe pain in the back
and leg. eg: Indomethacin

 If you have back spasms, you will usually receive

muscle relaxants .eg.valium,robaxin
 . Rarely, steroids may be given either by pill or
directly into the blood through an IV.

 NSAIDs are used for long-term pain control, but

narcotics may be given if the pain does not respond
to anti-inflammatory drugs.
 Steroid injections into the back in the area of the
herniated disk may help control pain for several
months. These injections reduce swelling around
the disk and relieve many symptoms.

Eg: Cortisone injections .

SURGERY

Surgery may be an option for the few patients whose

symptoms do not go away with other treatments and time.

INDICATIONS FOR OPERATIVE TREATMENT ARE:

 Failure of conservative treatment
 Cauda equine syndrome
 Severe sciatic tilt
The disc may be removed by the following techniques:
 Laminotomy
 Laminectomy( removal of a portion of disc).

5min Discuss the Lecture cum Listen and LCD Explain the self
selfcare discussion discuss care management
management of intervertebral
disc prolapse?
5Minutes