Referat

Hernia Nucleus
Pulposus (HNP)

By:
Rossa Setyowati 17710099
Isy Kam Yahya 17710011

SUB DEPARTEMEN BEDAH

RUMAH SAKIT TENTARA TK II
dr. SOEPRAOEN MALANG Mentor:
FAKULTAS KEDOKTERAN
UNIVERSITAS WIJAYA dr. Maksum Pandelima, Sp. OT
KUSUMA SURABAYA 2018 Letkol CKM 1

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DEFINITION

 Herniated Nucleus Pulposus (HNP) is an

occurrence of protrusion from the nucleus
pulposus through the annulus fibers of
intervertebral disc.
 This disease mainly attacks adults in the age of
30–50 years old and peaks at 40– 45 years old.
The ratio of HNP between men and women is 2:1.

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SIGN and
SYMPTOMS
 The most common symptoms of HNP is sciatica,
which occurs in 40% of HNP patients.
 Symptoms :
• Severe low back pain
• Pain radiating to the buttocks, legs, and feet
• Pain made worse with coughing, straining, or
laughing
• Tingling or numbness in legs or feet
• Muscle weakness or atrophy in later stages
• Muscle spasm

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 FACTOR
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 Obesity
 Smoking
 Weight training
 Heavy lifting
 Sedentary lifestyle
 Frequent driving

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DIAGNOSTIC

 When doing anamnesis, can ask about anything

related about the pain ; like the frequency,
interval between the pain, pain point, pain quality
and characteristic, spreading pain and any
activities that cause, worsen and relieve the pain.

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EXAMINATI
ON
 FABIR (Counter-Patrick) Test :
The inspector put a lower leg which will be tested at flect,
abduct, and internal rotation position, so patient’s knee is
above the other knee from another leg, and then press the
leg that tested passively toward the desk, while stabilizing
white give a pressure toward ileum which opposite the limb.

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 Straight Leg Raise (Laseque) Test:

The patient lay supine with legs extended. Place
your hand beneath the lumbar spine, ask the
patient to relax leg. Graps the ankle of the leg and
place your other hand on the front of the thigh to
maintain the knee in full extension. Slowly raise
the leg until the patient complains of pain.

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 Ankle Jerk Reflex

Knocking at achilles tendon. If dorsoflexion doesn’t

happen at foot, this means there’s a nerve pinch
at colummn vetebrae L5-S1

 Knee-Jerk Reflex
Knocking at knee tendon. If extention doesn’t
happen at foot, this means there’s a nerve pinch
at colummn vetebrae L2-L3-L4

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DIAGNOSTIC
TESTING
 X-Ray

Can show a narrowed disc space, bone spur, which

may rule out disc herniation

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 CT-Scan

Can show bone changes of spinal or foraminal

stenosis. These test will show the stage and
location of the herniated disc.

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 Myelogram

Procedure of injecting contrast material into the

spinal canal with imaging via plain radiographs.

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 Magnetic Resonance Imaging (MRI)

This test is a gold standart for diagnostic and also
MRI image can pinpoint the location of the disc
and the affected nerves.

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TREATMENT
Medikamentosa
 NSAID
• Beneficial, no differences, watch side-effects
 Relaksan Otot
• Can decrease pain and improve mobility
 Opioid
• No more effective than NSAID’s
• Many side effects

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Surgery
 Laminectomy

Is an operative way to throw vertebralis lamina

away. It can be used for decompress a pressed or
pinched radiks spinalis by protrution nucleus
pulposus

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 Discectomy

is an activity that lift a part of discus

intervertebralis for reducing pressure toward
nervus. Discectomy can be used to remove a
bulge part using a general anasthesia.

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 Mikrodiskectomy

Is an procedure that move the fragment of

nucleated disc through a little incision, using an x-
ray and chemonucleosis. It can be done by
enzyme injection (called chymopapain) into discus
herniasi, to dessolve bulging gelatin subtance.

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THANK YOU
FOR
ATTENTION
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