LUMBAR HERNIA NUKLEUS

PULPOSUS
Presentan
HARRIS MURDIANTO

Moderator
Prof. dr. MI. Widiastuti, PAK, Sp.S(K), MSc
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INTRODUCTION
HNP is one of the
common disease that
happens all over the
world

Patient complain is low

back pain that
commonly attach with
pain at same side leg

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Definition

What is
Lumbar
HNP???

https://www.google.co.id/search?
q=hnp+lumbal&biw

A protusion from an
intervertebral discus inside
the vertebral canal
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Disc herniation occurs when the

annulus fibrous breaks open or
cracks, allowing the nucleus
pulposus to escape

Epidemiology
cause of the acute, chronic
or recurrent lower back
pain.

PERDOSSI at 2012 showed that a

patient with low back pain is 19,27%
from all of patient with pain.
L4-L5 & L5-S1
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Unmodified

Etiology

Modified
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Anatomy

In between each of
the five lumbar
vertebrae (bones) is
a disc, a tough
fibrous shockabsorbing pad
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Anatomy

Each disc contains a tire-like

outer band (called the
annulus fibrosus) that
encases a gel-like substance
(called the nucleus
pulposus).
https://www.google.co.id/search?
q=hnp+lumbal&biw=1024&bih=499&sourc
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e=lnms&tbm=isch&sa

Patofisiology

https://www.google.co.id/search?
q=hnp+lumbal&biw=1024&bih=499&sour
ce=lnm

Main cause of lumbar HNP is Injury

and degeneratif changes that
happens by aging process
Stage to a disc herniation like
degeneration,
prolapse, extrusion,
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sequestration

Diagnosis
Diagnosis of the Lumbar HNP is based on :
- History
- Physical examination
- Radiology

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History
History

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when it began to
feel pain?
which area is
painful?
how the nature of
the pain?
whether the pain
suffered by starting
physical activity?

Physical Examination
Elevating of the limb

The test is positive when

the pain
occurs
with
less
than 60
degrees
of hip
flexion

Laseque Test
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Physical Examination
Elevating of the limb and
dorsoflex
the foot

Dorsoflex of the foot will

also
reproduc
e sciatic
pain in
this
position

Bragard Test
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Physical Examination
Elevating of the limb
and
dorsofl
ex the
foot
and
than
dorsofl
ex the
thumb

Sicard Test
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Radiology
Herniation of
Disc Lumbar
vertebrae

http://www.google.co.id/imgres?
imgurl=ht/QcG1B0h32uw/VPVvZ4A8F8I/AAAAHQ/
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https://www.google.co.id/search?
q=hnp+lumbal&biw=1024&bih=499&source=l
nms&tbm=

Distibustion of Nerve L4-L5-S1

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Different Diagnosis
Spondylolisthesis
Spondylosis
Spinal stenosis

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Treatment
It includes:
Conservative treatment
Rest
Medicine
Physiotherapy

Surgery

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Rest
Elimite mechanic pain and intradiscal pressure

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Medicamentosa
Pharmacological therapy is the most
common treatment given to the HNP.
Drugs provide short-term benefits are
quite good in patients with HNP
Analgesia
Muscle Relaxan
Corticosteroid
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Physiotherapy
Physiotherapy for avoid recurrent
pain
muscle strengthening exercises
aimed at maintaine flexibility,
fisologik, muscle strength, joint
and soft-tissue mobilization

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Physiotherapy

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Lumbar corset is not useful in acute

Lumbar HNP

Physiotherapy
Exercise maintain
lower back arch

http://asiatronik.blogspot.co.id/2010_01_0
1_archive.html

Hamstring muscle
stretching exercises
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Physiotherapy
This exercise aims to increase the
lumbar lordosis
Exercises to lift the
hips

Exercise stand

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http://asiatronik.blogspot.co.id/2010_01_0
1_archive.html

Surgery
Discectomy
Removal of the herniated portion of the disc
Usually through a small incision

- Laminectomi
Removal of the lamina of the lumbar
vertebrae

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Prognosis

Age
Neurologic Deficite
Relaps
Morbiditas

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Thank you

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